Positive Impact

Given the trepidation surrounding economic news for the past three months, physical therapists and PT assistants might consider checking out our annual Salary Survey coverage somewhat more desirable than, say, having root canal.

We'd understand. But there is some good news sneaking in behind all of the concerns of layoffs, hiring and salary freezes and loss of quality jobs.

According to a recent report in Forbes, amid all the talk of recession and continued financial turmoil, there are some sectors where more jobs will be created over the next few years. The second-fastest growing industry and job sector is health care-related fields, according to the Bureau of Labor Statistics' (BLS) latest 10-year outlook for job creation.

According to the report, the predicted upswing is driven partly by demographics. The number of people 65 and older is expected to increase to nearly 46.4 million by 2016, from 35.6 million two years ago. The sector as a whole is projected to add 4 million jobs through 2016; that includes 480,500 home health care aides and 512,500 nursing home workers.

Other recent job outlook reports have indicated that therapists in all disciplines will be increasingly needed, especially in the area of home health. Medical advancements in the treatment of stroke, brain injury, cancer, paralysis, amputation and motor disorders are likely to create more of a need for both physical and occupational therapists across the country to serve growing older populations in high demographic states such as California and Florida, and in those rural areas who need therapists willing to commute in states such as Wisconsin and Nebraska.

So don't be wary about reading on. Our stats on salaries from ADVANCE readers shed light on the trends for 2009 and beyond-and it's not all gloomy.

The Breakdown

As part of the 2008 Salary Survey, ADVANCE broke down data by nine geographic regions nationwide. These regions included East North Central, East South Central, Middle Atlantic, Mountain, New England, Pacific, Upper South Atlantic, West North Central and West South Central (see box to find out which states belong to each region).

For physical therapy professionals as a group, the highest-earning region was the Pacific (including Washington, Alaska, Oregon, California and Hawaii), with an average annual salary of $66,166. The lowest-earning region, meanwhile, was the West North Central (Minnesota, Iowa, Missouri, Kansas, Nebraska, South Dakota and North Dakota) at $51,677.

Andre van Commenee, PT, director of Active Rehabilitation in Pasadena, CA, has been a physical therapist for 24 years. He discussed the survey results with ADVANCE.

"It's not surprising to me that the Pacific region was the highest-earning," said van Commenee. "I believe a lot has to do with the difference in cost of living. For example, I have in-laws who live in Wisconsin. The kind of house you can buy there for let's say, half a million dollars, is a mansion. Here, that kind of money will basically get you a shack."

With the economic recession impacting salaries and job security all over the country, van Commenee also offered thoughts on what the PT profession can expect in the future.

"The national and local economies certainly impact your livelihood, so you need to be aware of what's going on in those sectors," van Commenee related. "But at the same time, you have to focus on your own economy. I tell people many times, the world, domestic or state economy can be great, but if the economy in your clinic is not good, your salary cannot be good. The type and quality of services that you offer is what you can control. You can't control what politicians do."

Southern Salaries

The second highest-earning region in the survey was the West South Central (Oklahoma, Arkansas, Louisiana, Texas), with an average of $63,674. But the East South Central (Alabama, Mississippi, Tennessee, Kentucky) was second lowest at $52,718.

Joe Black, DPT, PT, SCS, ATC, owns Appalachian Therapy Center, Maryville, TN, in the middle of the East South Central region. Like van Commenee, he was not surprised by where his area placed in the survey.

"I love my state but this region does tend to lag behind the rest of the country in a few areas, such as education, childhood obesity and health care delivery," explained Dr. Black, who is also president of the Tennessee Physical Therapy Association. "But you also have to consider cost of living, which is better here than many other places. The same dollars are going to be worth a whole lot more in this part of the country than Los Angeles, for example."

Dr. Black did not expect, however, the amount of the average salary for his region to be so low.

"I would suspect that this part of the region [pays more] than the overall region itself," he commented. "I don't think I could recruit anybody to my clinic with an offer of $52,000. We don't generally hire new graduates but even they are usually looking for at least $55,000. Of course, all the programs here now are graduating doctoral-level students, so that has made a little difference in their expectations."

Education Effects

According to the respondents of our salary survey, salaries in the physical therapy industry are not necessarily dictated by level of education. "Simply obtaining a DPT should not mean a salary increase. There are many clinicians with bachelor's or master's degrees who have superior outcomes and drive evidence-based practice in our profession," said Trent Nessler, PT, DPT, MPT, managing director of Baptist Sports Medicine in Nashville, TN.

Survey participants were asked to identify their level of education from four main categories-non-four-year college graduates (high school or GED, some college experience, associate's degree), college graduates (bachelor's degree), master's degree (MA, MBA, MPH, MS) or doctorate degree (DPT, PhD).

Among 2,216 respondents, most clinicians hold a master's of science (MS) degree (26.4 percent), bachelor's of science (BS) degree (25 percent) or doctorate (DPT, PhD) degree (23.6 percent). Those who fell into the non-four-year college graduate category showed the lowest salaries, with the three categories reporting an average annual salary of $28,340. College graduates with bachelor's degrees reported an average salary of $59,292. The most surprising differences were among those who hold the highest degrees in the field. PTs with master's degrees reported an average salary of $68,735 annually and those with DPT or PhD degrees averaged just $58,925 annually. The disparity is likely explained by time on the job.

Compelled to prove his dedication to his profession and patients, Dr. Nessler enrolled in a DPT program in 2000-when it was relatively new to the profession-to further his education. "My DPT education was the most refreshing and professionally enriching experience I have ever had," Dr. Nessler shared. "It continues to affect my drive for clinical excellence and furthering our profession."

Dr. Nessler believes both experience and clinical specialties need to be considered along with education level when determining a PT's salary. As an administrator, he would be willing to compensate a veteran PT who has shown the initiative to go back and obtain a DPT. "It says a lot about therapists when they are willing to take on the extra work, despite the fact that they already have the skill set needed to survive in our profession," he said.

Therapists with clinical specialties have been directly related to improved outcomes and as such, Dr. Nessler believes salary requirements tend to be higher for those therapists.

As the industry moves toward a different model of providing health care with the establishment of the APTA's Vision 2020, salary compensations may be affected. According to Dr. Nessler, Vision 2020 will push the profession along the road of life-long learning, which should impact the profession's overall outcomes.

"With an influx of DPTs or clinicians going back for their DPT, you hope that practice patterns will change," Dr. Nessler said. "Reimbursement will improve for those providers with superior outcomes and might mean increased salaries for DPTs."

Years of Experience

Between December of 2007 and December of 2008, more than half of respondents said they had one to five years of experience under their belts. Another 22 percent said they had six to 10 years, while 10.7 percent had between 11 and 15. Almost 13 percent had between 16 and 40 years of experience.

In terms of salary, consistent increases were reported within the first decade of work. Physical therapists with one year of experience made an average of $51,842. Five years in, average salaries increase to $64,473. Respondents who had worked for a decade reported an average salary of $69,785. Just three years ago, first-year physical therapists reported an average salary of just under $43,000 per year, according to our 2005 salary survey.

Erica Gerlach, PT, MPT, Cert. MDT, clinic manager at Excel Physical Therapy and Fitness, Philadelphia, PA, graduated from University of the Sciences, Philadelphia, PA, and has worked in the PT field for 5.5 years.

"New grads cannot expect to make as much as an accomplished veteran PT," she stated. "A new therapist needs to develop his niche, improve his skills through continuing education and/or post-graduate studies, and prove his worth to the company he works for."

Newer PTs should research the average salary for a PT with their same experience, the type of setting they will be working in and the geographical area. "All this will prepare you for what to ask and expect as an offer," she said.

In the ADVANCE survey, physical therapist assistants reported an average salary of $31,115. After five years, it was $37,571, and after 10, it was $41,166. The height of a PTA's earning potential hovers in the high $40,000s to mid-$50,000s.

Brian Jerva, PT, DPT, clinic manager at Excel Physical Therapy & Fitness, graduated from Arcadia University, Glenside, PA, and has been working as a PT for 3.5 years.

Dr. Jerva, who works in outpatient orthopedics, said he is not convinced that today's salary reflects the amount of money invested in the current PT education, which leaves new grads with increasingly large debts.

Dr. Jerva advises PTs who have landed their first job out of school that "incentive packages are nice, but be sure to negotiate as high a base/guaranteed salary as you are able so you don't have to rely on a performance incentive to pay off student loans."

Besides salary, other perks to keep in mind are continuing education benefits, performance-based incentive packages, 401K/Roth IRA/stock options, travel expenses, vacation/sick/personal time, health benefits, flexibility with coverage and overtime pay.

Several issues have affected salary for PTs in recent years, said Tina F. Whalen, DPT, MPA, department head of rehabilitation sciences at the University of Cincinnati. They include an increase in inflation affecting cost of living over time, and a change in the degree required to be a PT. 

"In addition, the opportunities for physical therapists to own their own practices-a result of direct-access laws passed in 44 states-have impacted salaries," Dr. Whalen told ADVANCE. "Since the program has gone to graduate level, there has been a flat curve in salary for practicing PTs. An entry-level physical therapist can expect to have an average starting salary of $50,000 with hospital facilities on the low end and skilled nursing facilities on the high end. Experienced PTs who have been out in the field can expect to average around $70,000."

Despite the current economic status, Gerlach noted that good PTs are still in demand. "Ask for what you feel you deserve as a PT with your experience and you may get it, or at least be able to negotiate a contract that makes both you and your new employer happy," she said.

Work Setting and Other Questions

The top job setting for 2008 Salary Survey respondents was in the outpatient clinical setting, where almost 55 percent of therapists reported working. Of the other options offered, community or home health netted 10 percent of employment, with school or other educational settings comprising another six percent. Almost 26 percent indicated they were employed in "other" settings.

Our evidence also showed the gender gap narrowing, with male respondents reporting a salary, on average of just under $67,000 a year, while females are making, on average, over $57,000 per year. Past surveys have shown variances of more than 20 percent between the genders, but the difference has shrunk to just 16 percent this time around.

For the first time this year, we asked readers to compare advanced credentials they had earned with their peers. The PTA credential or "others not listed" comprised exactly half our responses, but among specific credentials, ATCs were most popular with 8 percent of survey participants reporting holding the certified athletic trainer distinction. OCS, NDT and CMT were also common responses.

Over the past few years, many companies and the PT profession at-large have increased the emphasis on getting more physical therapists into less-populated, rural areas. Some strategies the profession has used to make these opportunities moreattractive include increased relocation assistance and student loan forgiveness. It appears the initiative is starting to yield some results, with 21 percent of readers reporting they are currently employed in a rural setting, up from 16 percent of respondents in our 2005 Salary Survey. Suburban-based employees made up just under 50 percent of responses, with the balance (30.6 percent) based in cities.

With the current economic crunch across the nation, it was reassuring to see 84.1 percent of responders indicate that the majority-or all-of their health care coverage is paid for by their employer. Another 9 percent said they were covered under their spouse's health care plan, with the remaining 6.8 percent saying they paid for all of their coverage.

Brian W. Ferrie, Rob Senior, Beth Puliti, Lauren Fritsky, Rebecca Mayer and Lisa Lombardo contributed to this report.