Taking Control of OUR Future

First, let’s establish our purpose with the upcoming series….
As a clinician of 18 years and one that has experienced many aspects of our profession as an employee, clinician, owner, mentor, and influencer, I feel it critical to lead a conversation focusing on our therapists.

This requires self-reflection and emotional intelligence in navigating the history, the present and the future. And establish the mindset that will re-define our opportunities as therapists by being open, curious and solution oriented.

Part 1 – Sources of Our Pain

Along the course of our careers as physical therapists it’s inevitable that we will seek greater levels of autonomy. Exploring both our relationship with the demands of our profession and with our expectations is crucial to creating sustainable success and taking control of our future.
 
A mentor of mine once told me to get the attention of physical therapists, especially leaders you have to appeal to their pain! My experience has proven her recommendation correct many times over. So that's where we’re going to start, as uncomfortable as that may be for some.
 
Sources of Our Pain…Within Our Practices
Working with hundreds of owners, leaders, and therapists a few common themes arise and they’re what I call the 4 R's….
The top 4 challenges for physical therapy practices:
Reimbursement
Referrals
Retention
Recruiting

The first two R’s represent the recurring issues that have plagued our profession for decades. Strict cost containment programs driven by insurance carriers have led to contract rates that challenge even the most operationally efficient organizations. And despite a variety of efforts, our ability to connect with our referral sources the message just isn’t translating. An article published by Freburger in June 2018 Journal of General Internal Medicine found that from 2003-2014, primary care referrals to physical therapy for musculoskeletal injuries dropped by 50% from 94.4 to 42.9 per 1000 visits. During the same time, referrals to physician specialists increased. Are we really being seen as a valuable part of the healthcare community?

The last 2 R’s focus more on the inside, and that being our teams of therapists. Turnover is a hot topic but let’s throw in some information to help us get a sense of where we are headed. With respect to:
Retention:

• Student debt exploding to 6 figures (WebPT), resulting in job hopping for financial gain.
• 91% of millennials expect to stay at a job 3 years or less (Ganapathy).
• A study from 2016-7 PTs saw the highest increase in percentage of turnover amongst allied healthcare professions (2018 National Health Care Retention).

Recruiting:

• PT is the 2nd most difficult job to fill (American Staffing Association).
• According to the APTA, there is an expected shortage b/t 10-26K therapists in the next 5 years.
• 12 states currently have shortages; 48 of the 50 states are expected to have shortages by 2030 (Zimbelman).

Sources of Our Pain – Industry
Let's get an even bigger picture of the sources of our pain …..shifting to where has our industry been in the last decade. Want to preface this dialogue by stating that I strongly value each of these issues and the effort that has been forth to execute them. My reflection here is merely meant to facilitate curiosity about our CAPACITY to see what really creates a successful future for our profession and our practices
 
Direct Access
Since 2014 all 50 states have had some form, yet only 8% of those pts dx'd with a MSK injury seek PT so it begs the question is access the issue?

Vision 2020
Although its intention was to elevate our profession, it may have been a bit shortsighted in defining our reach as therapists. The fact that a modified version was later adopted reflects that:
Professional division resulted as the initial language made non-PT providers somehow less than. The scope also de-valued niche providers (pelvic health, CrossFit), and let to judgement based off of environment you work in (private practice/hospital/SNF/mobile/home health). Further example of that division may also contribute to only 30% of therapists being members of the APTA as a show of support for their position in representing all therapy providers.

Entry level doctorate
There are three groups in which I believe this advanced degree was intended to influence: First being 3rd party payers. Ironically since the DPT was implemented reimbursement has only continued to declined and we are now more of a commodity than ever. Are we falling into the same mindset trap and believing the DPT is not enough? Growth of residencies and fellowships suggest we are still seeking approval and value as a profession and not just from within.

The second group are our referral sources. We can simply refer to prior comments on direct access and PCP referral rate as to how this relationship just isn’t creating results for therapy providers and the community they can serve. Speaking of the community, they are the third and final group. Numerous studies show we have a branding issue. People simply don't know what we do our how we can help.
All the while, the fitness/wellness, health coach and alternative medical industries have all blossomed so our target is willing to engage. Are we focused on the wrong message?

Outcomes
Looking forward to a forth area that our profession is currently focused on is outcomes data. My question is this opportunity going to fall prey to the same misconceptions about its potential impact? Time will tell.

Each of the 4R's as well as the industry-based sources of pain represent a scarcity mindset, in which 'not enough' will always be present. The true opportunity exists in seeing opportunities within. Part 2 of Taking Control of Our Future will address the internal reflections that we each individually need to undertake as well as identifying our true stakeholder that will have the greatest impact on our fulfillment as physical therapists.

References:
Freburger, J.K., Khoja, S. & Carey, T.S. Primary Care Physician Referral to Physical Therapy for Musculoskeletal Conditions, 2003–2014. J GEN INTERN MED (2018) 33: 801. https://doi.org/10.1007/s11606-018-4426-6

WebPT. (2018). The 2018 Rehab Therapy Salary Report. Retrieved from: https://www.webpt.com/resources/download/the-2018-rehab-therapy-salary-report

Ganapathy S. (2016, Sept 1). 10 Millennial Personality Traits that HR Managers Can’t Ignore. Retrieved from https://www.mindtickle.com/blog/10-millennial-personality-traits-hr-managers-cant-ignore/

NSI Nursing Solutions, Inc., (March 2018). 2018 National Health Care Retention & RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/files/assets/library/retention-institute/nationalhealthcarernretentionreport2018.pdf

American Staffing Association. (2014, Oct 15). ASA Skills Gap Index Introduced to Track Trends in Hardest-to-Fill Jobs. Retrieved from: https://americanstaffing.net/posts/2014/10/15/asa-skills-gap-index-introduced-track-hardest-fill-job-trends/

American Physical Therapy Association. (2017, April 17). A Model to Project the Supply and Demand of Physical Therapists 2010-2025. Retrieved from: https://www.apta.org/WorkforceData/ModelDescriptionFigures/

Zimbelman, J.L., Juraschek, S.P., Zhang X., Vernon Lin, V.W.H. Physical Therapy Workforce in the United States: Forecasting Nationwide Shortages. PM R 2010;2:1021-1029 http://healthcarousel.ph/wp-content/uploads/2014/08/PT-Shortage-2010-Zimbelman-Et-Al-Article.pdf

Part 2 – Mindset Shift Within

This part of the series will focus on perspective from a practice owner or other members of leadership to get a better sense of how we’re doing ‘on the inside.’ Question for practice owners…
To what extent does your budget for all things marketing exceed the dollars you spend internally developing your greatest asset, your therapists?

Therapists on average generate roughly 3.5x their salary as revenue to your business. Do you exceed that level of ROI with your marketing? Or at least have the same level of impact financially for each dollar spent on external marketing?
 
Why does this matter? Part 1 laid out the data that supports that an external focus likely isn't the answer to our long-term vitality as professionals or owners.
 
Clearly, the value or importance we place on ourselves is NOT MATCHED by that of payers, referral sources or even clients. Yet we spend ENDLESS hours and large sums of hard-earned money in attempts to elevate THEIR impact on OUR success.

Honestly should we expect it to be? Looking to others to create our fulfillment is not a sustainable model. As humans, we want to feel affirmed for our authentic selves (Guignon). What exactly will be our tipping point in which to acknowledge this?

That’s a much greater topic for discussion, but in the meantime, what am I encouraging you to do?! Start from within! How…..

Shift your mindset and re-establish your experiences as a professional.
Again, by looking within… and how you relate to things.

3 step process

• Get clear on our motivations and intentions.
  These are not material things that we seek, but rather the deeper meaning behind what we do). It asks the question, what does living your purpose truly FEEL like. Yes, it's the feeling part of you that's out of balance right now.

Why do we need to get clear? Clarifying these intentions dictates what we give attention….. To be present with what we value, and decrease impact of distractions that inevitably exist. For this to happen we must:
Let go of the status quo. Have you noticed the recycling of old patterns when where holding on! Trying to control, being defensive or closed, sense of never enough? Is that pattern giving you any value?

After realizing the need to let go, we can develop a healthy mindset, one that is open, one that sees opportunity and is curious, and seeks to learn in ALL circumstances. This was your mindset when you started your journey to become an owner. Our freedom and fulfillment only come from within ourselves.

• Live our intentions, consistently in our life.
  It takes more than ‘wanting’. Success demands commitment, and not just when it’s convenient.
• Reflect across situations whereas you can continue to grow and build perspective that re-defines your experience.

This is where personal development happens. Building your self awareness and ability to see the context in which any circumstance arises will provide confidence with challenges we face.
 
Owners / Directors
An additional part of looking within for leaders has to do with those you lead and influence - your therapists! This is where the 4R's come back in to play with retention and recruiting. I’m not here to discuss your decisions around your network status and payer relations, nor how to make the most out of your marketing budget but rather how we connect with our therapists!

Who better to transform your business into a thriving practice?
Their journey, commitment, passion is one that you can relate to AND they are the only one of the target groups that are actual stakeholders in your business health.

For the naysayers that are likely out there, I challenge you to reflect on your relationships with your therapists over the last 6 months. Have you truly sought to relate to them and help them fulfill THEIR wants as individuals seeking success as therapists? Or are they a simply a widget in the flow of your daily operations?

Some of you may still may have some resistance so let’s look at some hard truths:

#1 reason employees quit….. THEIR BOSS!
People will leave a job NOT because they don't like the work OR because they found a better position, BUT because they don't like their boss. They don't have a sense of belonging. - Can't relate….

Study in 2018 by Kota -looking at job satisfaction in PT's - greatest influence is 'better human relations' which correlated with prior data showing interpersonal domain and organizational culture were crucial.

Newer generation of therapists coming into the workforce provide the PERFECT opportunity to cultivate a thriving future for your business. Drivers of satisfaction and therefore retention can be broken down into 2 categories:

• Purpose - their motivations and drivers (connect and relate).
• Environment - experience they has as your EE (non-arbitrary engagement).

As owners we can all relate to these motivations along our own journey.
Purpose and a sense of belonging are demonstrated by way of:

• Being motivated by meaning, that is:
  • Sharing their gifts
  • Making an impact
  • Living their desired quality of life
• Want relationship with boss 
• Hunger for learning - they want to know why!

Environmental attributes are seen in:

• A tendency to challenge hierarchical structures and the status quo YET:
  
  • Open to change so being creative in HOW they can contribute and grow - this is an opportunity to evolve how to encourage retention of you’re A players
  • Tech savviness
  • Task oriented - this reflects emphasis on contribution rather than time
  • Crave feedback
  • Want recognition
  • Having fun

Circling back around to retention and recruitment as being vital aspects of a thriving business, I encourage owners to connect with the motivations of each of their therapists and create environmental opportunities to build your dreams together.
 
Message for the day…Taking care of those we're in charge of - Focus inward. On ourselves - get clear, live our intention and grow our perspective. Inward also reflects who we are as therapists so bringing focus to our clinical teams, to nurture and influence their professional future is vital to your fulfillment as an owner. In doing this OWNERS will continue evolve our industry, by committing to the people that have dedicated their lives to our professional health - Therapists.
 
 
I hope that our time together has inspired us to reflect on our own journey and aspirations in making a difference as providers, as owners and for our families both professionally and personally.

References:
Guignon C. (2004) On Being Authentic. New York: Routledge.

Campo MA, Weiser S, Koenig KL. Job strain in physical therapists. Phys Ther. 2009;89(9):946–56.10.2522/ptj.20080322

Chopra D. (2010). The Soul of Leadership. Unlocking Your Potential for Greatness. London: Rider.

Abed R. (2016, September 26). LinkedIn CEO Jeff Weiner Says This Is Why Most Employees Quit. Retrieved from https://www.inc.com/robbie-abed/the-ceo-of-linkedin-says-this-is-no-1-reason-why-most-employees-quit.html

PT in Motion (2015, October 19). Keeping PTs in the Workforce May Be Key to Reducing Anticipated Shortage. Retrieved from http://www.apta.org/PTinMotion/News/2015/10/19/WorkforceStudy/

Kota M, Kudo H, Okita K. Factors affecting physical therapists' job satisfaction: questionnaire survey targeting first-year physical therapists. J Phys Ther Sci. 2018;30(4):563–566. doi:10.1589/jpts.30.563