Mountains Out of Molehills: Why Therapists are Sometimes the Biggest Barriers to Patient Success • Posts by EIM | Evidence In Motion Skip To Content

Mountains Out of Molehills: Why Therapists are Sometimes the Biggest Barriers to Patient Success

July 28, 2022 • Behavioral Health • Heidi Jannenga

As much as it pains me to say, finger-pointing has become a regular practice within our profession, whether it’s at payers, competitors, or the APTA. Let’s face it: it’s easy to focus more on external obstacles to professional success without considering the barriers we might be placing in front of ourselves, or those we serve. And although there is plenty of thought given to the impediments to our patients’ recovery, many may not realize that we ourselves may be unconsciously hindering outcomes. Of course we’re giving the best possible treatment when the patient is under our care—but are we making it too difficult to get access to that care? Are we not giving them enough reason and motivation to keep going along the path to complete the required treatment for a full recovery?

As of June 2022, there’s all-new evidence suggesting that we as therapists can do better to support first-line PT, improve the patient experience and outcomes, and create lifelong advocates of PT. And it can all happen with small, consistent changes made at the individual level.

It should be easier for patients to get into PT.

WebPT and Clinicient commissioned a survey earlier this year that now forms the bedrock of The PT Patient Experience Report. The report gathers insights from more than 550 patients to better understand what they liked about their physical therapy experience, and, more importantly, what they didn’t. Our goal was to determine what drives patient success today from the mouths of the folks who have actually done PT. One of the key findings showed that PTs are overlooking and therefore failing to optimize one of the most important steps along the patient journey: the beginning.

Increase your clinic’s online visibility.

Let’s dive into this topic by discussing how patients today find care providers, online. PTs can do a lot to bring in new patients just by improving their digital presence. While a website may matter less for your physician referrals, it can do wonders to draw in those who are seeking care without a referral and this percentage might be higher than you think! Per our report, the number of people who said they would return to a PT without a doctor’s order was a whopping 64%. And for these people, things like online reviews of a clinic as well as the relative ease of scheduling an appointment that fits their schedule are incredibly important when weighing their options.

Relatively simple things like optimizing your website, offering digital scheduling tools and a list of services, and getting your clinic on social media can be tremendously effective for meeting patients where they are. Plus, asking patients to leave online reviews of your clinic isn’t as nerve-wracking as you might think. The trick is to identify your most-satisfied patients. Typically, they’re all-too-happy to spend a few minutes recommending a service they fully believe in.

Understand patients’ needs.

Similarly, PTs must understand how to best serve the needs of their respective communities. If you’re not getting as many patients or not attracting the specialty patients that you’d like, adjusting or expanding your offerings to match what people are looking for might be the answer. Our survey found that PT patients are also frequenting OTs, chiropractors, nutritionists, and other wellness providers. Thus, it might make sense to consider adding some of those services to your own practice, or to partner with those other providers to create a referral network.

The same goes for your business hours; you might prefer to keep a 9 to 5 schedule, but let’s face it, we are in the service industry. There are many potential patients who don’t have the luxury of stepping away from work for a midday appointment. Our report found that 27% of patients who dropped out of PT cited time and scheduling restraints as the main reason. Expanding clinic hours outside of regular working hours, possibly including evening and weekend appointments,   provides prospective patients more scheduling flexibility. Capturing feedback from patients to know exactly what hours would serve your patient population the most will be important prior to implementing these types of changes to your practice.

Open the digital doorway.

Upping your clinic’s convenience factor also means letting patients get on your schedule without having to call the front desk. If your clinic doesn’t offer patients a way to book appointments online, or to provide basic information for your intake process digitally, you’re likely to lose out on patients to other clinics that do. In fact, 60% of patients prefer to schedule online if they’re not doing so at your office, and nearly 80% prefer filling out paperwork digitally from home rather than in your waiting room.

Along with the 70% of patients that preferred a digital method for payment, PTs have an opportunity with scheduling tools and automation to not only give patients what they’re looking for, but to ease their front desk’s workload. This is truly a win-win for all involved, and a clear sign as to where our industry is headed.

PTs need to give patients every reason to keep coming back.

Every PT knows the challenge of retaining patients. And while it might be easier to write off attrition as simply a cost of doing business and a side effect of the profession, PTs often aren’t doing enough to actively combat the issue.

We know that 70% of patients don’t complete their full plan of care. can lament patients walking out the door and not returning for remaining appointments—but how are we working to get them to come back? If you’re taking the approach of  “setting and forgetting” when it comes to patient appointments, you’re going to lose more patients than you would with a more active approach.

Set patients up with automated appointment reminders.

Over 80% of patients surveyed preferred digital appointment reminders, and while it’s not a guarantee of a return visit, patient reminders greatly increase attendance and reduce no-shows. How much of a difference can it make? According to one study, automated reminders reduced no-shows by 38%, in addition to being more cost-effective and less labor-intensive. Automated appointment reminders help you to catch patients at risk of feeling disengaged, or those who simply forgot about their upcoming visit.

Embrace hybridized care models.

Offering telehealth services can also help to retain patients. As Bay State Physical Therapy President and CEO Steve Windwer notes in this post, his clinic saw a decrease in no-shows and in cost of care for patients, and an increase in patient satisfaction. He also notes that older patients were as satisfied with the telehealth experience as younger patients, so the notion that telehealth isn’t a viable long-term option for Medicare patients post-COVID doesn’t really hold water.

What’s more, 45% of our survey respondents stated that “they would use telehealth to avoid the inconveniences associated with in-person visits.” This underscores what we’ve known for some time, but seems to be hard for therapists to fully accept: the future of PT lies in hybridized care models. I would never recommend shifting patients’ entire treatment to a virtual environment—our hands-on techniques are a critical differentiator to our care we deliver directly with a patient, after all. However, there are a lot of studies cropping up reporting the success of integrating telehealth appointments into prescribed plans of care. Plus, we now know about half of the patients we currently see are receptive to receiving it.

Digitize your HEP delivery.

While we’re riding the digital health wave, I’d be remiss if I didn’t discuss our report’s findings regarding home exercise program (HEP) delivery. Half of those surveyed over the age of 45 stated that they prefer digital HEP delivery, and our study found that a whopping 75% of those patients were still receiving paper HEPs from their providers. This was mind-blowing to me. To think that the majority of PTs are still distributing HEPs in a format that can easily be damaged, misplaced, or forgotten altogether in this digital age is a hard pill to swallow.

We all know that what patients do outside of the clinic is just as important as what they do inside the clinic. But, if you’re not empowering them with the tools they need to succeed at their prescribed at-home exercises, their chances of reaching their therapy goals diminishes greatly. In fact, our report states that patients who received regular check-ins experienced a 94% success rate with their HEP. Digital HEP software can easily and automatically facilitate these check-ins and help improve one of the greatest barriers to optimal outcomes: patient adherence.

(Bonus: HEP follow-ups are also another instance in which the hybrid model can be implemented.)

Communication is the biggest driver of patient-perceived success.

This is a perfect segue to my final point, and what I hope will be your biggest takeaway from this article. Per our report, we found that the number one driver of patient perceived success is (drumroll please) … regular communication. I know, right—such a simple answer! But it’s the simplicity that makes the virtues of regular communication easy to overlook.

To put a finer point on this, the report suggests that patients who received regular check-ins between appointments were twice as likely to achieve a successful outcome and were far more likely to recommend or return to PT than those who didn’t receive regular provider communications. Again, this underscores the importance of using patient-centered technology, like digital HEPs and patient marketing tools, to better engage your patients in the process.

Beyond digital enhancements, though, there are some other fundamental ways to improve patient communications in your practice.

Set clear and reasonable expectations upfront.

PT is difficult for most patients. Not only does it take a physical toll, but it also requires a level of mental strength, commitment, and resolve. Setting and communicating expectations from the start can go a long way in preparing your patients for the work that lies in front of them, as well as getting ahead of any patient-perceived challenges—whether logistical, financial, physical, or psychological—before they have the chance to morph into bigger issues, or worse yet, giving up.

What’s more, our research found that patients who felt their therapist clearly outlined expectations were more satisfied with their care, and therefore far more likely to recommend PT to others as well as return to PT should the need arise in the future.

Align with your patient on their recovery goals.

On an even more basic level, communication is essential for the trust and dialogue that is needed in a relationship between provider and patient (a.k.a. the therapeutic alliance). For patients inclined to believe that PT isn’t for them, feeling like their clinician isn’t listening to them or their concerns will only compound that feeling. Likewise, if a patient feels that a PT doesn’t care enough about their progress to check in on their HEP, they’re likely not going to care enough to complete a full course of treatment. Talking to patients early and encouraging them along the way often helps therapists overcome concerns and adjust to keep patients engaged in their own care.


As PTs, we know the importance of our work, and the value it provides to improving our patients’ lives. But considering the challenges our profession faces, we have to do everything we can to simplify the path to care and create patients who are fans and believers in PT. That means pointing that finger inward and getting out of our own way sometimes.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC, is the co-founder and Chief Clinical Officer of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for the rehab therapy profession on a national and international scale. She’s an APTA member,...

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