When we first started hearing about COVID-19 (coronavirus) in the media, it seemed like the chances of a global pandemic—while possible—were more hypothetical than anything. After all, we’ve seen other health concerns rise and recede—but in this part of the world, we’ve experienced little social impact. And now, here we are: almost overnight, it seems, we’ve found ourselves in the middle of a global crisis. And while solutions are in flight, it will probably be some time before things fully return to normal—whatever the new “normal” may be.
As physical therapists, we have also found ourselves in an unprecedented predicament: we are musculoskeletal experts, driven by helping those who need us most—but this is one situation we cannot address with our skillset alone. To compound that, many practice owners, therapists, and office staff are feeling the impact in a way I don’t think any of us could have predicted—and that’s left many asking one question: where do we go from here?
With that in mind, I wanted to put together a plan of action to address that looming concern. While every circumstance—and every practice—will have its own unique set of challenges in the coming months, with the right strategies in place, I truly believe we will pull through this together.
Taking Care of Yourself
This may seem oversimplified, but your first line of defense starts at home. I suspect this won’t be news to any of you, but keeping your home environment clean is the key to ensuring you and your family remain healthy as well as slowing the spread of illness, so:
- wash your hands thoroughly,
- avoid touching your face,
- use a hand sanitizer with at least 60% alcohol content,
- cover your cough,
- keep communal spaces clean and sanitary, and
- disinfect objects you use frequently (such as your phone and other electronics).
And of course, consume plenty of fresh fruits and vegetables. Chances are, your local grocery store is fully stocked with both at the moment.
There’s also been a lot of discussion regarding social distancing (or “physical distancing,” as the World Health Organization now refers to it), which you should practice at all times. Stick to critical gatherings only, and limit them to 10 people or fewer. When you have to leave your home, keep about six feet of distance between you and other people.
Of course, taking care of yourself goes beyond cleanliness and proximity, which is why aggressive hand washing and sanitizing isn’t the only thing you should be doing for yourself.
One of the things that makes this health crisis so unique is that it’s not isolated to a single continent or hemisphere—it’s everywhere. As a result, the entire world is feeling the effects—both physically and mentally. In moments of stress—and when we experience feelings of helplessness—our brains become flooded with cortisol (the stress hormone), which has been proven to impair brain function, decision-making abilities, and rationalization. For that reason, it’s not uncommon for people to turn to unhealthy coping mechanisms. But, as I’m sure you know, unhealthy habits can weaken the body’s immunity—and when we’re stressed, our immunity is already sub-optimal.
For that reason, it’s important to be kind to yourself: go for a walk; meditate; do a quick yoga routine; play with your dog. Companies like HeadSpace (a guided meditation app) are offering extended free trials in light of this crisis. And if you find yourself with extra time on your hands, pick up a hobby you wouldn’t otherwise have time for: learn an instrument; make a new recipe with the kids; put a dent in your reading list. Devoting time to self-care and wellness is crucial to keeping your mind happy, which will make your body happy, too. These self-care reminders have been very helpful for me, personally, as I have been juggling helping run our company, home-schooling my 8-year-old daughter, and shielding my 87-year-old mom from harm’s way.
Monitor your health.
Due to the hands-on nature of rehab therapy practice, we are automatically at a higher risk of exposure to any communicable disease. Fortunately, if you’re already following the advice above, you’re significantly decreasing your risk of contracting the virus. However, you should still keep a close eye on your health—as well as the health of anyone in your home. If you don’t already, make sure you have a thermometer readily available so you can check yourself or your loved ones if anyone exhibits flu-like symptoms. And if you do start displaying symptoms of COVID-19, be sure to immediately contact your primary healthcare provider and self-quarantine for the recommended 14 days (or until you receive the all-clear).
Taking Care of Your Clinic
Once you’ve taken all necessary precautions to ensure the health and safety of you and your family, you can extend those efforts to your clinic staff. If you’re a clinic owner—or you’re in a position of leadership—then your team is no doubt looking to you for guidance, which means it’s your duty to not only set an example, but also ensure the wellbeing of everyone in your practice. Strong and empathetic leadership is essential, as you’ll be guiding your team through unfamiliar territory while trying to maintain as much normalcy and continuity as possible.
Make tough decisions.
Every owner or clinic leader has the discretion to do what he or she thinks is best for his or her business. Some may say the risk of perpetuating the spread of the virus is too high to keep their doors open to the public. After all, the only way to be absolutely certain you aren’t putting any patients or staff members at risk is to cease all clinic operations. While this may seem like an extreme solution—and one that may have you concerned about how to keep the lights on in the long term—you may eventually be in a position where you don’t have a choice. As it stands, several states have already imposed mandates forcing “non-essential” businesses to temporarily close their doors. And while the US Department of Homeland Security recently announced that PTs, OTs, and SLPs are included on its list of “essential critical infrastructure workers,” it’s ultimately up to state and local jurisdictions to decide who can—and can’t—continue performing their job duties during this crisis.
On the other hand, many physical therapists may feel that as “essential” healthcare providers, we have an obligation to serve our patients. Those therapists may choose to keep their clinics open for business. But I think that more often than not, we are seeing a blend: many practices are staying open, but some of their employees are choosing to stay home, while others are coming in to treat patients—and we must respect both of those decisions. As a community, we must reserve judgement on whatever decisions an individual practice makes.
Our profession has gained some regulatory momentum.
Here’s some food for thought: our profession has fought hard to get to the level of autonomy and recognition we’ve garnered thus far. The fact that physical therapy has been recognized at the federal level as “essential work” is monumental. We now have an opportunity to shine and truly show that we have the skills, education, and fortitude to be considered primary care providers for neuromusculoskeletal issues. What better use of our skillset than to assist in this time of crisis in order to reduce the volume of musculoskeletal pain patients in emergency rooms and urgent care? We are trained in use of personal protective equipment (PPE); we understand the science behind viral transmission and can help educate our patients—and their families—on proper handwashing, sanitization, and other ways mitigate infection.
But perhaps most importantly, our patients need us: they need to see us as front-line medical professionals, stepping up and doing our part during this crisis. There’s never been a better time to show our value as clinicians and healthcare professionals. Strong advocacy efforts from our state associations have won PTs, OTs, and SLPs the rightful “essential” designation—even under extreme “shelter in place” mandates—and I strongly urge continued advocacy on this front. We need to build on the momentum we have going. It’s already showing results; we’re even seeing major employers like Walmart ask specifically for physical therapists to assist them in making sure their workforces are staying healthy during this national crisis. That’s huge!
Implement containment best practices.
If you do decide to keep your clinic open, take those same sanitation guidelines covered above and immediately apply them in your work environment. You should also keep a close eye on your patients’ and clinicians’ health. Implement precautionary screening measures, such as asking any patients exhibiting flu-like symptoms to reschedule their appointments for at least two weeks and conduct their visits via telehealth in the interim—if possible. Patients entering your clinic should be screened prior to each visit with questions such as:
- Have you been in contact with anyone who has tested positive for COVID-19?
- Have you traveled to New York, Seattle, or other COVID-19 hot spots in the last month?
- Have you traveled internationally within the past month?
You’ll need to check the temperature of every patient and ask him or her to wash his or her hands prior to starting treatment. (The CDC has released a comprehensive set of prevention and containment guidelines for healthcare professionals, which you can review here.) In truth, the guidelines aren’t anything outlandish in a healthcare setting. In fact, following strict guidelines that ensure the health and safety of patients and staff alike is simply best practice in the healthcare world—particularly for facilities that work with a large number of geriatric and immuno-compromised individuals.
Embrace social distancing.
In addition to carrying over sanitization best practices from your home to your clinic, you should also follow similar social distancing guidelines. By nature, physical therapy has some unique challenges when it comes to maintaining a healthy distance between patients and providers. However, here are a few best practices that will reduce the risk of unnecessary contact:
- Avoid booking concurrent appointments with the same therapist whenever possible.
- Encourage non-clinical employees to work from home.
- Wear gloves during hands-on treatment procedures.
- Maintain at least six feet of distance between patients during exercise sessions (as possible).
- Put a temporary halt on in-clinic services with vulnerable patients to avoid potential exposure.
- Rearrange your clinic waiting area to increase distance between chairs, or ask visitors to wait outside of the clinic.
- Wipe down all equipment, chairs, and treatment areas between every patient interaction.
Work on your business if you can’t work in your business.
With many practices already experiencing patient attrition—either as a result of medical quarantine or precautionary social distancing—you will eventually see a drop in visits and, as a result, staff productivity. If that happens, you’ll need to adjust staff schedules or send hourly employees home early from their scheduled shifts. Consider this an opportunity to work on projects in your clinic that you have been meaning to do, but never have time because you are treating patients. Salaried employees can stay busy with any behind-the-scenes operational or strategic work like:
- catching up on discharge notes,
- creating frequently used HEP templates,
- cleaning up referral sources and other data in your EMR, and
- creating a business plan for additional services.
After all, there’s little chance of this pandemic being permanent—so, you might as well use this time to lay the groundwork for any major projects you’ve been putting off so you can come out of this stronger than you went in.
Make staffing decisions.
Of course, if lower productivity stymies your cash flow too much, you might be forced to make some tough decisions—and those decisions are even tougher when you have to make them in the midst of so much uncertainty. So, if you find yourself in this difficult position, be sure to (1) remain empathetic, (2) consult a healthcare attorney, and (3) consider the following if you are forced to lay off or furlough an employee:
- Provide whatever type of severance package you can.
- Maintain the employee’s benefits through a furlough.
- Provide resources to help the employee obtain unemployment benefits.
- Compensate staff for any accrued paid time off—especially in states that require it.
Seek additional financing—if needed.
The federal government has recently finalized the details of a $2 trillion stimulus package to help individuals and businesses during this time of crisis, but it could be a several weeks before anyone receives a check. So, if you’re currently in a situation where cash flow has become a serious issue, you might be able to obtain a disaster relief loan through the US Small Business Administration—which you can learn more about here. Additionally, many state and local governments are offering financial relief to small businesses, and some large companies—like Facebook—are offering grants to relieve small businesses impacted by COVID-19.
As I mentioned earlier, excess stress has a huge impact on your overall mental and physical wellbeing—and chances are, your employees are experiencing similar inner turmoil. Right now, our social media feeds, email inboxes, and news alerts are filled with discussions around the coronavirus. And for physical therapists—as with all healthcare providers—that discussion bleeds into our workplaces, too. We’re surrounded by it on all sides, and while we can’t control the media, we can control our actions and attitudes—and thus, influence the atmosphere in our places of business.
Maintaining positive working relationships, building camaraderie, and keeping an open line of communication between you and your staff will be the difference between a team who crumbles under the pressure and one who comes out of this situation stronger and tougher. So, in addition to keeping your employees abreast of any clinic changes and policy updates, be sure to (1) have regular check-ins with them, (2) assess their needs, and (3) provide them with a positive work environment as best you can. After all, the time they spend at work may be the only reprieve they have from the stress of the outside world.
Taking Care of Your Patients
In light of all the business and financial uncertainty, it’s vital that physical therapy practice owners not forget our overarching mission as healthcare providers: ensuring the health and wellbeing of our patients. Our patients are our most valuable asset, and many of them fall into the “high risk” category, which means they are even more scared. Plus, they’re hearing all kinds of information, statistics, and hypotheticals from people who may or may not be trusted sources. As their physical therapist, you play the role of care provider, educator, and—now more than ever—a guiding light in the storm ahead.
Many of the points I covered in the previous sections will have a direct impact on your patients as well. By having your staff adhere to strict sanitation and social distancing guidelines—and reinforcing those guidelines with a written policy—you’re ensuring the safety of your patients, some of whom may be exceptionally vulnerable to contracting a communicable disease like COVID-19.
Furthermore, if you’re able to offer telehealth services and e-visits, these can provide your patients with an avenue to continue care, as well as allay concerns over unnecessary exposure. (My team and I recently hosted a webinar that explained the differences between telehealth and e-visits, along with strategies to implement them in rehab therapy practices.) Additionally, in-home visits offer similar benefits to virtual care services, but they could be a better option for patients who don’t have access to a computer, webcam, or smartphone. And for those patients who do come in for their appointments, cultivating a positive and uplifting environment with your team not only alleviates stress and anxiety—two widely-known adversaries of the healing process—but also helps you gain their trust, loyalty, and continued business.
Taking Care of Your Community
Finally, we absolutely cannot overlook the importance of community during this public health crisis—whether that be the PT community, the greater healthcare community, or the community in which you live. We’re all in this together, and if we stand as a united force in the face of this pandemic, I know we can come out on the other side stronger and more cohesive.
Connect with your healthcare community.
If you find yourself in a position where you can devote some time to helping your fellow PTs, I encourage you to do so. While some practices may be forced to limit their hours of operation—or shut their doors entirely—others may find themselves in urgent need of an extra set of hands. Conversely, if you find yourself short-staffed during this time, I encourage you to reach out to your local PT community for assistance.
As it stands, many hospitals in metropolitan areas are already running out of space. COVID-19 test kits have only recently become available at scale, which means there are almost certainly a large number of infected individuals who have yet to be tested. As those numbers increase, so too will the need for skilled healthcare providers and emergency responders to help manage the influx of patients. If you happen to hold an EMT license—or possess some other form of emergency training—seek out opportunities to put those skills to use.
Devote some spare time to community members in need.
Individuals outside of the healthcare community may also need your support. The most vulnerable members of our society (e.g., low-income families, elderly individuals, and the homeless population) are the ones who will need the most help in the months ahead. So, I encourage you to take every opportunity to assist those in need—whether that means bringing groceries to a family down the street, providing meals to homebound elders, or volunteering at a local homeless shelter or food bank. Now is the time to embody the philanthropic spirit inherent to every physical therapist.
Advocate for physical therapists everywhere.
If there’s a silver lining to be found in any of this, it’s the opportunity for real, meaningful regulatory changes in the physical therapy space. Already, we’re seeing movement on issues that had long-since stagnated or fallen to the wayside. As I mentioned previously, physical therapists may now provide certain virtual care services to Medicare beneficiaries—and receive payment. However, while CMS has lifted some restrictions off PTs in response to this outbreak, the current regulations are not a forever solution. But as long as we have our foot in the door, we must build on this momentum and advocate for further expansion of telehealth opportunities in physical therapy—including adding clear verbiage to state practice acts indicating that telehealth falls within the rehab therapy scope of practice. (In fact, the APTA recently added this form to its patient advocacy center to help therapists petition lawmakers on telehealth expansion in rehab, and I strongly encourage you to share it with your patients as well.) After all, demand for these types of services will only increase in the coming months, and PTs have to be ready.
I know this is a lot to consider. So many in our community are already stretched thin, and finding time to give of yourself may be a tall order for many of you. Remembering why you got into this profession in the first place should be top of mind. And if you’re like me, it’s because you want to help people. For that reason, I urge you to start small by keeping yourselves and your families safe and healthy, which will give you a strong foundation for taking other necessary action. Stay vigilant, and consider keeping your clinic doors open and serving as the front-line primary care providers we are. This may be one of the greatest challenges our profession—and humankind in general—will face in our lifetime. But I am an eternal optimist, and there is always lemonade to be made where there are lemons. As I see immediate and positive regulatory movement—and the resilience of my fellow physical therapists—I also see hope. And that hope is something worth fighting for.