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Debt and the DPT: What Went Wrong?

July 30, 2018 • Other • Heidi Jannenga

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.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC/L, 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...

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Leda McDaniel, PT, DPT

Commented • January 25, 2020

Hi Chris and Mark, I LOVED this podcast and diving into the importance of the subjective exam! I also have been inspired by the work of Atul Gawande's "Checklist Manifesto" and have applied that reasoning to creating PT evaluation "checklists" to facilitate some of the similar points that you mention: keeping a logical flow and structure for an exam, asking comprehensive red flag screening questions, guiding a systematic decision making process and allowing for "checking" and self-reflection after patient evaluations to assess whether my clinical thought process for diagnosis and treatment followed a rational progression (also as a teaching tool for students learning exam skills). Would love your feedback on how I apply this and if you find these checklists useful (Below are 2 links to blog posts that I wrote specifically about these ideas, and within are links to my checklists): Thanks very much for sharing your experience and expertise! Best, Leda

Jon Waxham

Commented • January 24, 2020

Heidi, I appreciate you sharing your thoughts. I share in your frustration and certainly agree we need to think creatively and be pro-active when evaluating the administrative side of things and our commitment to high level documentation. I also agree that patient advocacy is the primary driver of change for an organization like CMS. My greatest frustration is that this seems fairly obvious, however the APTA has done nothing to communicate these changes to the patients directly other than social media. Drug companies long ago realized that they needed to cut out the middle man and make the case for their products directly to the consumer. As a result, every other commercial these days is from a drug manufacturer, so now patients go into the doctor's office asking about these drugs instead of waiting for the doctor's suggestion that they might help. We wouldn't still be bombarded by drug ads if they weren't effective. I can't understand why the APTA has not used some of it's marketing budget to speak directly to consumers about our services so patients were educated about the benefits of physical therapy, so they were aware how CMS policies will affect their care and can get directly involved, so when they went in to see the doctor because of neck pain or balance issues that they are the ones asking to go to PT. You point out that we must think proactively and advocate, but when productivity requirements continue to go up and more personal time is spent on documentation we need to rely on our professional association. I feel it is time that they consider some forward thinking and radical changes to the way they do business. I refer to the old adage that doing what you have always done and expecting a different result is the definition of insanity. The APTA needs to change their methods and communicate directly with our current and future patients if we are to stop this steady decline in reimbursement and spread the word about the benefits of physical therapy care.

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