I have been a student on rotations and working as a Doctor of Physical Therapy in numerous insurance-based clinics for a number of years... and I was burnt out.
Think about this for a second. When you go to see your in-network orthopedic physical therapist, how old are they normally? The next question that may pop into your head is, "where have all the older physical therapists gone?" Coming out of PT school, many of my classmates had the same question, but some of us have only just realized the answer after working in the field.
For therapists who really care about their patients, working in an in-network clinic is hard work. Reimbursement rates from insurance companies are dwindling each year. Note-taking and justification for each patient is thorough and time consuming. What does this mean? Factory physical therapy clinics where patients are brought in every half an hour, sometimes every twenty minutes, sometimes even double booked! So after those twenty to thirty minutes, that may or may not be double booked, the patient is then whisked away to a tech/PT aide, whom may or may not have proper training from the physical therapist, to guide the patient through their exercises. What does that say about the exercises we are giving our patients? What kind of quality care is that really providing?
If therapists are getting burned out so quickly from seeing 16-24 patients per day, who comes in to replace them? New graduates. Don't get me wrong, being a new graduate fresh out of school has its perks. They are hungry for knowledge, they are eager to work, they sacrifice and go above and beyond for their patients. But, what kind of experience do they possess? What exactly have they learned coming out of school?
Unfortunately, insurance companies have a lot of influence in the world of physical therapy. They influence who can be treated, how often they can be treated, how long they can be treated, sometimes even when a certain body part can be treated. Insurance companies even influence what we learn in school. Ever have your orthopedist or physical therapist ask you to hold a certain position with your arms or legs and ask you to resist their pressure? That's called a manual muscle test. It measures the strength, on a scale from 0 to 5, of a particular muscle, isolated as best as possible. Insurance companies require measurements such as these during your evaluation, re-evaluations, and discharge to see how you have progressed with therapy. But, what relevance does this number have in real life? Not much. If you really strengthen your left medial hamstring, or ischiocondylar adductor, or your anterior gluteus medius, does that mean those muscles kick in when it is truly needed to stabilize that leg during early stance of your gait cycle? Ever reach a 5 out of 5 with all your muscle tests but still feel pain? How about range of motion? If we're measuring the length of your hamstring, are we taking into account the position of your pelvis or rib cage during the measurement?
I'm not saying these skills are not useful, but most therapists will tell you that coming out of school, skills such as these are only baseline tools that must be used to expand our knowledge once we're actually out in the field. These are baseline skills PT schools need to drill into us so that we can justify treatments to insurance companies (and receive reimbursement) instead of focusing on research-based treatment interventions.
Physical therapists care. We care so much that we'll try to give each patient as much of our time as possible even though we realistically only have twenty to thirty minutes per patient. We care so much that we'll work with each patient as long as possible and save all of the documentation work for after hours when all the doors have closed. It is because I care for the well-being of my patients that I decided to start my own clinic to give each patient what they deserve: my full, undivided attention.