You know what a PT mill is like:

  • 3-4000 sq ft open facilities
  • Busy front desk
  • A couple of overworked folks with a phone permanently attached to their ears
  • Phones and faxes ringing off the hook
  • Some automated voice answers the phone each time you call
  • Half a dozen physical therapists (PTs) manage traffic
  • 4 or 5 techs and aides don/doff hot packs and set up “stim”
  • More rubber bands and teeny tiny dumbbells than you’ve ever seen anywhere
  • A machine that looks like a bicycle for your arms
  • A beehive of activity but not much real work happening unbeknownst to the patients in the room at the time.

Physical therapists are so inundated with work that it’s a wonder that any of them get any treatment done at all. Mounting patient loads, mounting regulatory work, and handling the day-to-day operations of a busy clinic is far more than a full-time job. But our colleagues do this every day. It’s a feat of work ethic that is admirable but may be a Pyrrhic victory when you examine the suffering quality of care our patients are receiving.

The Way It Should Be: Are You Prepared?

A shift back to real customer service, patient advocacy, high-level MOVEMENT proficiency, and a patient experience that clients will never forget. From volume-first to value-first care. The health-seeking public is smarter than ever and is demanding excellence (even if they don’t want to pay for it). They are becoming hyper-aware of the shortcomings of the 6-minute physician visit or the 15 minutes with their PT. They see the staggering numbers supporting good conservative care vs powerful pain meds and surgery. They want good PT. If you can’t offer it where you are, get out; find a place where you can or hang up your own shingle. If you have the support of your directors to offer value-first care then these 2 concepts will be the key to unlocking a new plane in your professional growth and advocacy abilities.

1. Get Comfortable With an Uncomfortable Paradigm: Entrepreneurism

Whether you are the clinic owner, a therapist in a small private practice, or an employee in a PT Mill, thinking and practicing in an entrepreneurial manner is a major key to changing your practice and the value you project to those around you. Do you have a personal stake in the clinic’s success? Can you project a personal stake in each client’s successes? What can you do to increase your own patient census? Have you asked a client if you can help them by treating a friend or family member? The answers to these questions will deepen your roots and allow you into an immeasurable amount of goodwill in your community and give you access to networks of care you never knew existed.

When you can vest more energy into each client experience, you create a richer and more positive environment for each client to have their victories. I ask that our clinicians really listen to each client's story. Carefully pick through their monologues and uncover relevant clues that will guide your care. There is no boilerplate care in this scenario. There are no one-size-fits-all treatment approaches or exercise programs. This kind of care is delivered with a sure voice and a kind hand.

Clients will wonder to themselves whether they are speaking to the actual clinic owner by the way you speak with them about their care. Everything you say and do will be in targeted contrast to the “fast-paced, crossing guard, units machines” of the PT Mills.

When the opportunity to do more than the client expects arises, seize it!
It’s these small value-adds that make the client experience a rich one and will be the calling card by
which the community will come to know you.

We don’t tend to think of our work in physical therapy the same as in many other industries. In PT mills, the work will never stop coming in. In fact, the workload is currently far surpassed by the number of professionals. But what if that wasn’t the case? What if we had to put in effort for each referral? What if our career was dependent on the outcomes of each client we saw? Would you work differently? This is the entrepreneurial mentality that will restore the public’s view of physical therapy.

Work each day to have the honor of working tomorrow. No one’s job, nor business, is guaranteed to them.
Those who hunt will eat. Those who rely on the hunting of others will be forced
to accept what comes their way until the pickings become lean. When/if that happens, only those who hunt will remain.

 2. Competitive Lock-Out Is the Single Most Important Professional Strategy You Will Implement

PTs are some smart folks. There are so many kinds of PT and so many amazing people practicing PT that the breadth of life and movement experience is near infinite. Did you realize that there’s probably a coach making a living as an expert in your favorite hobby, sport, or movement right now? You might also know that the public has already established a value for that kind of work.

“Personal trainers charge from $60 – $200/hour for health and fitness exercise.
Isn’t that what we do? Do we? Can we?
I was told a long time ago in my PT education, “We aren’t training you to be a personal trainer who is also a physical therapist.” To which I replied, “Why not? What’s so bad about that?”
Plus, I didn’t learn a thing in PT school about how to be a good strength coach or trainer, so thanks for that.

Did you know that your experience performing that skill carries its own real-world value? What if you add in the value of being coached and guided along this movement journey by an EXPERT in human movement? That would be an amazing combo, no? Well, that’s what we are. That’s what we do. Anyone can claim to be an expert in a skill but the formal training that goes along with being a PT adds an incredible knowledge base to improve your ability to deliver that service. Not to mention the value of licensure and credibility that it brings. It says, “Here is a professional the public can trust.”

This is known as a competitive lock-out: a situation whereby few can offer the combination of skill and experience within a given scope of professional ability/practice. This isn’t new in the world of business, but in the world of physical medicine and the hyper-specialization that we see across medicine, physical therapists really have a unique ability to be a powerful go-between and create these competitive lockout situations.

Physical therapists who wish to make a real impact on the field and their clients should be seeking ways to improve their understanding of how we are supremely equipped to answer the health-seeking community’s needs. Fortunately for everyone concerned, it’s also an amazing way to protect the public from less-than-scrupulous salespeople who may be providing less-than-optimal care or outright dangerous work.

The 'Yeah, But’ers

You know these people too. They exist in every walk of life. These are the people who think what you’re doing is great and all, BUT… (insert some excuse here as to why they can’t). Well, I’m here to say that you should just start looking past the ‘yeah but’ers. In most cases, I run into these people at conferences or other events where I’d expect to run into folks who have PT Mills already established. They are ‘used to’ the day-to-day of how to manage treatment units, teaching their staff to do the same, and have become accustomed to the system of billing a 3rd party for payment for services rendered. These folks literally have the most to lose if what we are doing is the direction that PT is going. If value-first and real one-on-one care delivered by an expert is the demand, well, they better build a new mouse trap soon!

For the ‘yeah but’ers. Yes, you can do this. Yes, you can demand more time with your patients. Yes, you can deliver higher value. Yes, you can go back to delivering one-on-one care as you were trained to do. Yes, you can liberate yourself from the burden of time, energy and money hunting down the payments you are owed. Yes, you can work again toward advancing the public’s knowledge about the breadth and depth of knowledge offered by PTs.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.

Carlos remains active in several sports and is an avid agility training, power lifting, and adventure race runner. He is an advocate for his patients, clients, and his fellow PT colleagues. He can be reached at [email protected].