“Dear Mark,
Thank you for including me in an email about what might be a perfect physical therapy opportunity for me. The benefit package is exquisite – a compensation package worth a potential $93,467 being paid $55 per hour plus mileage and time reimbursement as well as a full benefits package, sign-on bonus, relocation assistance, and matching 401k (currently 7%). Practicing in a new facility with state-of-the-art equipment and having flexibility in my clinical hours sounds great for a working mom like myself.
This opportunity isn’t the “one” for me though. You do know I am a member of the American Physical Therapy Association. (I’m almost positive you bought my email address from the organization that represents my profession). This opportunity you are sharing with me – and the rest of the members of the association – really isn’t the “one” for any of us. I understand the amount of responsibility you have to assist your client in finding staff physical therapists, but you have targeted the wrong population.
What you think might be the “one” for me (or anyone within that mass email), sadly isn’t the “one” for any of us. In making professional decisions, matters far more important than benefit packages, equipment and flexibility are first and foremost. Our role in the health care system isn’t a commodity or even an ancillary service. Being employed by physicians is riddled with issues. The biggest issue is conflict of interest. Data has been collected and analyzed and the Medicare Payment Advisory Commission published a report on this very topic. The headliner sentence in this article states the real reason for physicians to own a physical therapy practice, “Physician owned physical therapy services have provided an alternate source of income to many physicians who have been forced to cope with declining reimbursement.”
Physical therapists can most definitely be a cost-effective solution in the musculoskeletal world – but physical therapist aren’t the solution for physicians looking for ways to pad their pockets and diversify services within their offices. It’s not right to knowingly take advantage of patients. In physician owned physical therapy practice situations, sadly the recommendations of the physicians can be questioned. Did the physician recommend physical therapy services due to a real patient need or did the physician refer the patient for physical therapy services to increase practice income?
I’m sorry, Mark, although you’d like to think you’ve introduced me to a great opportunity, you really haven’t. Although I know you have a client in Georgia in need of a physical therapist, I truly hope you fail in meeting your client’s need. Please realize, if you do fail with this particular endeavor, don’t take it personally. Failing with this endeavor is just a result of physical therapists taking a stance and not getting involved in situations that have the potential to exploit patients.
~Selena”
––– Comments
Jay
Commented July 6, 2017
DR Hartman writes: --"I guess I can make the same assumption about you that has a physical therapist you only own a clinic to make a buck, correct?"-- No, not correct. It's as unreasonable for a orthopedic surgeon to own and run a physical therapy clinic as it would be for a physical therapist to own and run an orthopedic surgeon's practice. We are trained to do what we do - so do that. No one is saying that an orthopedic surgeon does not have a right to make a living owning his orthopedic practice. Your question reflects a poor understanding of the inherent conflict of interest.
Andrew
Commented March 15, 2017
I completely agree with this view. It's great that everyone wants our field to grow and we have such a wealth of knowledge that goes undervalued! If I would have known the "real" numbers before deciding to go into the field I would have changed my mind, but now I have a ton of debt to pay off, and how does anyone expect me to have a life?family?help others? On a related but separate topic, the cost of education has become a crock and a crime in itself. The cost to get into the PT world does not reflect what we "should be" making. The APTA vision seems more hopeful than promising. As a field entirely, we need to start doing more than talking. The majority of PTs accept jobs just because and should always fight for a higher salary to show their worth because we are valuable. Do I care if I piss people off along the way? Heck no! I value myself for the right reasons, but I bust my butt day in and day out to make sure my patients are getting the best care possible because you cannot put a price on healthcare or a life. It's unfortunate that the field has become political and frustrating when I have a business person with no medical background or insight telling me how to do my job. Guess what, you can't!
Lianne
Commented February 23, 2017
I completely agree! I've been a PT for 17 years and worked in several practices....corporate owned, PT owned, Physician owned. I actually feel that physician owned practice is very beneficial for the patient as I can walk directly over to my physicians and give them an update or let them know when there is a problem. I can look up records, op reports and office visit appointments with the physician. My physicians have never told a patient they had to come to PT at their facility. In fact I have had multiple patients say the physician never told them we had PT in office. They have never asked a patient to drive any distance to attend PT at there office and if they have a PT they like working with, they are fine with that. I worked for corporate owned and PT owned and had more patients crammed down my throat to meet monthly quotas. I have half the load here. They actually prefer quality over quantity. I have great benefits and they give me a greater yearly allowance for continuing education than anyone ever has. I also do not see that working for a physician is holding back our profession. Its just a different setting. Selena, you need to get off your high horse........
Dr Richard Hartman
Commented February 26, 2016
The arrogance of that response is amazing. Why would you assume that physicians only provide physician-owned physical therapy clinic just to make a buck? I guess I can make the same assumption about you that has a physical therapist you only own a clinic to make a buck, correct?. I'm an orthopedic surgeon and we have to do physical therapy clinics that work wonderfully. 3 physical therapist work total between the two and they have near complete autonomy on how they treat the patients, the frequency with which they see the patient, and whatever equipment they want they get. All three of them were skeptical because of the bias built into their schooling by individuals who see the only way to make themselves more important is by trying to knock down the group about them. We work together as physical therapist in physicians. I have 15 years of schooling to back up my decisions from a musculoskeletal standpoint. Even a DPT doesn't have nearly that much. We actually respect each other unlike the verbiage in the above-noted response for a job offer. I find the entire transformation of a vulnerable group of students into phusician haters completely disgusting.
Selena Horner
Commented November 16, 2011
Hi Jay, You can most certainly ignore the APTA's standpoint. How can you ignore MedPAC though? There is a huge conflict of interest in a POPTS situation. Now, granted, there ARE procedures and steps that can be taken by POPTS to ensure overutilization is not occurring and to support positive outcomes from services. If those types of procedures are not implemented, then without measuring the results of those procedures, the general public can only refer to the large national reports indicating the problems with POPTS. I completely agree with you with regard to the DPT focus versus real direct access and diagnosing.
Jay Wijnmaalen, DPT, MBA, MTC
Commented November 14, 2011
hmm, this is always a very interesting dicussion and I do not agree with the APTA's standpoint when it comes to POPTS. As a Physical Therapist myself, my Initial Evaluation will guide me as to how I will treat my patients, not the referral from the MD who owns the clinic. I'm sure the research supports the vision of the APTA but what should also be researched is how larger companies use and abuse PT for their profits and share holders. Seeing 17 patients a day, including MCR's happen all around us and nobody seems to care about that aspect of the field. I work in a POPTS since about 2 years, in fact I set this up for our MD's and I can guarnatee you that our patients get a much better, multidisciplinary apprached treatment experience here, than they get in many other local clinics owned by some of the national chaisn, such as Select, Helathsouth, CORA to name a few. What the APTA needs to work on first is to push for legislation wherein we can diagnose our own patients. That is the real problem here. Once we can, we don't need a referral. Look at Western Europe. That's how they practice. They wre trained on a Master's level, have direct access and get paid by their govenrment and private insurance. So to put the focus on the DPT part first was a very wrong move in my eyes, the ability to set a medical diagnosis should have been their main focus initially,
Physical Therapy Supplies
Commented January 6, 2011
Lovely and really appreciable post. That's having an enjoyed examples. I must try it. It is so helpful in my work and save a lot of time. Thanks for this post.
Amar Patel
Commented December 30, 2010
The toughest competition I face as a private practice owner is a POPTS. In Michigan, we have the highest concentration of physical therapy clinics than anywhere else in the country. Our association should try to focus on this issue as their number one priority above anything else. Physician-owned physical therapy practice is not the only threat. i have come across Non-medical professionals who own physical therapy clinics and is driven solely by profit. I think we should focus on the fact that only a physical therapist should be able to own a "Physical Therapy" practice. we don't see non-physicians owning a "physician Practice"!
Amar Patel
Commented December 30, 2010
I admit I have worked for a Physiatrist-owned PT practice before I started my own Private Practice. Although i was making a good amount of money at the POPTS with excellent benefits I decided to go into private practice due to a number of reasons. The physician I worked for had a hard time understanding the concept of evaluations and plan of care decisions being made by me. He never wrote a script for physical therapy for his pateints to indicate "Evaluate and Treat" . He always marked of every single treatment option on his script except "evaluate and treat". I wasn't allowed to make appropriate referrals to other medical professionals if indicated. He wanted me to continue to see the patient even though the patient reached their goals. These were just a few of the reasons that prompted my decision to leave his practice and venture out on my own. I currently work very closely with a few physicians who exclusively refer their patients because of the quality of care we provide to their patients.
Amar Patel
Commented December 30, 2010
I admit I have worked for a Physiatrist-owned PT practice before I started my own Private Practice. Although i was making a good amount of money at the POPTS with excellent benefits I decided to go into private practice due to a number of reasons. The physician I worked for had a hard time understanding the concept of evaluations and plan of care decisions being made by me. He never wrote a script for physical therapy for his pateints to indicate "Evaluate and Treat" . He always marked of every single treatment option on his script except "evaluate and treat". I wasn't allowed to make appropriate referrals to other medical professionals if indicated. He wanted me to continue to see the patient even though the patient reached their goals. These were just a few of the reasons that prompted my decision to leave his practice and venture out on my own. I currently work very closely with a few physicians who exclusively refer their patients because of the quality of care we provide to their patients.
jw
Commented December 30, 2010
I need to comment on Julie E.'s comment about including Hospital Based clinics with POPTS. I dont know why you think we get all referrals! Our clinic is has Medicare mandated documentaion that you MUST have them sign showing they have a choice, as well as with all DME providers. We also have multiple checks a balances both internal and externally to ensure we are compliant with billing and treatment protocols/stratagies. That is considerably more than the majority of privately owned clinics in our area...which are still utilizing cranio-sacral (etc.) therapies and billing as manual! No wonder we are fighting to be considered specialists! Also, I feel there are plenty of poorly run POPTS, but that is like saying all private clinic owners are money driven also. How appropriate is that?
Selena Horner
Commented December 28, 2010
H Rizvi - I'm sorry you've been ripped off due to the changes in the educational world. You are absolutely right... as vision 2020 was rolled out and seemed to appear to look fabulous on paper, one important aspect was left out of the picture - the real world and dwindling reimbursement. I'm not sure if you are being "cheated" as much as you are the victim of poor leadership and poor strategizing when it came to vision 2020. By any chance have you wondered how the physician is able to pay you what no PT can ever offer you? You are not alone in your thoughts... I'm not sure if you are "selling out" or not, but your choice reflects you aren't a risk taker. Your choice kind of also reflects that you want to have a certain lifestyle immediately - basically without working hard to earn it - like you have an immediate right to it. Your statement "If the APTA does something," also indicates you aren't interested in having a role to create change... to change the profession to what it could be and what you had envisioned it to be. There are alternative options for learning cool things (since you find this a positive aspect of the practice environment). You can grow and learn anywhere. Epocrates (free): http://www.epocrates.com/products/iphone/rx.html For $40 you can download Procedures Consult Application: http://www.imedicalapps.com/2009/10/procedures-consult-superbly-demonstrates-common-bedside-orthopedic-techniques/ For $6 you can download Radiology Assistant: http://itunes.apple.com/us/app/radiology-assistant-medical/id383464901?mt=8 I most definitely understand the communication aspect. Sometimes you won't be able to actually speak to the physiatrist though - I mean, I'm sure he does injections when he is doing that procedure, you aren't going to be standing around waiting. If he's gone off-campus to perform EMG's, he won't be around to discuss patients. Also, if he has a new evaluation, you won't be standing around waiting for him because he'll be in there longer than an in/out visit. You really don't have to be in a POPTS environment to have a physician's ear... physicians will surprise you at times and actually come to the phone. If you are ever interested in alternative options for employment, find me. If your credentials, qualifications, expertise, attitude and practice philosophy match and fit another company's need, you could very well have a position in a different environment. I'd be willing to help you, if you ever changed your mind or wanted to change employers.
H Rizvi
Commented December 27, 2010
I would like to ask for those responding, how many of you recently graduated with a DPT and are faced with over $150k in loan repayment? Our education cost does not match up to what we actually get paid and as a relatively recent DPT grad, I feel like I am being cheated. We are the lowest paid doctorate profession and I would have been better off becoming a teacher for a few years just to make a comparable salary. I work for a pain management clinic owned by a physiatrist. The MD really had no intention of hiring an on-site PT, but was more or so convinced by the office manager to do it, obviously to boost revenue. Our office sees several probono patients and we also do income-based copay reductions for our patients. I don't work for a greedy man, he pays me what no PT can ever offer me. And at the end of the day, takes home some more revenue. It's a win-win situation if you ask me. And as much as we are "autonomous" and have "direct access," face it every private PT practice relies on physician referrals in order to be successful. We as a profession cannot survive without physicians being on our side. I make a salary that I can actually raise a family with, manage my finances and be able to live a little on top of it! And that is what I expected when I applied to PT school. I think therpists who jump to conclusions about POPTS need to actually work in an environment before judging it. If the APTA does something to increase my base salary and increase my earning potential, I would stay true to the profession. Otherwise, if I'm considered a sell-out, so be it. My quality of life is so much better now than it would ever be in a sole-PT environment. I learn about new medications, procedures and imaging results more than ever. I feel like I am growing and learning more from where I am. I made the right decision for "me." And there are several PTs that are just as bad, if not worse. I was required to bill 6 units for each patient for one of my outpatient internships. Scumbags are everywhere, even within our own profession. The MD doesn't tell me how to bill, how to treat, he doesn't micromanage; I get everything that I ask for and it really is the same as working at any other PT practice. The benefit of working with a physician is that POC for the patient is so much better. I don't have to get on the phone and hope to speak to the doctor; I just stop in between patients and discuss any relevant findgings I have about our patient with him directly. Of course the downside is that you only see patients from that one doctor. There is the good and bad with everything we do. Stay away from chiropractors. They need us more than we need them. MDs are on our side, especially if you find a good physician who is compassionate and cares for his/her patients as much as you do. Happy holidays.
Felicity Feather Clancy
Commented December 23, 2010
Hello, Selena. Regarding your suggestion that APTA sold its email address list to "Mark," I think you'll be happy to hear that we have a policy that we don't sell -- or even give away -- our email addresses to anyone. Also, on the subject of physician owned physical therapy practices, we also make every effort to keep these ads out of our publications. If we are able to identify an advertiser or prospective advertiser as a physician owned physical therapy practice, we will either remove their ad or not allow them to purchase the ad in the first place. -- Felicity Feather Clancy, Vice President of Communications, APTA
Selena Horner
Commented December 21, 2010
In Michigan, the main reason hospitals take the full blow of Medicaid is due to Medicaid only allowing physical therapy services in hospital systems. No, I couldn't operate a business on what Medicaid reimburses and in a way, I'm actually glad I don't have to have those kind of contracts. In referral situations, the poor patient is like the monkey in the middle. The physician has control and the patient doesn't want to upset a relationship with a physician. Patients won't rock the boat and will go where a physician recommends. So, somehow, we need to create a polite and empowering strategy to encourage patients to maintain their relationships with us too - even in the event when a physician refers to a different company/physical therapist.
Carina Lowry
Commented December 20, 2010
As one of those "hospital based" PT's, I can assure you that you don't want our patient payor mix. Over 2/3 of my pts are Medicaid (whopping $50 a visit) and Medicare (Average $26/unit and will be getting that nice discount due to MPPR). I think that if private practice PT's had this payor mix, there would be many a PT out of business. In the environment where I work, the docs send the pts with insurance either to themselves or to private practice unless there is a prior relationship with a specific PT. For example, a pt I saw for 5 visits with no change (because he had a massive SLAP lesion which I dx on the first visit) was sent to ortho. Surgery done in Nov and the pt was referred to a different facility for follow up care for PT even though he had seen me for 3 weeks. Yes, the docs do this quite often...because it's all about $$$$$$.....
Todd
Commented December 20, 2010
And therein lies the problem, PT's unwilling to take the hard line and stand up for up for what is just and the right. IMO nothing will change until we as a group are willing to step up to the plate and put an end to PT's who sell out their the profession.
Selena Horner
Commented December 20, 2010
Oops... my apologies for misunderstanding. I think we have enough laws and regulations that sometimes I think it might be better to trust our colleagues to do the right thing. The only way to do that is to help educate on the impact of various scenarios. I know many will be completely upset at me... although the majority of physician owned practices are most definitely going to be structured/modeled in a way that does exploit patients, I can't believe 100% of them are. The devil is in the details AND in how the physical therapists within the physician owned clinics choose to practice. I refuse to put full blame on physicians... those in our profession also have a role in the problem. With the high likelihood of physician shortages, a growing population of 65 and older, and a potentially high influx of individuals needing services with this health care reform (if it isn't illegal), our role in the health care world may evolve where we are within physician practices and are truly working side by side with them (or with nurses) in more of a consultant or musculoskeletal expert type of role. If that is the case, we do need to have the foresight to not limit our freedom to serve consumers and have licensing laws (which are difficult to change) reduce our ability to truly practice in different environments - even if they are owned by physicians.
Todd
Commented December 20, 2010
Selena, I'm more concerned with targeting PT's and their license than worrying about what some physician is doing. Until we can ultimately remove these types of PT"s from our profession or block their licensure this will continue to grow.
Selena Horner
Commented December 20, 2010
Todd, I have been employed in both types of situations - physician owned and a satellite outpatient hospital department. I lasted 90 days in the physician owned because 1) I was upfront and made sure the patient was completely comfortable coming to the physician's physical therapy and if the patient wanted a closer location or a different location, I would immediately contact the other facility, send registration information and set up an appointment for the patient at that facility AND 2) I refused to go down the route of billing fraudulently. The only way mathematically to offer the compensation package listed above is to have a large volume of patients per 8 hour day. Hospital outpatient departments would be more difficult to eliminate. The rule to keep all referrals in-house is unwritten and finding documentation to prove this really does happen would be somewhat difficult. I have only heard how the hospital systems track in-house referrals and never really, personally saw the reports used to determine if a hospital physician was referring to hospital owned outpatient departments at a high enough rate. The only proof and only documentation that alludes to trying to keep the services in the system was the referral sheet signed by the physician. The only locations listed on the sheet (from my experience) were hospital owned locations.
Todd
Commented December 19, 2010
Great response Selena! Most people don't realize that Hospital outpatient PT is just as bad a situation as the independent POPTS and the only way i see to put and end to it is through state licensure restrictions such as the one in South Carolina. Any thoughts?
Julie Eibensteiner, PT, DPT, CSCS
Commented December 19, 2010
Selena- Excellent response. Thank you!
Jason Harris, PT, DPT
Commented December 19, 2010
Great response letter Selena. Hopefully, as a profession, we can all eventually see the truth.