Therapist Productivity

The following is a letter to the editor about the January article, "Gaining Ground," by Paul Martin, MPT, CBI:

I was appalled at the article "Gaining Ground." It should have been titled "Giving Up the Farm." The author has sold out caring and attention for profit.

His instruction to find multitask-oriented therapists decreases quality care severely. The literature on these people indicates they are scattered and poorly focusedÉMr. Martin cites mobilization as the prime activity being done while observing an aide. Mobilization needs to be done with total attention—to be done well. The patient deserves nothing less than total attention from his treating therapist.

Then Mr. Martin advises that the therapist have strong service and sales skill. The emphasis is on "sales," as he advocates a "minimum of hands-on, one-on-one time with the patient," and "yet making the most of every patient's interaction. Every patient walks out with a smile." But are they getting better? Physical therapy is a one-on-one profession. When we lose this, we lose what our profession is all about.

Then he advises "scheduling three to four patients per hour." Goodbye quality. Hello profit. And I love "educating the patient about the value of seeing more than one therapist." There goes continuity of care–the value to the patient of having someone care for him, who sees his progress from previous visits. Gone is the value to the therapist of seeing if his treatment plan works. The value of a group is not in all of them seeing a single patient, but in the interaction with colleagues as they discuss difficult patients and appropriate care plans.

Yes, physical therapy is changing, but changes such as theseÉwill not make us a better profession. When we lose time for one-on-one interaction, time to get to really know our patients and to devise and change treatment approaches, time to touch and teach, we really lose physical therapy.

By the way, doing notes at the end of the day usually means the notes will be less accurate, as time erases memory. However, from the tone of the article, I'm sure Mr. Martin means the therapists will do the notes at the end of the day–on their own time.

I wonder if Mr. Martin would get treatment for himself or his family at his facilities. I would also wonder about the morale of his staff. Would his staff recommend PT as a career to anyone they know? I doubt it.

–Donald C. Courtial, PT
Belleville, Ill.

Following is the author's response:

I would have appreciated the feedback regarding the article Gaining Ground in the January 2002 issue, but unfortunately, the reader chose to get personal and is obviously someone who is resistant to change.

Changing our methods of clinical or medical delivery does not have to mean that our quality, one-on-one interaction, or getting to know our patients extremely well, will be threatened in any way. It simply means that in a business, our greatest asset (our clinical staff) is also our highest cost; it is critical that we maintain high levels of productivity. I would also hope that these staff members would have strong interpersonal and sales skills as well.

Please read the article closely. The article clearly states that productive therapists will write or dictate notes by the end of the day, which means that they are performing this throughout their day of treating patients.

In response to the reader's question of a family member being treated in one of our facilities, my mother is starting therapy at our former flagship facility in Moorestown, N.J. AndÉthe therapist who will be treating her has been a member of the staff since 1995. My former facilities, Physical Therapy and Sports Services, provide phenomenal care to all of its patients and has terrific staff morale.

—Paul Martin, MPT, CBI
Mt. Laurel, N.J.

The following are comments about Susan Fish's letter to the editor, which ran in the March issue. Her original letter dealt with the "Gaining Ground" article by Paul Martin.

It is our experience that a multitherapist approach provides healthy conflict and more progressive plans, provided trust is established in the clinic. Without trust and respectful conflict between all the therapists, treatment plans become stagnant and repetitive, losing the dynamic professional energy that is created with multistaff treatments. Have you walked into a solo practitioner family practice that has energy and enthusiasm for patient care?

Scheduling three to four patients an hour in an outpatient therapy center can be accomplished with respect, provided staffing is adequate.

Mr. Martin provided tools in past writings, mentioning 12 to 15 visits per day, per FTE. This equates to 1.5 patients per hour, or roughly about 1 patient per 40 minutes for an individual physical therapist. This number should be achievable, even with the most complex cases.

Finally, a review of the literature fails to quantify the one-on-one time required for a successful outcome and/or a satisfied patient. Successful physical therapists agree that no matter how much time you spend with a patient, it's your customer service skills, patient satisfaction rates and relationship-building that is the core of their success. The best outcomes are obtained by the therapists managing the patient's needs and expectations, the insurance restrictions and the referral source's perceptions.

—Robert Babb, PT, MBA
Philadelphia