The PT Shortage Conundrum: The Flipping Workforce Predictions
Remember a famous 1999 prediction that forecasted a cataclysmic event? The one by Nostradamus’s most famous quatrains refers to “the year 1999 and seven months” when a “great King of Terror” was supposed to come “from the sky.” Many took this to mean a catastrophic event — an asteroid hit, the start of World War III, or some apocalyptic terror — would happen in July 1999. Clearly, no global cataclysm occurred then. No harm no foul.
Did you also hear about the 2020 prediction and physical therapists by the American Physical Therapy Association workforce development study? It effectively communicated, “We’re about to be swimming in way too many physical therapists!” This was then followed by The American Council of Academic Physical Therapy (ACAPT) publishing an open letter on its website in March 2020 that urged university leaders to consider the changing landscape of physical therapist education before adding new physical therapist professional education programs or increasing class sizes at existing programs.1As it turns out, like “the great King of Terror”, it was off-by more than a little. And unlike Nostradamus’ prediction, it probably set the supply curve back a bit, giving us now an unprecedented shortage.
Wait, Did We Really Predict a Surplus?
Yes, once upon a time — cough 2020 — the American Physical Therapy Association (APTA) predicted that by 2030, we’d be rocking a 25,000-strong surplus of physical therapists. That’s right: we’d supposedly be standing around in hospital corridors, twiddling our thumbs, fighting each other to do an initial eval. While APTA’s historic workforce development data was reasonably solid-using numbers from the Bureau of Labor Statistics (BLS) and practice data, the 2020 study was a complete farce-and oh, how times change!
And that’s the frustrating part: that original “we’ll have too many PTs” forecast was never formally retracted. Which means every once in a while, an unsuspecting physical therapy program might pop up and say, “We don’t have a shortage and don’t need any more PT programs; we have too many PTs!” Meanwhile, most PT’s are like, “You sure about that? Because I haven’t slept in 36 hours and just saw 16 total knee replacements.”
PT Shortage at All-Time Levels
In reality — brace yourself — we’re short on PTs. Like, really short, especially if you compare job openings to actual licensees out there. And it’s not just me saying it: more recent APTA data says so, too.
What triggered this about-face, you ask? Real-time market conditions, common sense (ever tried scheduling a PT appointment lately?), and, oh, actual data from multiple studies — All of this my PT colleagues John Childs, Mike Walker and myself (along with 2 terrific others), published a report that debunked the flawed assumptions and rational for the 2020 surplus prediction.
So, now we have from the newly published report, in PTJ: Current and Projected Future Supply and Demand for Physical Therapists From 2022 to 2037: A New Approach Using Microsimulation with the take home message:
“All forecasts, including the baseline and five alternative scenarios, project a physical therapist shortage for most years from 2022 to 2037. By 2037, demand in the baseline scenario for physical therapy services is expected to grow by 14.7%, outpacing the population growth rate of 8%.”
Translation? We might need more than 25,000 new PTs just to keep older adults from stampeding the waiting room.
APTA has released a 25 page companion report to the PTJ article (for members only, if you are not a member, please join, we need you!).
For full disclosure, I was on the Technical Advisory Group for this Workforce Forecasting Project, which provided input and review of the publication. However, my math shows a much more dire circumstance relative to shortages. As outlined in this post, we currently have roughly 48,000 total PT/PTA combinations treating 12% of MSK, we need 352,000 combos of PTs and PTAs to treat the addressable market of 100% of MSK visits! Using 60% as PTs, that’s an additional 211,000 PTs we need today! As an important aside, MSK complaints are expected to increase. And this is just MSK! If you factor in the entire realm of physical therapy, we are well on our weay to the need of 300k FTE PT’s!
The biggest contributor to the shortage is not deliberated as much as it should be but the startling numbers showing that on an FTE basis, there are only 19% of PTs doing clinical work. We have a profession that does everything we can do get to clinical competency and then about 80% depart clinical work for a lot of different reasons including burnout and the attractiveness of higher paying jobs outside of our traditional placement. One identified factor for an upcoming post will be the “mill effect” which I am terming the phenomenon of how PT employers monitor PT’s more than PT’s monitor patients-not with wearables but with real time feedback and constant prodding-more visits per day, more units per visit, more evaluations! This leads to turnover and departure.
The Flip Flop Backstory and the “Oops” Moment
To be fair, data analytics can be a slippery beast. Predicting how many PTs we’ll need 10 or 15 years from now is an inherently flawed crystal-ball routine. Market conditions change, people retire early, new grads realize they prefer coaching to manual therapy (hey, it happens). But the big question is this: why was the 2020 APTA workforce plan so off the mark? Highlighted in our report:
• They used historical data: Great for some industries, but physical therapy evolves faster than we can say “functional capacity evaluation.”
• They assumed consistent PT school enrollment: Newsflash — programs keep popping up, or in ACAPT’s dream scenario, they slow down. Real-time seat counts are a roller coaster.
• They didn’t predict exoduses: Some PTs left the field during the pandemic. Some shifted to telehealth. Others realized they would rather do yoga on a beach than check insurance authorizations.
Speaking of Education…
If you haven’t read my prior rant — er, post — on Physical Therapy Education, particularly the cost issue, go check it out here: Physical Therapy Education — The Problem. The gist: Physical therapy education is too expensive causing massive student debt and negative ROI for students thus applications to PT schools are way down even though a huge shortage exists. Best solution is for students to take a first boards midway through doctorate training and get a master’s degree and get licensed. Internships can then pay them and reduce education cost. After successful completion of terminal internship, they graduate and get their DPT.
Final Thoughts/conclusion:
Short answer: We’re short.
Long answer: We’ve got to tackle the shortage from multiple angles. Let’s be real — burnout is high, staffing is low, and the APTA’s new data finally acknowledges the truth: the demand for PT services is growing much faster than population growth. Aging Baby Boomers, the pandemic’s backlog of patients who need rehab, and a general uptick in health awareness all spell “We need more PTs!” in neon letters.
@physicaltherapy
Chief Complainer of Old Workforce Plans and Eternal Optimist for the Future of PT
