In May 2023, the APTA released a data-filled study on the effects of the COVID pandemic on the PT workforce. The market had already begun to tighten in 2020 as demand for our services was increasing, but when the dust settled, the results showed that even with new graduates entering the workforce, our industry saw a net loss of over 10,000 clinicians in 2022. Our profession was not unique as the US Bureau of Labor and Statistics showed that 47 million Americans left their job in 2021 and a report by Definitive Healthcare stated that over 230,000 healthcare providers left their jobs as of Q4 2021. That same report showed 22,000 PTs left the workforce in 2021, which equates to only 7% of all of the healthcare providers leaving the industry.
Now more than ever, the healthcare industry—including rehab therapy—is facing an existential staffing crisis. From new DPT graduates who do not feel ready to join the workforce immediately after degree completion to veteran PTs who are exiting to join companies in non-clinical roles for a variety of reasons, our retention rates are not commensurate with the increasing numbers of patients who are seeking our care. And, many of these underlying factors were brought to light at this year’s Ascend Conference.
We kicked off our 10-year anniversary with a bang, not holding back any punches in a keynote panel discussion on the labor shortage including perspectives from academia, employers (large and small), and a recent new grad. This stirred a series of tough questions from many industry leaders and clinic owners in the audience looking for answers. One attendee lamented his frustration in “understanding this generation of new graduates,” stating that this barrier appeared misguided and their current situation did not seem that much different from when he was a fresh PT 20 years ago. But, that did not stop him from working hard, long hours to erase that debt and go on to start his own successful business. He posited, “Could this be about work ethic?” A younger PT—identifying as a millennial—took offense to that judgment, stating that they were willing to work hard, but also had other interests and priorities in life, “like traveling and mental health.”
As I considered both sides of the argument, I recognized the same generation gap that we had found in the data submitted for WebPT’s 2023 State of Rehab Therapy report was playing out in real-time. New graduates reported facing unprecedented headwinds like student debt, rigid work hours and lack of mentorship when entering the workforce, while leaders listed job relocation and misguided salary requests as the biggest issues. So, to correct our PT pipeline problem, we must first recognize and find consensus on our areas of weakness and work collectively toward some actionable solutions.
Where the Pipeline is Getting Pinched
First, let’s take a look at why we’re losing so many current PTs in the first place. In the State of Rehab Therapy report, over 36% of respondents reported feeling burnt out, and the top three attributable factors were low salary, high patient load, and high levels of administrative burden due to regulatory and specific insurance requirements.
Obviously, those are big problems that need to be addressed. We, here at WebPT, take the documentation burden seriously and are doing our best to improve the efficiency of note creation to help minimize the administrative burden placed on therapists. We also are present in over 150 PT programs so that students get exposed early to using a digital documentation system. But even so, under normal circumstances, we would expect the incoming pool of graduates to be willing and excited to help fill the ranks and rejuvenate the workforce.
Unfortunately, that has yet to happen to a significant degree as workforce attrition is greater than graduation rates—and a growing number of less tenured therapists are also choosing non-clinical roles or opting to go on to residency, further limiting the availability of a clinical workforce. Many new grads are exiting academia feeling underprepared, and their hiring managers are underwhelmed. When asked about their level of preparedness when exiting school and entering the workforce, over a quarter of the student cohort selected these five areas as the weakest:
- salary negotiation/understanding,
- clinical technology use,
- best business practices,
- understanding all settings of rehab, and
- CMS compliance and regulatory guidelines.
Do you see a pattern? I certainly do—our data appears to highlight that students lack insight into the very things that keep executives and clinic leaders up at night. So, let’s dive into these pain points and find some actionable solutions for our pipeline problem.
Where We Can Restore the Pipeline’s Flow
Understanding that we may have some work to do as employers taking on new grads is obviously a first step. This isn’t necessarily new and rings true for any new clinician: they will need some extra time and attention during onboarding, a ramp-up period to treating a full caseload, mentoring to build full confidence, and continuing education to hone their skills. Unfortunately, with the stress of reimbursement decline and waitlists for patient care, that extra hand-holding takes patience and extra time from a seasoned therapist or owner. But, personally, I remember those in my early career who took the time—and wow, what a difference it made for not only me and my career but also for them in lightening their load after just a couple of months of added stress. Let’s break this down into some specific solutions that can be implemented fairly easily to get this flywheel started again.
Setting the tone early—via your website, interview process, and of course, walking the walk daily to create a best place to work—well, takes work, but most importantly focus and intention. If we want our staff members and prospective new hires to truly embrace the mission of our practice, then we must be forthright in sharing what the rules of engagement are upfront, have training in place to ensure a clear understanding of the expectations, and most importantly, ensure adherence to those values and expectations. Provide mechanisms for feedback, and if something isn’t working, then try to fix it.
This doesn’t stop in the clinic, this intentionality must be embraced at every level of the profession, including academia. We all have headwinds and challenges, but asking ourselves as a profession: holistically, what are we all trying to accomplish? Hopefully, it is to make a difference in the world, patient by patient. Right now, I believe we are losing some ground as patient waiting lists grow and the provider shortage remains. Patients are going to find something else—or someone else—to help with their ailments.
Embrace a Pipeline that Reflects the Communities You Serve
I can take this concept of intentionality a step further and implore you to look at the latest DEI measures in a different light. This is about expanding our TAM—or total addressable market—of not only patients we serve, but also in our recruitment of the next generation of therapists.
When I launched Rizing Tide in 2021, I did so to allow future BIPOC PT leaders an opportunity to start their careers in rehab therapy with as little financial burden as possible and to be more proactive in creating a diverse physical therapy workforce. Now I’ve come to recognize that it’s bigger than that—this is about expanding the brand and value of physical therapy to demographics of people who do not have exposure to our services. Patients want access to care!
Despite our outstanding reputation as a profession of choice, applicant pools are declining for PT programs. Our targeted audience from the past is finding other career pathways and we must address the big reasons for that decline (i.e., student debt, cost of education, etc.). However, we also must widen the pool of applicant interest. Organizations like the APTQI and APTA have launched programs to connect with high school students—with an emphasis on underrepresented populations—to prime the pump of interest in our field earlier in the educational journey. Embracing diversity within physical therapy—and the greater healthcare industry—is vital for the ongoing success of our profession and our ability to provide care to even more people across our nation. With more unique perspectives, experiences, and insights, the efforts to bring more diverse clinicians to a growing diverse patient population can only enhance the quality of patient-centered care.
And in case you’re in need of some inspiration, here are some ideas to help:
- Reach out to your local high schools and ask about career days, so that you can share what it means to be a physical therapist.
- Stay informed about what’s happening in the profession to remain pragmatic when asked about the opportunity to become a physical therapist.
- Have a shadow program once a month for patients’ high school kids, and open/expand your clinic as a clinical affiliation site for student PTs/PTAs. As therapists, we all can remember at least one clinical affiliation that inspired us, be that clinician for a next-gen PT!
Get Creative With Solutions
Although the narrative of a pipeline problem may not be a new one, some of the headwinds we have seen in the last few years affecting our workforce certainly redefine what it means to fight adversity. Thus, times like these require an amount of creativity and grit to solve this problem locally in your own clinics and nationally as a profession.
Bring down education costs.
The cost of PT education is a complicated one and not an issue that can be solved overnight. However, making your voice known and heard on behalf of your students that come through your clinic is critical. We know that hybrid programs like EIM, Arcadia University (big fan of the 3+ programs), and NAU are working to lower the cost as well as time to enter the workforce while still producing highly qualified graduates.
While we can see the evolution of PT education happening, it’s a slow process. Employers are in desperate need for more therapists immediately and taking matters into their own hands. For example, Athletico, like many other PT businesses, recently launched a student loan repayment initiative as part of their employee benefit package to help new grads manage their debt loads.
Other organizations like WebPT, offer to assist with professional development beyond continuing education. For the past 2 years, we have sponsored a scholarship award winner to attend CSM through the Catherine Worthingham Fellows scholarship program. Award winners can attend the largest APTA conference and start their journey of networking, advocacy, and action. Rizing Tide is launching its new Employer Connect program which connects new graduates with employers seeking to diversify their workforce. Any way that the greater private practice community can assist future pipelines to thrive is a win in my book.
Leverage assistants with creative care plans and schedules.
Although PTAs and OTAs have been handed some regulatory bad news from Medicare, their utility still remains in providing excellent care to all populations. Effective use of PTAs and OTAs in a rehab team environment can continue to provide patient-centered care with a minimal hit to clinics’ bottom lines. Remembering to include Junior and community college PTA/OTA programs as clinical affiliation prospects can also help to expand the caseload capacity in your practice.
Increase Our Advocacy Efforts
With the release of the Physician Fee Schedule final rule by CMS at the end of every year—and the now routine cuts to reimbursement—the holiday season may be synonymous with calls to action for advocacy campaigns. We shouldn’t let the consistency of cuts from CMS turn into complacency. We must remain diligent and active participants to affect change at the state and national policy levels.
Advocate at home.
Luckily for anyone fed up with the political landscape, advocacy does not have to stop on Capitol Hill. The interactions clinicians have with their patient base and community are a critical method to put advocacy into action with major downstream effects. One such example of how local advocacy can be seen in this year’s Ascend Clinic of the Year award winners, Rehabilitation and Performance Institute of Owensboro, KY.
Clinics that serve rural communities know the pipeline problem all too well—perhaps better than any other setting. But Craig Phifer, PT, MHA, the owner and CEO of Rehabilitation and Performance Institute, has used local advocacy efforts to thrive in rural settings across three states and do so with a strong talent pool that continues to grow. I recently sat down with Craig in the Practice Experience Podcast, but for a quick view into how he has achieved his success, it all starts with personal community engagement—including with local high schools and colleges to advocate for the profession and the power of physical therapy.
Leverage the Flywheel
One topic that came up often in my conversation with Craig was the concept of a flywheel. For a quick background, I have often used the flywheel example in many of my presentations to highlight how one small act or initiative can build on the next over and over again until the “wheel” is virtually spinning itself. So, instead of taking on a massive initiative—like lowering the cost of PT education—that requires hours of labor from many stakeholders, commit to small, but intentional, acts that can easily build on each other to ultimately start to make a difference and move the needle on the end goal. This is a concept every clinic can endorse when trying to strengthen their own pipelines that eventually adds up to help the entire profession.
Inspire, engage, and support in your community.
In my conversation with Craig, I found that he is a master of success in growing his business in rural America. I think many of us have heard of food deserts—well, healthcare deserts exist as well, and they will worsen without using the flywheel of opportunity that Craig has put into practice. By engaging with high school-aged community members who go on to become aides or observers, get inspired to become PTs, and later return to their community to be a part of the solution, Craig has his own flywheel started in helping to grow his talent pipeline and—even better—make a difference in the lives of community members.
With 2024 upon us, we are met with a new year of hope, renewal, and expectation. To quote the investor Warren Buffett, “Someone’s sitting in the shade today because someone planted a tree a long time ago.” So let’s leverage our collective energy and propel our profession—and pipeline—forward with long-term solutions that support the longevity of our profession.