Everywhere Americans look, grim news about the country's financial climate confronts them. While experts claim jobs in health care fields remain sound, it's still hard to choke down the fear about an uncertain future. Will physical therapy positions and practices soon be on the chopping block as well?

ADVANCE decided to get to the bottom of the issues by speaking with therapists in different settings around the country. They'll tell you how they're surviving the tough economic times and how you can keep your career thriving.

PT: A Pretty Picture

Is the economy negatively impacting the physical therapy profession? It depends where you look. According to an online poll on ADVANCE's Website, 41 percent of therapists say the economy has affected how many patients they have and 15 percent are concerned about being laid off. Almost half of respondents are untouched-their patient count has remained the same or has grown.

Brett Frankenberg, PT, CAE, who works in industrial rehab and ergonomics in Carlsbad, CA, says the picture still remains promising for the PT profession despite other faltering fields. Not convinced? Look to the past, he said.

"Physical therapy was picked in 1989 by U.S. News and World Report as one of the top professions for the 90s. That remained true, especially during the recessions of that decade," he said. "In general, when the overall economy is doing poorly, people covet their health care. Conversely, physical therapy took a hit when the stock market was flying high in the late 90s."

And it's true that despite massive job cuts across the country, health care is still an industry posting gains- it added 32,000 positions in December.¹Less than 2 percent of physical therapists are unemployed, according to 2007 data from the American Physical Therapy Association.²

Health Care Hardships

But those statistics may soon change as the number of Americans losing their jobs and their health insurance rises. Twenty percent of respondents in Consumer Reports' recent national survey said they're unable to afford medical bills or drugs, while 15 percent said they lost health coverage or had their benefits cut because of the recession.³It's only a matter of time before these individuals walk through the doors of a therapy practice or facility with an empty wallet.

"There are problems with patients losing jobs and insurance and moving to COBRA plans and then having to drop COBRA because it gets expensive," said Tannus Quatre, PT, MBA, principal of Vantage Clinical Solutions, Inc, a national consulting and practice management firm based in Oregon and Colorado specializing in physical therapy businesses. "It's getting to the point where the patient is responsible for more of his services, and he just can't afford that."

The physical therapy work settings that stand to suffer most from this trend are privately-owned outpatient clinics that rely on co-pays for a portion of their revenue, Frankenberg said. Inpatient rehabs, community-based hospitals and Veterans Affairs (VA) clinics will be the least affected. In addition, Frankenberg thinks workers' compensation servicers-both large corporate entities and private clinics-will be disturbed because of workers becoming more protective of their jobs and being less likely to report an injury for fear of reprisal.

The Private Practice Owner

None of the sources ADVANCE spoke with saw a trend of physical therapists getting laid off. But most agreed that patients are coming to sessions less frequently, most likely because of financial hardships.

Brian Thornton, PT, launched his private practice in Altamont, NY, 15 miles outside Albany, 10 years ago. He started seeing changes to his business before the economy began struggling.

Instead of coming in for the recommended two or three sessions, more patients started attending therapy once a week, something Thornton suspects has to do with rising co-pays, which are as much as $50 in some cases. Many individuals, it seems, are beginning to save that money for other necessities such as gas and groceries.

"I think it's a source of some embarrassment for people to say that they can't afford something," he said. "Some people are very open about it, and they'll tell us right up front, 'You need to teach me what I need to do at home because I can only come once, or once a week for a couple of weeks.' Others will want to defer making co-pays until their check comes in. We're seeing a lot more deferment of payment and non-payment."

Thornton still has a solid patient base, but the decline in frequency of visits has forced him to worry over his two full-time therapists' schedules. Because they're not seeing regular patients as often, the practice has been forced to evaluate more new patients, which takes more time.

"I'm constantly perusing the schedule for the future to see how busy everybody is, so that is a concern. There's more turnover, certainly," he said. "So there's more time we need for evaluations and things like that, because we're seeing different people."

Patients not following through with rehab concerns Thornton as much as the prospect of losing business. When patients aren't seen consistently, it becomes harder to track their progress and help them reach their goals.

"It's been frustrating. We have to do a better job just of selling our services to these folks, convincing them that the investment will be worthwhile for the outcome," he explained. "Often with [many] procedures, there's a window in which you have to try to regain a lot of their functionality. And if they don't get most of it in that timeframe, then their outcome will not be as good as it should be. So our job now is to try to convince them to do a little bit more up front even though it's more expensive, and then we'll tailor it down from that."

The Private Practice PT

Chrys Kub, PT, works for an outpatient pediatric clinic owned privately by an occupational therapist in Pineville, NC, just outside of Charlotte. Five physical therapists, four of whom work part time, five full-time occupational therapists, one full-time COTA and four support staff make up their team. The facility has seen parents struggle with being able to pay for their children's therapy.

"Higher insurance co-pays place a bigger financial burden on parents whose children are suffering from disabilities," she said. "Worrying about paying for your child's therapy can be quite stressful to parents who already have a full plate. We do everything we can to help themcontinue coming to their visits. This translates into more time by our administrative staff in calling insurance companies to fight for benefits, time that could be used more constructively to improve other processes which would more directly help facilitate improved patient care." 

Thankfully, the clinic has a long waiting list, which somewhat compensates for the patients who cannot attend therapy. Kub remains more concerned about retaining clients than losing her own job.

"We are all concerned about not filling our open slots, but at this point we do not fear losing our jobs. We assume that if worse came to worse, we could always get a job in an extended care facility, although none of us desires to work in that setting." 

Unfelt at Facilities?

In hospital outpatient departments, therapists still deal with some of the issues plaguing privately-owned clinics.

Nancy J. Sterantino, PT, MS, outpatient supervisor at St. Peter's Physical Therapy and Fitness outside Albany, NY, said she hasn't needed to cut hours for her two full-time and five part-time physical therapists. But like Thornton, she has noticed in recent years more patients coming to sessions once a week and asking for home exercises for the rest of the time.

She's also noticed that it takes more effort to keep business coming in. To help, her facility has started spending more time marketing and monitoring volume in outpatient and other areas.

"It used to be working for a hospital, you had a lot more rollover into hospital outpatient departments. But now that physicians are working more with PT private practices, it definitely makes a hospital outpatient department work a little harder than we are used to for marketing."

Jennifer Colella, DPT, MTC, who works for the outpatient therapy department at the Orthopedic Center of South Florida, has also seen patients unable to afford the recommended number of sessions.

"We are lucky. The doctors that I work for, they're willing to negotiate that price and make it a little more affordable for the patient. But it has affected compliance," she said.

Dr. Colella says post-operative patients who request to only attend therapy weekly must be "on the ball" with their home regimen. "If they're right after surgery, I'd like to see them for at least two weeks so I can at least get them mobile. Then I can get them ready for doing it themselves at home, and have them coming back once a week to make sure they're doing everything right and see if they have any problems."

'Ambassadors of Business'

Nearly everyone ADVANCE spoke with said they were ramping up marketing efforts to keep business afloat. But advertising can be expensive-how can you justify spending more dollars when you're worried about revenue?

The answer is probably sitting in your clinic or facility, said Quatre, the Vantage Clinical Solutions principal.

"Where it starts from our perspective is with internal marketing-marketing to those who are already in your practice," he said. "It's something that's widely forgotten, because you think the deal is done with patients who are coming in the door. But each of those patients has such a greater opportunity to understand the benefits you offer, and they go out in the community and connect with another 30 people a day."

Therapists can also better connect with current clients by stressing that they can call them whenever an issue arises, even after they are discharged.

Even external marketing to attract new patients does not have to be as costly as it once was. Practice owners and physical therapy managers can now use free online tools such as Facebook, MySpace, Twitter and Google or set up a blog to which they can refer current and prospective patients, Quatre said.

Referencing Referrals and Creating Chances

Quatre thinks at some clinics, a discrepancy exists between the number of referrals coming in and the amount of evaluations getting scheduled.

Better monitoring of these numbers can help both practice owners and therapy managers determine which patients might not be following up for financial reasons.

"Something is happening after a referral is made. The PT clinic is now trying to follow up and get this patient in the door, but they can't get him in the door, because the patient realized he can't afford any more care. The intervention in that case is setting something up to make the payment for services more feasible for patients. Then, that should be communicated to the referral sources that patients are not scheduling appointments possibly for financial reasons."

Talking to the referral source is crucial, not only to check up on patients, but also to communicate that your business is prepared to help financially struggling clients. This is where business owners can actually capitalize on the down economy, Quatre feels-by selling physical therapy as a low-cost alternative to other health care options and promoting financial hardship policies.

"We're a really good alternative despite what's going on in the economy," Quatre stressed, "and because of what's going on with the economy, [clients] should not be limiting how much they are trying to use us."

References

Newsday.com. (2008). December's job losses push unemployment rate to 7.2 percent. Retrieved from the World Wide Web, www.newsday.com/services/newspaper/print edition/saturday/news

Star-Telegram.com. (2008). Beyond the Business Degree. Retrieved from the World Wide Web, www.star-telegram.com/819/story/1063742.html

ConsumerReports.org. (2008). Survey: 56 Percent of Americans Think U.S. Needs To Help Citizens More In Tough Economy. Retrieved from the World Wide Web, www.pressroom.consumerreports.org/pressroom/2008

Lauren Fritsky is associate editor at ADVANCE and can be reached at lfritsky@advanceweb.com