This post was written with assistance from Dana Gundrum, WebPT’s Culture Captain.
Earlier this month, WebPT made a lot of people on Facebook very, very angry. Our goal wasn’t to purposefully incite anger, but we did want to incite a discussion, and we expected that some people might bring their anger and frustration to the table. Needless to say, we were unprepared for the wave of impassioned responses (and, frankly, pure vitriol) that flooded our Facebook post. We wanted a discussion, and boy, did we get a discussion.
The topic in question? Racial diversity in the rehab therapy industry. I recognize that this, all around, is a very tough topic to discuss, but it’s one that we absolutely cannot ignore, especially when the US in the midst of so much racial turmoil. Industry data, even beyond WebPT’s, indicates again and again that there’s a serious diversity problem in the rehab therapy industry. That is to say, there is no diversity.
I believe that this homogeneity prevents us from delivering the best possible care experience to each and every patient who seeks therapy treatment, and we have to talk about it. If we sit on our hands and pretend that all of this will go away, or, even worse, lash out when someone tries to initiate an open conversation, we’re perpetuating the problem and dooming ourselves to failure. Diversity is important, and we have to talk about it.
Before we begin, please know that I’m opening this conversation in good faith, and that I want to promote thoughtfulness and genuine discussion, not anger.
The racial and ethnic distribution in the rehab therapy industry does not match the distribution across the US, period.
Let’s start with the objective facts. The racial and ethnic distribution in the rehab therapy industry does not match the wider racial and ethnic distribution across the US. We don’t even come remotely close to meeting those numbers. Take a look at this table: It compares data from the US census, our 2019 industry survey, and the APTA’s survey of its member demographics.
These numbers paint the most objective possible picture of the state of our workforce. The rehab therapy industry (and especially the APTA member base) has a significantly higher percentage of white workers, and a significantly lower percentage of minority workers compared to the wider distribution across the US.
Hispanic or Latino and Black or African American therapy professionals are especially underrepresented in our industry. Only 6.5% of our workforce identifies as one or the other, even though the communities cumulatively account for more than a quarter of the country’s population. There’s no denying it. The rehab therapy industry, as a whole, is not as diverse as the patient population.
Patients benefit from a diverse staff.
A diverse staff is better equipped to handle the cultural and social needs of an increasingly diverse patient population. Just to be clear, I am not saying that therapists provide lower-quality service to patients who fall into a different racial or ethnic category, nor am I implying that therapists should only treat patients who look like them. Pushing for diversity in health care isn’t about assigning blame or segmenting populations; it’s about providing patients with access to a healthcare experience that meets their needs.
As I’ve said before, patients should have the option to choose a therapy provider who they feel comfortable with, who they can relate to. A lack of diversity could prevent patients from feeling wholly comfortable in a medical setting, which could then prevent them from engaging in open dialogue with their providers, thereby preventing them from receiving the best possible care.
Diversity gaps often begin with small cases of unconscious bias.
Diversity gaps generally don’t happen because of a conscious decision or action; most people don’t purposely weed out prospective employees because of their race or ethnicity. But biases can (and definitely do) exist outside of flashing neon lights and glaring prejudices. And, more often than not, these quiet, unconscious, implicit biases slip entirely under our radar and affect our hiring practices, even when we think we’re being totally fair.
What is unconscious and implicit bias, and why does it happen?
At any given time on any given day, our brains are bombarded with millions of pieces of information. Some of that information is relevant, but often, it is not, and our brains have learned how to use shortcuts to filter, sort, and use that information the split second after we take it in. These shortcuts rely on intuition and generalizations, and they often bypass objectivity. These are our unconscious biases, and they’re notoriously difficult to identify, let alone mitigate.
How do these biases affect hiring practices?
Unfortunately, it’s difficult to unshackle ourselves from our biases, and they can rear their heads at any time, even when we’re actively trying to be fair. Consider this case study about the Boston Symphony Orchestra. The orchestra was comprised almost entirely of men, so it kicked off a diversity initiative and began conducting blind auditions. Orchestra hopefuls would perform their audition pieces behind a screen in an effort to avoid bias. However, the orchestra still hired men, overwhelmingly so.
After looking into the problem, the organization realized that the judges could hear the women auditioners’ high heels and, thus, could identify their gender. Once the orchestra began asking auditioners to take off their shoes, the number of women hired increased dramatically.
We may not be able to conduct blind interviews for staff therapists, but perhaps we could review r√©sum√©s without names visible in an effort to reduce bias. We must recognize that even the most well-meaning people can be susceptible to skewed hiring decisions, and seek out ways to test for and remove bias in the hiring process.
Where else do these biases exist?
Biases aren’t just limited to race, ethnicity, and gender; they can crop up around religion, age, sexual orientation, or socioeconomic class. I would even argue that one of the biggest diversity barriers in rehab therapy, and part of the reason why our talent pool is so limited, is our profession’s high barrier of entry. This is something we discussed during the 2018 Graham Sessions: the financial cost of obtaining a DPT is out of control, and we’re preventing lower-income would-be applicants from considering PT as a career path because it’s just too expensive. If we want to make a serious effort to diversify our profession, one of the most important steps will be making physical therapy education more accessible to more people.
Encouraging diversity will not diminish the integrity of the profession; it will only make us better.
There was one theme in our Facebook comments that really stood out to me. Several people argued that diversity efforts would diminish the integrity of our profession. I’m going to say this outright: diversifying the therapist pool and making an active effort to combat our biases will not hurt us. In fact, it will only make us better. Therapists are naturally altruistic, kind, and intently focused on the patient experience, and with a diverse pool of therapists in our clinics, we can improve the experience of so many more patients. This can only help us in our relentless pursuit of reducing the percentage of patients (more than 90%) who have a musculoskeletal diagnosis but don’t seek PT care.
If that’s not enough to sway your opinion, I’m going to leave you with one last factual tidbit. According to Health Affairs, minority providers often choose to work in Health Professional Shortage Areas (HPSAs), “to a disproportionate extent.” If diversifying the industry means that we can help reach the patients who need us the most, then I say we should redouble our efforts to open the industry doors, so to speak.
This is just another reason to engage in legislative advocacy, or even to donate to the PT-PAC. (Learn more here.) We currently have a bill on the table, The Physical Therapist Workforce and Patient Access Act (H.R. 2802/S. 970), that would allow physical therapists to participate in a student loan payment program if they practice in rural or underserved areas. Currently there are 43 House and seven Senate cosponsors, but we need more support to get this passed. Let’s do this!
We can be better, together, but only if we continue to challenge ourselves to discuss diversity, recognize the issues, and work collectively to solve them. We can’t ignore this problem any longer. We must invest in diversity to strengthen our industry.
Jose Gonzalez Mejia
Commented June 28, 2020
Thank you so much for touching this topic. As a hispanic individual who is seeking to apply for physical therapy this year. I truly believe we need to diversify the field to be able to push the field of physical therapy forward.
Commented September 7, 2019
As an African American female PT with more than 25 years in the field, I couldn’t agree more. Over the years, I’ve seen my white counterparts not understand, or misinterpret communication from AAs and other minorities because of a lack of cultural understandings. And to further your point, I continue to be the only person of color at many of the continuing education courses I attend. However, I find the gap to be across the board in healthcare. I did not see the original post, but it is sad if people are offended by an attempt to provide understanding on a very important topic.
Commented September 3, 2019
Promoting diversity in the field is a worthy endeavor. There are tons of patients who are lacking trust in their providers because they don't feel that their providers really care. We've all heard stories of black women being believed the least of all demographics when it comes to chronic pain. And I don't understand the argument that diversity would compromise integrity. What would that even mean?