Most physical therapists have a picture of the perfect job. The one where you work hands on, one-on-one with each patient. There is ample time for cuing, education, and manual interventions. The physical therapist guiding each patient safely toward high level dynamic exercise without pain or dysfunction. Even though everyone’s vision for the perfect PT environment probably also included some selfish ideals like flexible scheduling, team building, learning opportunities and the ‘appropriate’ amount of paperwork (keep dreaming!) the majority of the criteria centered on quality patient care.
How many of these ideal environments do you think exist? I can tell you from experience this number is low and most patients would agree. Instead, the physical therapy clinic more closely resembles a factory. Every patient comes in with pain that, despite its unique characteristics, is given the same combination of interventions to treat it. Patients with knee pain are slowly progressed in quad exercises, those with back pain are given “core” exercises and stretches, and patients with shoulder pain all have rows and pull downs.
The PT Mill didn’t happen overnight. Most physical therapists want the best care for their patients and are completely equipped to improve function and lessen pain. But when the mill owners push for more patient visits and increased charges the staff gets overwhelmed. Soon the easiest way to remember a patient amidst the multitude of patient visits each week is to categorize them by diagnosis, generalize their treatment, and, at best, each patient receives the minimal amount of one-on-one care to justify their time in your clinic.
Before you know it patient care has reached a new low. You hear things like, “I’ve tried PT and it didn’t work. They just stuck me in a corner with some machine on me that shook my muscles. It felt okay but my pain is still with me.” Or, “it seems like I always did the same exercises no matter how my pain changed or how easy the exercise seemed to become.” As a physical therapist you begin to hear things from management like “we don’t like dry needling because patients are getting better too quickly,” and “put every patient on e-stim so that we can bill another unit to their insurance.”
In the healthcare industry this is happening across the board. In order to fight this several things need to happen.
1. Be honest with yourself and your patients. This may be the most important step of all. If your patient needs more individualized care than you are able to provide based on the limitations of your work environment, let them know about alternative options. Instead of feeling as if you have given up on their care, you can be the PT that is advocating for the best continued care by connecting them with those quality providers with whom you have developed relationships. Your patient will appreciate you, they will reach their greatest goals in much less time, and other patients will take notice. Patients will begin to observe the unmistakable difference between the quality care experienced by some and the care given at a PT Mill. If that patient wants to get better (and who doesn’t?) they will demand higher levels of care and the health care industry will have to take notice.
2. Keep looking! Look for professionals in the field that are doing it the right way. Learn ways that they emphasize quality care in their practice and try to incorporate it into your own. If that doesn’t work, getting to know professionals can help in other ways. At my first continuing education course for dry needling, there was an instructor in the course named Carlos Berio (anybody know this guy?). During the course of a year when I took additional dry needling courses, I learned that at SPARK Physiotherapy, Carlos has been able to create the ideal patient environment. All of the staff are highly trained not only as physical therapists but also as Certified Strength and Conditioning Specialists. With one-on-one 60 minute treatments he has ample time to provide a full treatment including assessment, treatment, re-assessment (repeat as needed), education, and HEP prescription. After physical therapy, patients have the opportunity to transition to personal training with the same physical therapist that already knows their injury history, weaknesses, and how to efficiently and safely meet their clients specific fitness goals.
Through my encounters with Carlos, I was encouraged to advocate for my patients and that quality patient care wasn’t some mythical creature like a white unicorn or the Loch Ness monster. When my efforts at my previous job continued to be ignored, I was blessed with the opportunity to endeavor on a bright, exciting, quality career at SPARK Physiotherapy (that ideal environment I described at the start).
3. Voice your concerns loudly. I’m a well-mannered southern girl and was still able to do this in a clear, bold way. When I worked in a PT mill, I spoke to co-workers, supervisors, and colleagues about my concerns and how we could address them. This sometimes resulted in resistance against the push for numbers (aka money) and other times was ignored.
4. Make the time for quality care. When the circumstances of your job limit one-on-one time with your patients, being straightforward with them helps. I would say, “Hey Joe. I am currently treating you and three other patients. I would like to give you each some individualized care. This might mean that I am slow to give you your next exercise or to treat you but it also means that you will get ten minutes of my direct attention.” Most patients will appreciate your honesty and are in favor of skipping repetitive exercises for more quality interventions and education.
To ensure that you and those you love do not go down this road, take these first four steps toward quality physical therapy.
Dr. Kristen A Lattimore, PT, DPT, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. She has also had experience as an athlete and coach of the speed and jumping side of Track and Field. She is passionate about integrating her knowledge and experience with fast and powerful exercise into the practice of physical therapy. She also enjoys working with patients whose concerns and complaints have been overlooked and perpetually deferred to the next medial professional.
Kristen continues to challenge herself with varied exercise including interval running, weight lifting, yoga, and Pilates. She is passionate about making her patients their best selves and adding power and intensity back into physical therapy. She can be reached at firstname.lastname@example.org.