Last month, my team and I released the results of our second annual State of Rehab Therapy industry survey, and while some of our findings aligned with expectations, there were several data points that left us pondering, and worrying about, potential implications for the profession as a whole. One such finding: The astounding levels of debt reported by DPT students. According to our survey results, which you can see for yourself here, the majority of PT students (more than half) will have more than $70,000 in student loan debt at the time of graduation, and over one-third will owe more than $100,000.
Salary expectations for new grads aren’t on par with other healthcare industry peers.
And if triple-digit student debt figures aren’t enough to make your head spin, bear in mind that most starting therapist salaries pale in comparison to the price tag of a PT education. In fact, according to our survey, nearly 75% of students expect to earn between $60,001 and $80,000 during their first PT job after graduation, which also aligns with current industry salary averages. To put that into perspective, the amount of debt medical students incur throughout their schooling is often comparable or slightly higher than that of PT students. However, med students can expect to earn starting salaries about three times higher than that of the average physical therapist.
Despite this, physical therapists still love what they do.
Now, regardless of where you stand in the debate over the true value of the DPT, one thing remains constant: on the whole, physical therapists continue to cite high levels of job satisfaction. In fact, our survey results revealed that, for the most part, PTs enjoy their work and find it highly rewarding. However, many respondents also expressed concern over the direction the profession, as well as the healthcare industry in general, is heading.
This shouldn’t come as a surprise. After all, there’s never been a better time to be a PT in terms of job availability and overall demand. Between the aging population and the rising cost of health care on the consumer end, patients with neuromusculoskeletal disorders are seeking out effective, lasting, and less-risky alternatives to surgery and other invasive treatments. At the same time, increased regulatory burden and lower reimbursements have driven many practices to increase productivity and revenue by incorporating cash-based wellness services in order to keep their heads above water. This isn’t necessarily a bad thing; however, I’m sure most of us didn’t spend seven years and thousands of dollars on schooling to lead exercise classes or provide massages.
Some therapists question whether elevating PT education requirements was the right move.
With such a massive wage-to-debt disparity, a number of PTs have found themselves asking the same sorts of questions:
- Was moving the requirement from MPT to DPT really in our best interest?
- Do PT students really need to be in school for seven years?
The answers vary greatly depending on the individual, but some would contend that the profession was better off before the change. And at first glance, it’s hard to fault that observation. For one thing, it’s driven PT grads even further into debt, and has increased their overall workload without increasing their skillset in any measurable way. Despite this, I believe that ultimately, the decision to level-up from MPT to DPT was the right one. After all, we’ve earned that “doctor” title; we are more than capable of not only assessing, diagnosing, and treating musculoskeletal conditions, but also directing our patients’ care journeys and advocating on their behalf.
Perhaps most importantly, the doctor title elevates our status and perception in a patient-focused world that recognizes titles. Part of the reason we implemented the DPT was to bring physical therapists up to “doctor” status in the eyes of the greater medical community as well as the general public, and to use that label as a branding mechanism to inform the layperson of our status as front-line care providers. (Unfortunately, many PTs have not embraced this title, instead shying away from calling themselves “doctors.” And in my opinion, that’s truly a shame.) And considering the fact that the switch to the DPT curriculum has not correlated to increased payment rates, it feels like all that work and effort has garnered little to nothing in return. So, in order to reap the benefits of a doctorate-level degree, I firmly believe that all DPTs must embrace the doctor title. This may be an uncomfortable adjustment at first, but it’s a crucial step toward informing the average patient-consumer about the value of the care PTs provide. (A good example of this is the shift in the public’s perception of chiropractors once they took on the doctor title.)
To me, all of this begs the question: At what point do students start considering the debt ramifications, and the apparent lack of ROI, and as a result, begin to avoid the DPT route? Or, will the culture of student loan acceptance among undergrad and postgraduate programs, a phenomenon that’s certainly not unique to DPT programs, cause massive, widespread burnout down the road? Either way, the future of our profession is, in my opinion, hanging in the balance. We’ve got a lot at stake here, and we must come together to address this problem, sooner rather than later. And that starts with awareness. (For a couple of ideas on how we can get the educational reform ball rolling, check out this blog post I recently wrote.)
Physical therapy education is still worth the price of admission, up to a certain point.
Now, I’m not saying that a career in physical therapy is 100% not worth the financial investment. And research conducted at the Carver College of Medicine at The University of Iowa seems to back that up. This study concluded that PT school is a good investment “up to a certain amount of student debt.” According to the study, with the average debt level reported by recent US DPT graduates ($86,563), physical therapy’s net present value “was higher than occupational therapy, optometry, veterinary medicine, and chiropractic but lower than dentistry, pharmacy, nurse practitioner, physician assistant, and all medical specialties,” all of which have a significantly higher expected starting wage. At $150,000 debt, which about one-third of our own survey respondents reported owing, physical therapy’s net per value “falls below all careers except veterinary medicine and chiropractic,” and students who report $200,000 worth of student loan debt are unlikely to achieve necessary repayment benchmarks. And beyond $266,000 of loan debt, physical therapy’s net present value doesn’t even exceed that of a bachelor’s degree.
DPT students report higher satisfaction with their education compared to students in other healthcare disciplines.
So, if the value of the DPT falls short of many other healthcare degrees, then why are DPT class sizes increasing year over year? Well, consider this: despite the lower perceived value of their program, PT students tend to report an overall better educational experience than their medical peers. According to a different study from the University of Iowa, DPT students “reported significantly higher ratings of the educational emotional climate and student-faculty interactions” than students in MD programs. Furthermore, the study found that DPT programs have significantly lower burnout rates than medical programs do.
To me, this only reaffirms something I believe most PTs view as a universal truth: despite the seemingly-endless struggle for proper recognition, payment, and pro-PT legislation, this profession is still incredibly rewarding. They say if you do what you love, you’ll never have to work a day in your life. And I believe that a genuine love of the work we do as physical therapists points to why so many of us elect to stay in this profession, and why the number of new grads entering the field continues to grow. However, I also believe that this love will only take us so far if potential DPT candidates no longer see value in the degree when other fields require the same amount of schooling (or less), but won’t result in mountains of debt that will follow them for the rest of their lives.
At the end of the day, one thing is clear: our profession, and its approach to education, is in dire need of a change. While groups like the APTA push for educational reform, their efforts will only be hampered if PTs are not active participants in that change, too. (Specifically, physical therapists can be a part of the discourse by joining efforts such as the National Student Conclave (NSC) or attending the Education Leadership Conference.) Ultimately, it’s on us to create a prosperous future for ourselves, and I think that’s a goal we can all get behind.
About the Author
Heidi Jannenga PT, DPT, ATC, is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.
Commented January 13, 2023
There seems to be a number of misunderstandings going on in this article and comments. From what I understand through research on the APTA's history, legislation, lobbying, educational mandates, ability and implementation of educational requirements, the changes in title, etc., several things have become clear - there was a big push to further amend the titles, but disproportionate amendments in education behind it. That is to say once the masters level PT title had been changed to DPT, the education didn't change to reflect that outside of continuing ed courses which were already required to maintain the license, like all of us in the healthcare field. This seems to be a large factor in why the scope of practice hasn't change to reflect the title change - the 2015 lobbying by the APTA was successful in allowing the title, but DPTs are now largely stuck with a burdensome title which may not reflect their capacity as a physiotherapist. It's quite the ask to take a high school basketball star and immediately put them in the NBA with the title of an NBA professional athlete; it merely harms the player, likewise, it merely hurts the PT. Having a greater title and assuming greater costs to education without the necessary doctoral level educational changes truly holds back the profession. I'm not sure what Phil G is referring to regarding the comparison of the DPT vs DC pedigree, as I don't see anything claiming as such in the article, but the sentiment is true - the DC's education is far more vast than that of the PT/DPT, as reflected in scope of practice and other later certifications/license opportunities available. I am a DC for the record employed by MDs in an integrative setting, as such I am both a "doctor" and a "physician," the latter of which DPTs cannot claim to be. It's a true shame because I do feel DPTs deserve the requisite educational changes to reflect the title, further garner the respect of patients and also fellow physicians. I'm not interested in gatekeeping. Nevertheless, as a DC, my income opportunities maintain a larger capacity in general. Meanwhile, many PTs are stuck in PT mills, bogged down by corporate overlords, insurance conflicts and requirements, and medicaid/medicare troubles. I remain unconvinced that the blame for these short-fallings lie squarely on the APTA, though they are a major issue from what I understand. The healthcare system as a whole has devalued conservative medicine, overvalued the plenary license & ignoring the empirical evidence of disparate outcomes and actual preparedness of MDs. This has been somewhat alleviated with the integration of the DO (doctor of osteopathy, originating from Chiropractic) into the medical setting, however this has yet to take-off en mass, and it has done little to shift the narrative and value of conservative care. If I had to provide plausible "fixes" to the DPT's financial conundrum, of which is not unfamiliar to us DCs mind you, perhaps they'd look something like this: Increase and standardize the educational requirements to meat the demands of the title of "doctor," which would also allow for more independence as a practitioner and broaden scope of practice (affording DPTs to be portal of entry physicians). Have the APTA develop a government program for new grads to work in public hospital/healthcare settings for x amount of years for total loan forgiveness. Implement educational services linking up the medical community with DPTs by way of a program which better allows both to further understand what each can do, the limitations of each, and provide a streamlined means of referring back and forth. Ditch the PT-specific EMR programs and embrace the more commonly used ones in medical practice (as a DC, using eCW has changed how well we are reimbursed, especially when it comes notes needed to justify to insurance). Like any healthcare profession.... actually have formal classes on how to code in a way which best allows for reimbursement (DCs, MDs, DOs, OT, DPTs, etc.,.... we're never taught this beyond maybe a couple of slides over 9 years of academia). Lastly, the APTA needs to get together with relevant DC governing body counterparts (we have too many haha), maybe even MD/DO as well, and put forward the research demonstrating the value of conservative medicine for insurance companies. I'm not sure who may or not be aware of this, but conservative medicine has been shown to save the insurance companies a projected 6 and 9 buttloads of money (definitely a technical term) each year even when we're properly reimbursed. Our governing bodies allowed insurance to become the overlords, and we have the power to change that.
Commented January 20, 2022
Howdy All, It is very easy to blame the APTA as they are the group that created Vision 2020. They deserve the blame because they do not accept the responsibility and accountability. The epic fail of the DPT (a non clinical degree) was discussed for several years during the reign of APTA's President Ben Massey, Jr., PT. He and I, and others, discussed the merits and fails in many editorials over a couple years. These editorials are available on line. Here is a brief synopsis of the obvious ways the V2020 plan was a fail. (as discussed in the editorials of 2008 etal.) 1. PT profession should trade the extra education for extra clinical scope and responsibility. The example given was how the nursing profession traded extra education for the FNP degree/license and now we see how the FNP profession is excelling and thriving. 2. DPT is an academic degree. The only designation for a PT licensed in the USA is the PT designation. There is no gain in privilege or responsibility because of V2020. The average increased cost is: 3 extra years of college x 25k per year is 75K. Plus loss of wages x 3 years of 70K is 210K. For a total loss of $285K. 3. The PT profession should have requested a 2 stage license. PT and DPT (just like RN and FNP). The PT license could remain as is. The DPT could order and interpret all diagnostic imaging, perform trigger point injections (not just dry needling), prescribe limited drugs such as anti inflammatory, antibiotic, neuro (gabapentin), lower level opiods like tramadol and up to 7.5/325 oxy etc and of course muscle relaxers flexeril etal; direct access all 50 states, treatment codes are converted to procedure based vs. time based, refer for specialty consults, authorize handicap license plates, authorize light or no duty work status, exempt children from PE, order w/c and prosthetics, discuss and make nutritional advice and use of supplements like Vitamin D etal. And so much more like prescribe a home tens unit....... 4. Stop bashing the POPTS. So let me get this right. You trust your obstetrician to deliver your baby but if they owned a PT clinic they would be unethical? Yeah. Right. In conclusion, the APTA is at EPIC fail levels because they caused V2020 to occur even with logical and persistent warnings and they are still not doing anything to correct this huge mistake. Best to all. Have a great 2022. James Toffolo, BS PT
Dr. Derek Austin 🥳
Commented March 2, 2021
To quote the author Heidi Jannenga in the comments section, "[M]any students state that they are bailing after a couple of years to other industries because they can't pay the loans back fast enough. Hate to lose our best and brightest." This is absolutely true, and I recently changed careers back to web development because the hourly wage is often twice what I'd earn as a PT when taking into account unpaid documentation time. I have other PTs making a similar career switch reach out to me all the time because of an article I wrote on my blog titled, "I Didn't Learn Anything in PT School." ( https://medium.com/swlh/i-didnt-learn-anything-in-physical-therapy-school-80ba6591dc72 ) In the article, I detail how I entered PT school with such advanced skills from a background in massage therapy that I needed to earn a CSCS to feel that I had progressed clinically. Many of the PTs who switch careers are the best-of-the-best, including rehabilitation managers and skilled manual therapists like myself. Often, they stuck it out in bad jobs much longer than I would have been able to. But here's the reality: if I have to spend 4+ hours a day typing into a website, I'd much rather be building the website using a modern development environment like VS Code instead of a terrible documentation software. Heidi's WebPT is the best I've used, and it works worse than the first version of Facebook (released in 2004), which was also powered by the programming language PHP. But Facebook has since released React (in 2013) to build the modern website & app you see today, while WebPT is a brutal clickfest of tiny checkboxes. Sure, PTs "need" to justify their care to get paid by insurance companies, but no one enters the profession to spend all day documenting -- and that won't change until insurance companies stop being payers. Modern software with a better user experience would help reduce PT burnout by allowing more time for clinical care, but even then the pay just doesn't make it worthwhile to graduate with $100,000+ in debt.
Commented February 15, 2020
My daughter is graduating with a bachelor of Athletic Training this spring and just sat for the BOC. However, she prefers the rehab aspect of AT, as opposed to the on-field emergency care. A natural pivot would be to PT, however the doctoral requirement and the costs are just too much for her. She is considering becoming a PTA. Wondering if there is any research on this field, in terms of salary/long term earnings compared to PT, when there is generally zero or very low student debt related to the PTA degree. Also job satisfaction, in light of your article about PTs generally loving what they do, no matter the salary!
Commented January 14, 2020
Your words are harsh but unfortunately are absolutely true. I earned an MS from a top school. It cost me 50k at a time when starting salaries were around 45k. Fair enough. My worth has increased since graduation due to job experience and independent study. What is happening to tuition now is insane. And yes - a doctorate degree right out of undergraduate school is bogus. I feel badly for the up and coming PTs. They are graduating into a mountain of debt with no additional respect from employers or insurance companies.
Commented November 18, 2019
Interesting piece, but misses the mark entirely! Yes, physical therapy used to be a noble profession, labor of love for most of us. While we spend an comparatively inordinate amount of time and physical effort treating our patients when compared to the face-to-face encounters of most other health care practitioners, we now must spend Additional hours documenting our visits (now on ridiculous computer programs like WebPT for which we now pay a percentage of our income to these documentation ‘middle men’), just so insurance companies - the most notorious being Medicare - can decide to deny reimbursement for services rendered. We are no longer in service to our patients, now we work for insurance companies who actually reward their own employees based on the number of denials for payment they submit! What does the physical therapist then do to get reimbursed for services rendered? MORE documentation to justify the quality services we have already provided! If I had known These facts before spending 4 1/2 years earning a DPT as an adult, I would definitely have chosen a different profession! Forget this issue with student loans since this does not truly address the heart of the problem with the physical therapy profession today. This is now a career in documentation. How sad.
Commented November 17, 2019
I work for a company that I strongly believe misused the practice of physical therapy by allowing a personal trainer to promote the notion that he was doing physical therapy instead of general strength and conditioning. I informed the Senior HR Manager the employees thought and still believed they received physical therapy by actually saying they received physical therapy from my former manager who was only certified as a personal trainer. As you said many of us love our job. I was told from an attorney that if I were to say anything to my PT board, it would be considered unprotected speech and that anything I say would be grounds for dismissal. The PT before me, was fired (or involuntarily retired) according to my former manager who was the personal trainer. I'm not sure if that was a warning, or just part of the conversation. Retaliation comes in different forms that may not be proven as a form of retaliation. Laws cannot protect us if we are threatened from within for doing the right thing by advocating for our patients. I struggle with the decision as to whether I should say anything or just let it go. Because will anything actually get done? I believe I should say something, because in the long run it hurts our profession. One law that I believe should be implemented is that medically licensed professionals should be supervised under someone who is also, or had been medically licensed. I think if my former manager ( he retired earlier this year) had explicitly informed his clients that they were no longer receiving physical therapy, but a form of general fitness for duty conditioning, this would not have happened. If he were a licensed healthcare provider, he would understand the legal ramifications. Yet, the company allowed this misrepresentation to occur to perhaps save money. Long time ago, I complained to my state chapter about other ethical concerns where my former manager wanted me to not document certain things on my notes, but no action was taken. So I have little faith that things will change, but needs to change so that we can speak up and continue to advocate for our patients.
Commented November 3, 2019
I have been a Pt for 32 years, Graduated in 1987 with a BS in physical therapy. I have kept up with the continuing education requirements, though I think they are a bit much. After 32 years it’s hard to put a new spin on age old problems and treatment schemes. I Do understand there is new research and understanding of some of the same old maladies and treatment results and best practice patterns, but at the end of the day we still treat the patient much the same way. We document much better to show why a Therapists services are needed. To me ,this issue is the seems to be the most important topic to ensure reimbursement and it has been an ongoing evolution for many years. The insurance companies don’t care if your. DPT, or a PT with a 4 1/2 year education. They want to pay as little as possible for our services and constantly try to find ways to deny payment. In my opinion the move by the APTA to go to a DPT was a bad move. When they started moving in that direction, I stopped participating in the APTA . Of course you have a more well rounded education with A DPT, but it is not needed to perform the myriad of duties and tasks that a Physical Therapist actually does. Salaries are not higher because of the advanced degree, but the student debt sure is!
Commented October 29, 2019
I have licence in PT, as well as Chiropractic, and when you stated that Chiropractors don't have the academic pedigree as PT's that couldn't be further from the truth. I believe the physical therapy field has been suckered into thinking that they are actual doctors.. Colleges for most fields have increased credentials or years of study. Physical therapist are now strapped with greater student loans. The work is the essentially the same as when I first broke in the field. Be careful making assumptions when you don't know the facts about other disciplines.
David MSc, PT, DPT
Commented October 29, 2019
The fault lies squarely at the feet of the APTA. Instead of advocating for higher reimbursements for PT’s, those in the Ivory tower at the APTA believed that “Obama-Cara” AKA the un-affordable care act would bring us Millions of new patients with much anticipated increased revenues. Just like every other aspect of that failed law, it simply transferred power from the providers to the big hospital corporations, big Pharma and big insurance. Small town hospitals are closing their doors and going BANKRUPT because they are losing money on TKA and THA....the bread and butter of inpatient PT’s. WE TOLD you time and time again that this law would bring about changes NOT BENEFICIAL TO anyone in the PT profession but it certainly has consolidated 1/6th OF OUR NATIONS WEALTH IN WASHINGTON DC..... We all know how well they run the post office, Medicare, social security and maintaining our roads and bridges ..... Ive seen o er the past 10 years continuous greater government oversight, greater regulations, less freedoms, diminishing reimbursements and chronic burnout amongst our profession.....! Instead of the APTA maintaining close oversight of our profession and the deleterious consequences of saddling up to big government bureaucracies, they have inexorably hurt our profession. We should be at the pinnacle of healthcare as without physical therapy the majority of patient’s maladies CAMNOT BE CORRECTED BY pills...... However, Instead of lobbying hard for greater reimbursements, greater access and an increased numbers of visits, we HAVE BEEN LUMPED in with chiropractic, (the vast majority don’t have NEAR THE ACADEMIC PEDIGREE AS PT’s), Acupuncture, (seriously).... along with having to coMpete with our fellow OT, and SLP‘s for utter pittance reimbursements. Am I frustrated? You bet! I’ve been paying dues to the folks at the APTA for years to look out for my profession’s best interests. They have done nothing of the sort,,,, they have like everyone else in the Washington DC / Virginia corridor done a great job of looking out for themselves instead doing what they are supposed to do..... Watching outfit those that pay their salaries.., APTA, start fighting for our profession before your all fired do to frustration by those that pay your bills..,,,,
Commented October 20, 2019
I completely agree. It's ridiculous how much a Physical Therapist Education costs. I have been a PTA for over 23 years. I got all my credits for a Master's but when I did the Math 26 years ago, my education for a MPT was going to cost more than the current salaries. NO WAY. I chose PTA and paid off my student debt in one year. I love my profession but salaries have been stagnant for years. Insurance companies do not care about an MPT or DPT as sad as that is.
Commented October 2, 2019
Interesting blog post. I was wondering what PTs thought about this move to a DPT. I am a career changer. My first thought was to go into PT as I found it so fascinating. I am a fitness buff but had no clue what PT entailed until I had a knee injury then realized that would be a career I would love. I was an IT consultant at the time (20+ years). As I started researching, I realized I was looking at about 1.5 years of prereqs before I could even consider (because my BS was in IT). By that time it would be a Doctorate program. PT was a BS program back when I was in undergrad. Obviously, the idea didn't make much sense for me financially being middle aged and focusing on retirement. I started taking the prereqs at a community college while I was exploring options. Was deciding between nursing or PTA programs when I stumbled across an "Intro to Massage" class over the summer semester. I decided to become a licensed massage therapist and love it! I really think they need to have different levels for PTs with the aging population.
Commented September 26, 2019
Not sure what the "Aligned Health PT" is but a Physical therapist degree today is a DPT degree - a professional Doctorate of Physical Therapy, similar to DPM - Doctor of Podiatric Medicine or DC - Doctor of Chiropractic. There is an opportunity for DPTs to get a PhD, but its the same path as any other student pursuing a PhD degree and not specific to practicing PT or licensure. With regard to a Physical Therapy Assistants, PTAs cannot advertise themselves as a PT. PTAs have a 2 year degree program. They must work in conjunction with a PT. Payment for PTA services is currently under scrutiny by Medicare and other insurances.
Commented September 26, 2019
Completely agree Josh. We have not followed through with ongoing changes and the evolution of the profession with the DPT degree.
Commented September 18, 2019
You sounds bitter as hell. The title "Dr" does NOT only apply to people who have attended medical school. The title "dr" is given by the degree held. In which, a DOCORATE degree, would give you the title "Dr." Your opinion really is just your opinion, and nothing more. Try telling PhD students that their title as "Dr" doesn't mean anything.
Commented September 12, 2019
Great article thank you. Could you address a question for me? Are Aligned Health Physical Therapists also Phd's? Can a person with a PTA degree advertise themselves as a PT? The degree programs as certainly very different.
Commented September 11, 2019
I too am a PTA with 20 years in. My opinion hasn't changed from the start.... How can you be a "master" of anything coming out of school... let alone a "doctor"? Sorry, but the new grads I see just don't have the pt handling skills that rate a "doctor" title. I qualify that statement by the many thanks I've gotten from new grads for showing them how. I have no issue with a doctorate program for research... but truly, the biggest thing accomplished was pricing PT so high; the pt can't afford to go! Which also resulted in raising productivity rates that are truly impossible to ethically meet, (they expect 92% at this time). My speculation is that insurance companies will produce exercise videos and offer pts that option as opposed for paying $63.00 for 15 minutes on a bike.
Commented September 11, 2019
This may sound political and cynical but, universities are placing unnecessary debt on all students due to bloated administration jobs. Meanwhile they keep the professors'salaries low in comparison. Piles of money continues to flow into University coffers due to the federal government's money printing machine so that "everyone can get a degree"; Does the housing bubble of 2008 ring a bell? This is way out of hand and has been for some time. The University system is simply picking the pockets of student's future earnings. As you pointed out, the tipping point of risk vs reward may have been reached. I respect the time and investment made by students but, I'm sorry, I see little in the way of work place advantages over a therapist with a BS or MPT degree. Wise up folks.
Commented September 6, 2019
I've seen many changes in the my 30+ years experience as a PTA, working in Texas. From one year licensure for $55 and no CEU requirement, to 2 yr license renewal for $110 plus 20 CEUs, to the current requirements. I've loved every minute of my patient care experiences over the years and have grown to loathe the ever growing demand for documentation to support the clinical side. Yes, I do understand the reason behind it, but, for me, it is truly the one aspect of the profession that can, at times, make me question how much longer I want to treat patients. Fortunately, that thought only lasts until my next patient shows up. As pointed out in an earlier comment, I too am concerned about PTA education level. With the push to an entry level Doctor of Physical Therapy degree, why hasn't the PTA curriculum been elevated to Bachelor's degree? I looked into becoming a PT several times and all I heard about was how I'd need to re take a my prerequisites because they' were taken so long despite the fact I have a BS (Healthcare Admin) and have been actively working as a PTA for more than 32 years. Maybe an undergrad degree as a PTA would have helped. However, if I had to do over, I would have pursued a career as a PT earlier in my career. Regardless, I love what I get to do everyday, and don't really see myself retiring anytime soon.
Commented June 18, 2019
This article hit home. My daughter will be graduating with her BS in Athletic Training, and is considering the field of PT, post-graduation. She ended up preferring the rehab aspects of AT, as opposed to the emergency care aspect. When we looked at programs, we were stunned at the price tag. Not willing to sign on for $100,000 in debt (easy to do, even living at home) we began to explore PTA as an option. While she doesn't love the idea of attending a community college for two years (feeling like it's a step down after getting her BS), she will probably be able to waive many of the general ed classes (Bio, A & P, etc.) and come out paying less than 10K. It seems the PTA salaries we are seeing in job listings are decent, and she'll be able to do what she finds interesting and move forward financially. Definitely would love to hear from PTAs or PTs on the field of PTA, good and bad!
Commented May 18, 2019
I am apprehensive about encouraging our techs to pursue a career in physical therapy, given the ROI for PT education. What are other ways in which we can try to help our future coworkers not be so burdened by debt? Why is it that we as PTs are still unable to participate in the National Health Service Corp to qualify for loan repayment programs? How can we help to make that a reality? Here is the new link to the student conclave: http://www.apta.org/nsc/.
Commented May 13, 2019
I agree that PT's should be considered specialist. I also think you should not have to pay the price of a 3 year doctorates program to become a specialist. The educational system is taking advantage of students.
Commented March 29, 2019
Commented March 21, 2019
That's interesting and I agree, I often have not even recently minted DPTs ask me where did you learn that manual or neuro rehabilitation technique that was taught at my bachelors program at Stony Brook. I happen to believe that the DPT was a form of grade inflation and that therapists haven't really been elevated academically or in any other way. However, the specialist designations are quite rigorous and I have a lot of respect for their clinical expertise.
Commented March 4, 2019
The difference is 200k of debt at 300k salary is a massively different than 100k debt at 70k. Not only in regards to the debt:income ratio but also the absolute salary figure itself. 200k really isn't that difficult to pay off when you're making 300k a year.
Commented January 11, 2019
I was amazed to see this article inaccurately compare the debt of med school students to that of PT students, the debts are nowhere near the same, and lets not forget the years of residency during which doctors are not paid anywhere near a full salary. That's not to say debt isn't a problem for everyone, but it's disingenuous to pretend this is a problem exclusive to PT students. "In 2016, the average medical school debt was up to $190,000, with about 25% of graduates carrying debts higher than $200,000." https://www.studentdebtrelief.us/news/average-medical-school-debt/
Commented January 9, 2019
We can blame APTA all we want. Maybe the move to DPT wasn't a good move after all. It's easy to say this now, and it's easy to say the schools did this just to make more money. But I find these cheap arguments. I honestly think APTA thought the extra education and the new name would help expand PT's scope of practice. It didn't, but it was worth a shot. You can say that PT schools are "gouging" students, but it's students who sign the dotted line. No one is forcing these students to go to PT school. These students have had 100-200 observation hours before going into the profession. The high cost of education is not a secret. They know that the average private school is now $105k+ for three years (before room and board). Enrollment is up. The profession is hot. Why should PT schools lower costs when demand is so high and people are willing to pay the price? PT school would be way more valuable if they trained PT's how to monetize their skills. I got 2 credits of business in PT school and 4 credits in modalities. That's a problem. If students are going $150k into debt, they better have some business skills. PT school trains students to be employees, no businesspeople. It needs to be the opposite. If I could make $100k net my first year as a business owner, then maybe PT school would be worth it.
Commented December 21, 2018
I have long felt that the DPT was a way for schools to bring in more money. When speaking with DPT students, I always made sure to discuss what they were going to owe once graduating vs what they would be paid going into the work force initially. As a business person that is hiring a new grad vs an experienced PT (w/ a MS or BS), there is no comparison. DPT are a fancy name for entry level PT. Adding a year of classes and a D in front of one's credentials does not make that person a Doctor in the eyes of many. They are an entry level PT and in today's world, that is how they should and will be paid. Yes, I am a PT, with a Master's Degree, but I also have a background in running a business. If the APTA was serious about a doctorate program, they should have made the last year of school strictly clinical work where students earn hands on experience. What really is the value of the extra coursework they received in the final year when CEU's can cover many of the topics studied. In today's healthcare world, costs of doing business continue to climb while reimbursements continue to decrease or rise only slightly. Plus, PT's require more and more time for documentation (most often directed by insurance companies) to be paid. There are now some insurance companies that will not pay for the services of a PTA. Which brings me to one more question involving the PT field. Why are PTA students not required to have a BS with a 4 yr education?
Commented December 15, 2018
And so many students I have had lately are brainwashed, thinking they have superior skills than someone with many years of experience and ongoing con ed. As you said they have no more actual PT courses/skills than I did when I graduated with a BS 30 years ago.
Commented November 5, 2018
You didn't earn a legitimate doctorate. You went to PT school. In earlier times PT school was junior and senior year with summers included no breaks. Or it was senior year and a year after and a Master's. Now you go to PT school post an unrelated degree after which the program extended internships to justify the three years. You are not a specialty "doctor" who went to medical school. You went to entry level PT school. We assessed and evaluated with the license granted as a PT whether Masters or BS--having the doctorate didn't suddenly create that as you said above. We had an imaging section and a pharmo section. We differentially diagnosed the entire way through school in every course. We had research methods and an end of term paper. You did not do a real caliber graduate student "thesis." You do not teach lower level courses as a grad student does. You do not do real orals as a grad student does---and again don't point to end of term tests that we all did or the paper you turned in that we all did as well. You did not go to PT school then advanced PT school or specialize. But you did get 150K in debt so maybe it makes you feel better to say you're a doctor when you certainly aren't. In the academic environment feel free to use that term to teach. Don't do it in the healthcare practice community---you look ridiculous
Commented October 19, 2018
This is the very mentality that is hurting the profession. The APTA was right in mandating the doctorate, it is now failing to control the implementation of the result into the industry. Chriopactors have branded and lobbied extreamily well as chiropractic physicians, the DPT is currently in an identity crisis. In order to improve reimbursement practitioners must embrace the Doctor of Physical therapy title, maintain and expand scope of practice, and respect the MD medical scope of practice. The APTA must do more to protect private practice and encourage autonomy between the providers unlike the route of the DC.
Commented September 26, 2018
There are three issues the APTA did not take inconsideration. Reimbursement improvements with the increased presence of the DPT instead of accepting what CMS values our services. The public has no real understanding of what we can truly do unless the MD refers to the PT. Lastly, depending on state rules, PT's are not able to align with companies to endorse like physicians. If the idea is considering PT's as specialists and the 'doctor' added on the name offers this opportunity, why are states and the APTA not expanding our presence for the public to consider other forms of our need for our services? This presents that our scope is too narrow. Nurses and physicians have a wide spread of opportunities to be needed by the public without the public thinking too hard about them. Physical therapists? No idea until a person is injured or in the hospitals. I can not speak for other PT's, but it is hard to support organizations that speak about a direction that sounds great at rallies and conferences, but at the end of the day, pay and debt are real issues in this country. Until the APTA looks at the business of reimbursement as a priority, PT students will all do the same thing. That is, support with the schools pushing for that support, but stop supporting when debt hits them and they are not able to be called 'doctor' in the hospitals after graduation.
Commented September 15, 2018
Maybe it's time for a class action lawsuit against APTA for demanding that we go to a Doctorate, which allowed the PT schools to jack up their prices and charge for a year of school when we are not even on campus... and to top it off, the fact that the APTA has never increased my reimbursement rate. So based on false practice by APTA to demand Doctorate, and their failure to have us paid at a rate based on level of education and experience. So, to me it looks like APTA is out to line their friends pockets in the education system, but not improve work or pay conditions for the DPT.........
Commented August 8, 2018
This article hits on a lot of important points. To add to the discussion, there needs to be better regulation on the opening of new PT schools and the class sizes of existing schools. A close eye should be kept on supply and demand for physical therapists and PTA's forecasted based on accurate projections for future PT needs. These forecasts need to be based on the changing healthcare climate, including hard caps for OP visits and managed orthopedic care becoming more common practices. As physical therapy companies grow larger and larger, less of a value is being placed on experience and advanced coursework and more of a value on new grads and PTA's who can bill the same but don't demand as high of a salary. This will displace mid and older clinicians from the market. The high debt to income ratio will likely discourage the majority of young clinicians from pursuing advanced degrees and certifications. As for the DPT. It was nothing more than a cash grab on the part of schools to justify one more year of enrollment and tuition fees. The original enthusiasm for direct access is waning as the practical complexities of implementing it and reimbursing for it are exposed. We can all agree that physical therapy was, is, and likely always will be a great profession that empowers people to help heal themselves. However, in my opinion we have done a poor job of managing the long term sustainability of the profession.
Commented August 8, 2018
Could not agree more - we continue to fight over the 10% that access PT and should focus on the 90% that need our services but don't know we exist or have been restricted to our services. Re: silver lining - disagree from the comments our discussion has provoked - many students state that they are bailing after a couple of years to other industries because they can't pay the loans back fast enough. Hate to lose our best and brightest.
James E. Glinn sr.
Commented August 4, 2018
Physical therapist’s salaries can only increase when our profession is allowed the innovation to occur that has taken place in medicine. A physician,for example, can supervise aides, physicians assistants, nurses and nurse practitioners thereby allowing expanded access to care. PTs, on the other hand, are limited, in my opinion, by onerous and restrictive regulations that restricts access to patient care as well as reimbursement. All of this continues at a time when the large baby boomer demographics need access to service. Until we can innovate, salaries will stagnate regardless of graduate degree conferred. One silver lining perhaps, is that at least the large student loans incurred due to the DPT degree helps retain PTs longer in the workforce.
Commented August 3, 2018
Heidi, Great post/article here. You're right; the cost-benefit analysis needs to be done by every potential PT student. Don't get me wrong, I believe in our profession with all of my heart, and love being a PT. But because of reimbursement changes, the workforce has started shifting towards the use of PTAs for treatments (in many settings) leaving PTs to be paper pushers or administrators. The fun stuff is in the patients! I've taught in PT and PTA education and am now an administrator, and when I go guest speak to classes of potential healthcare classes, I make sure they see the data before they leap. PT school = $70k in debt on avg, and possibly more (to your point). PTA school (public) = 9-11k in debt. PT can make 70k out of school, PTA can make 55k. Sometimes the costs DON'T outweigh the benefits. And becoming a PTA in certain states and settings can be lucrative enough to pay off the debt quickly, and save for PT school (since so many PTAs come in with BS degrees already). The market is, and has, shifted. And while I do believe that what EIM is doing with 2 yr programs that are a little less costly in places, the entire profession in PT education needs to wake up! We're going to price ourselves out of the market! Thanks for this great article!
Commented August 3, 2018
My comment is in regards to "the doctors titles." Unfortunately, in our world, many outside of DPT world "fat-shame" DPT student and novice practitioners. I remember as a student, I had a PT with his MPT tell our class "don't think just because you have your doctorate, you are better than me." He is not the only case where this came into play. Also, to refer to yourself as a "doctor" around an MD will result in a catastrophic pedestal kick. I think we need to acclaim ourselves as specialist; however, the world has not adapted to the change.
Commented July 31, 2018
Thank you for the great post, it was a very interesting read. This is something that I have pondered myself quite often. I think the answer to the question, "What went wrong?", has less to do with education, and more to do with the wages that physical therapists earn. I have worked in the physical therapy field now for 6 years and in that time my salary has not increased much. I have interviewed for many different jobs and I have been surprised how low the offers often are. I was involved in an interview where, the interviewer told me that the best offer they could make me was $5000 less than what I was currently making with no benefits. She told me the reason was that, "As a PT you just can expect to make that much anymore." And this person was a PT! We all know that salaries are tied to reimbursements, and that to get higher reimbursement we need to show our value, etc. etc., but the more we talk about it, the worse this problem seems to get. Where this went wrong was when we decided we would take less and less, and now we are sliding down that slippery slope.