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I Still Believe Physical Therapy is the Worst Kept Secret in Healthcare

May 15, 2017 • Other • Brett Neilson

I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system. This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA. The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes,


I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.

So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.

Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.

So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:

  1. We have an identity crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters

Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.


I believe we have an identity crisis- In 2 words how would you describe a physical therapist?

With a sample of convenience of like-minded individuals at PPSIG, when asked how would you describe physical therapy, I received several answers across the board. There was no cohesion in our professional identity and I believe there would be even more disparity if we were to ask the broader community of over 203,000 physical therapists. Lisa Saladin, PT, PhD, FAPTA, said, as described in the guiding principle “identity” of APTA’s vision for the profession, The human movement system is our professional identity. We need to own this!

Physical therapists like to identify themselves with their training or specialty rather than their profession. I hear this on a regular basis “I am a Maitland therapist” “I am a Feldenkrais therapist” “I am a woman’s health therapist” and the list goes on. Are we ashamed of our profession? Have we tarnished our brand?

I believe that we lack cohesion in what physical therapy really means and that many therapists find that the professional title of “physical therapy” does not well define them. I believe this is why they choose to tout their merits over their profession. Ever since I attended my first house of delegates, I have always said, the beauty and the beast of physical therapy is the heterogeneity of our profession. Jeff Moore said it best, “The heterogeneity of physical therapy is killing our brand”. Unlike Starbucks, we lack consistency and this lack of consistency makes our brand unsellable and often times makes it difficult for our profession to be taken seriously by consumers and the rest of the medical profession. I believe that we owe it to our profession to not bury it’s merits in our alphabet soup, but rather highlight that we are proud to be a physical therapist first and foremost. I believe that our profession should define us and it is time that we band together as the MOVEMENT SPECIALISTS as our professional identity.

I believe we are the best profession.


We suck at marketing and our consumer does not know what we do.

I believe our consumers do not know what we do and if we lack an identity it is very hard to sell our product. Physical Therapy is not sexy, nothing says this more than the 7% who utilize our services. What about the other 93%?!? I agree, it is tough to compete with big firm advertising. Think about it, next time you are watching television, what are consumers being drawn to? Yep, drugs, surgery, and cool gizmos that make false claims and come with an attractive partner and a puppy. Where is PT? We cannot even compete with copper wear who pays Brett Favre ridiculous amounts of money to sell their products on ESPN. And people buy them because they believe it will solve their problems. I believe we can do better.

I believe APTA’s #ChoosePT is a nice start and a step in the right direction, but does not carry the weight to move the needle. Their campaigns largely focus on statistics and pain and fail to recognize the patients real problem (their internal motivator), the reason they seek our services, their function and participation. A direct quote from the tv ad is “physical therapist treat pain with movement and exercise”. Contrast this with the Advil commercials that shows people of all ages doing the things they love with the slogan of “what pain? Nothing works stronger and longer than Advil liquid gels”. What are you going to choose as the consumer?

I believe the vast majority of physical therapy companies waste their marketing budgets, marketing their services to potential physician referral sources. In doing so, they are trying to tell the physicians why their clinic is better than clinic XYZ down the street, killing our brand. I believe we do this because it is the thing we have always done. But let me remind you, what got us here will not get us to where we are going. I believe that the future of marketing in PT is direct to consumer marketing, cutting out the middle man. I believe in doing so, our profession will be liberated from the shackles that have held us back for so many years. I believe marketing to the consumer a consistent brand will allow our profession to grab a larger share of the healthcare pie. I believe it is time that we band together to showcase our great profession.

I believe we are the best profession.


We don’t know how to sell our product.

I believe that the vast majority of physical therapists undersell what we do. We sell services not products. Imagine just for a moment if “health” was a product like a good bottle of wine, rather than a service. If it was a product, our consumer could read the label, touch the bottle, taste it. I believe that if therapy was like wine we would sell a whole lot of wine, but it is not. Physical therapy is a service and a service that lacks consistency. Using sales and marketing campaigns based on emotional stories will outperform anything else and as a profession we need to learn how to better sell our product like a good bottle of wine.

I believe we expect our patients to buy our product, sight unseen and without even getting to sample it. Furthermore, most of us lack the ability to show our patient this value. I believe we fail as a profession to tell our consumer what is really going on, how long it will take to get better and what can be done about it. We just expect our customer to hand over their credit card and pay the $40 copay until we determine we no longer want to see them. There is no proof in this than the front office person who is TRAINED to schedule patients out for several weeks before they have even met the PT. Do we not value our own product? I believe that our product is superior than anything out their and we need to show our patients this value. We need to use test-retest of meaningful positions and activities. We need to keep our attention and their care focused on their internal drivers for seeking our care in the first place. We need to measure our outcomes. If we can do all this, we bring incredible value to our client that will keep them coming back for more.

Why on earth do we DISCHARGE our patients!?! What do you call a business that cannot wait to get their customer in the door, sells them something, and then says, I hope to never see you again? Physical therapists! Why do we do this? I believe we should focus on our customers who love our service and become their life PT. Get them back into our “store” as their first stop when they have a movement dysfunction.

I believe we are the best profession.


We are bullies to our brothers and sisters

Why can we not play nicely in the sandbox? Physical therapists are so quick to criticize each other, go to battle over internal issues and politics and put each other down. I see this on a daily basis with turf wars surrounding care models, use of assistive personnel, the use of interventions like dry-needling and the list can go on. I believe what matters to our patients has little to do with our care model or our interventions. In fact, John Childs showed us in his 2015 study of 750,000 patients that even the worst physical therapy was still far superior to no PT at all. I believe that we are our own worst enemy. We are not the enemy. I believe imaging, drugs, surgery and injections are the enemy. Often, my patients have been through the medical merry-go-round by the time I see them and for some of them, they are still spinning. They have been wronged by so many people in healthcare and in life, we are not the enemy, our healthcare system is. So, why on earth are we the shy kid in the classroom (called healthcare), yet we are the bully in the physical therapy sandbox, willing to kick, scratch and beat each other up over trivial things such as the interventions we use and care models we view as ideal. I believe we all have our own story which is based off our own point of view and we somehow are lead to believe that everyone should think the same way we do. I know I am victim of my own biases. I believe we are wasting an incredible opportunity to help a great deal more. When will we recognize that our POWER as a profession has little to do with what we do with our patients and has EVERYTHING to do with TIME, TRUST and delivering a consistent experience of HOPE, COMPASSION and EMPATHY that helps them on their road to recovery. We are wasting an incredible opportunity to help a great deal more!

Physical therapy is still the WORST kept secret in healthcare. Physical therapy is the best profession. I believe it is time we share our secret with the world. Thanks for reading my story.



Brett Neilson

Dr. Brett Neilson has 11 years experience as a staff therapist as well as clinic director. Additionally, he was a contractor for the U.S. Air Force and has served as Trial Coordinator, coordinating the day-to-day activity on two large multi-center randomized controlled trials in knee osteoarthritis and low back strengthening for Army combat medics. Currently...

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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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