For those new to this newsletter, our last series focused on burnout, and I am a bit jaded from reading even more recent studies demonstrating that it is not only an epidemic but also in #physicaltherapy: “exhaustion in PT school is even greater than medical school,” A comparison that sheds light on the intensity and other issues of the education process in physical therapy. At least in our last article, we learned as employers how to deal with it.
So, let’s migrate to more positive things, like these 5 surprising truths about All Things #Physicaltherapy
#1 Physical Therapist’s best skills are from the neck up-meaning examination and interpreting the body’s symptoms and what interventions will put a patient on a pathway to success. Multiple studies demonstrate the levels of knowledge in evaluating managing musculoskeletal conditions is at the top of all medical providers.
Two studies that back this up:
Childs, J. D., Whitman, J. M., Sizer, P. S., Pugia, M. L., Flynn, T. W., & Delitto, A. (2005). A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC musculoskeletal disorders, 6, 1–7.
Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists.
Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master’s degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues.
Study #2:
Moore, J. H., Goss, D. L., Baxter, R. E., DeBerardino, T. M., Mansfield, L. T., Fellows, D. W., & Taylor, D. C. (2005). Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. Journal of Orthopaedic & Sports Physical Therapy, 35(2), 67–71.
Clinical diagnostic accuracy by PTs and Orthopedic Surgeons on patients with musculoskeletal injuries was significantly greater than for Non Orthopedic Practitioners, with no difference noted between Physical Therapist and Orthopedic Surgeons.
#2 Physical therapy is the most underutilized service for musculoskeletal conditions, with only 10–12% of all patients with aches, pains, sprains, and strains accessing a physical therapist for care despite strong evidence and cost-effectiveness for PTs for all musculoskeletal conditions. Effectively, if you have low back pain or a shoulder injury, a PT is only part of your treatment 10–12% of the time, unfortunate but true.
Increased use of physical therapy would demonstrate the following:
- increased savings in downstream costs of imaging, surgery, injections, drugs
- better clinical outcomes and faster
- If used first or early in the course of treatment, over 40% savings
#3 Despite unprecedented inflation, salary increases, and physical therapist shortages, PT’s have taken the hardest hit reimbursement cuts by medicare cuts since 2021 and even greater by medicare advantage plans who pay 25–35% less to PT’s than medicare!
Let’s look at this published report:
• In 2021, a federal process to reset reimbursement began significant redistributions of Medicare physician payments. The Impact on Therapy Providers of Budget-Neutral Increases to Primary Care was paid in part by cuts to physical therapists. Unwittingly, Physical therapists have been collateral damage by these efforts. Instead, there should be higher payments to physical therapists, which would be a significant savings to the healthcare system. In Medicare, roughly 12% of the patients receive benefits at less than 4% of the cost of the medicare budget-talk about value!
By 2025, the cumulative conversion factor cut for PT will be as much as 10.4%. The net effect of this is that patients who need us the most, elderly with more musculoskeletal and other conditions best treated by physical therapists, will have less and less access as the cost to treat these patients will be higher than medicare rates.
#4 If you see a PT first for LBP vs. a primary care physician, the evidence shows that you will have lower odds of early and long term use of opioids. Said differently, the more exposure you have to physical therapists, the less likely you will ever even have any exposure to opioids. The best antidote to the opioid epidemic is complete avoidance.
Kazis, L. E., Ameli, O., Rothendler, J., Garrity, B., Cabral, H., McDonough, C., … & Saper, R. (2019). Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ open, 9(9), e028633.
#5 Physical therapists are in the behavioral health arena. The number one intervention for mental health is exercise/movement. Regardless of whether your philosophy is drugs or talk therapy, it is a secondary intervention to the best treatment-exercise and physical therapists are THE exercise profession.
Taylor, C. B., Sallis, J. F., & Needle, R. (1985). The relation of physical activity and exercise to mental health. Public health reports, 100(2), 195. And many others!
For a complete list of all physical therapy research supporting these 5 surprising truths and on physical therapy efficacy, cost-effectiveness, and evidence for PT First, go right to our compilation HERE.
If you have any thoughts on these or other surprising truths, please become part of the conversation.
And hey, if you’re enjoying this this post from All Things #Physical therapy, consider subscribing to my Substack and recommending and sharing, posting, tweeting to friends. For a treasure trove of past wisdom, check out EIM’s blog, where over 350 posts await your eager eyes.
Lastly, 100% of all proceeds from my book Called to Care: A Medical Provider’s Guide for Humanizing Healthcare goes to The Foundation for Physical Therapy Research
larry
@physicaltherapy
