Transcript
Marla: Welcome to the Practice Growth Series, where we are helping clinician owners, clinicians, and students stay ahead of the latest trends in the industry. So today I have a very special guest. We have Drew.
Drew: Hey, thanks for having me.
Marla: Such a pleasure to have you on the show today. And you have a great background where you are the head of Strategic Affairs at the APTA and also have a vast background in the military.
So we'd love to hear a little bit about you before we begin today.
Drew: Yeah. My background is I'm a physical therapist by trade and training. I did over 20 years in the Department of Defense as an Army physical therapist, which the practice setting's a little different. The scope and scale of what you do as a physical therapist and the DODs a little different than civilian setting.
And notably, there's some interesting opportunities I had there. I was deployed with the 82nd Airborne working as an individual physical therapist in Iraq for 15 months. And I also was the White House physical therapist for the Barack Obama administration. Different opportunities to see different things.
And after retiring out of the military I still was trying to figure out how I could best help the profession in what I could do. And I took a position at A PTA on the senior leadership team, and now I sit in the strategic affairs role, which really looks at where is the profession going, what are the opportunities, what are the things we need to consider about making sure that the profession is in alignment for the future?
Marla: So being in that strategic affairs role, you have a really good tap on where we're headed with the physical therapy industry. So we'd love to hear from your perspective, what are the most pressing issues that we're facing, and what can we do to maybe combat those?
Drew: Yeah, I think the thing that everybody wants to talk about initially is the declining reimbursement rates, right?
And then that is a strategic problem for the profession. But the problem with that is it becomes a focal point that tends to get so engaged in that you start to look at all the other potential opportunities or all the other things that you need to consider as an organization for looking out for the wellbeing of the entire profession, not just the outpatient segment.
So there's a lot of things you have to look at other than just that one, but that's clearly one that, it's first and foremost in most people's thoughts. One of the things to really understand is the health of the profession, the health of the number of students coming in every year into the profession, the health of the programs, right?
Understanding where they're at with their admission rates, where they're at with how many PTs are they producing every year because one of the most recent things the APTA looked at was that we're looking at a growing workforce shortage. The number of clinicians is not going to meet the demand moving into the next decade.
And some of that is because of the growth of the profession. Some of that is because of PT starting to find other opportunities and other things to work at that are outside of clinical care, which sometimes is amazing, right? They take positions within organizations like up in the C-suite or they start working with industry or they're doing research, which is phenomenal and amazing, but it does take some people away from the clinical roles.
And then I think the other thing is just understand that the overall healthcare as a system in the direction that it's going is also going to have its own challenges and PT’s not immune to all those challenges.
Marla: And as you said, with the the clinicians starting to leave the field and leave us completely, and we have that growing patient demand, how are we thinking about the future? Eventually we can have that gap between where the clinicians are able to treat and the patients are able to get in.
Drew: And then also understand that we've got a growing population. The baby boomer generation is now getting that retirement age, and their medical needs will continue to expand.
Increasing demand. And then at times PT is a victim of its own success. We start getting popular, people start understanding all the things that a PT can do. It increases the demand, right? People start understanding, oh, you can help me not only post-surgery, but before surgery or surgery avoidance.
You can help me with lots of things. Other areas that are expanding rapidly, women's health, cancer, these areas are seeing huge growth and understanding that it's an opportunity. But it also comes, brings challenges to us when we do that.
Marla: And why do you think that people are leaving the field or that we're having this issue where maybe we're not satisfying our PTs as much as in the past?
Drew: I think there's two things that come with that, right? The first one I think is that the requirements to get into a physical therapy program now it are very strenuous. Over the last 10, 20 years, it’s become where you have to be a top tier student, you have to have high test scores, you have to put in time volunteering before you even get into the program, right?
So what happens is you start elevating the students that are coming in. And then I think what you find is as students come in and they obtain their degree and they start working, this cohort is looking to do so much more than just come in and show up and see patients, right? They want to pursue their own entrepreneurial endeavors.
They want to do work in multiple settings. They want to do things that we don't even know or understand yet. So when you get a really talented cohort in they're looking to do a lot more, right? And so sometimes I think that when they don't find the opportunities right away in a clinical setting.
They start looking for those opportunities and scratch those itches somewhere else. And I think that's the big pursuit that kind of drags them out of the clinic.
And then I think the other part of that is the clinical setting it is like it's a lot of work. And I think that sometimes people get into clinical settings and they're not quite sure what maybe when they show up in that setting.
We're not ready to understand like how much it's going to take, not only schedule wise, but how much a toll it takes on you emotionally, mentally, right? You're giving to people all day long. You are there selling to people and it takes a toll on you. This is a lot different than certain decimal points on a spreadsheet.
Like you are interacting with human beings and it's exhausting. It can take a lot out of you, and I think that sometimes people get into those rules and they find that it's challenging and it's draining, and sometimes then they're looking for something else.
Marla: And what you mentioned earlier is they're coming out at the top of their game, right?They're the highest of the highest getting accepted. It's hard to get accepted to PT school and then going into the field and maybe not necessarily practicing at the top of their game when it comes to, I just graduated as a doctor and I may not be considered a doctor when I get out in the field.
Can you talk a little bit more about that and where you see some struggles may exist there?
Drew: Yeah. I think the challenge becomes you're a doctoring profession, so you graduate and you're a doctor of physical therapy, number one. Are you and your colleagues acting and treating each other as doctor? I think that's the number one thing, right? So many times I talk to people and they struggle with being called a doctor. And I don't understand that clinically when I realize how much work and energy you've put into this, right? And we have a lot of parallel professions that are doctoring professions.
With, very similar educational backgrounds, optometry dentistry, like pharmacy, like all these other doctoring professions are absolutely fine with it. But PTs in general have struggled. And I think part of that is because of our legacy system. And I don't mean to upset you guys, but some of our legacy owners who have never made that mental mind shift, even though we've been a doctoring profession.
Stepping into that role and assuming the responsibility of a doctoring profession and the title and kind of what comes along with that can be a challenge. So like you said, you graduate with this concept of I'm a doctor, but then you show up and you're not doing doctoring. And by that I mean you are not using your mental acuity skills that you've gained.
Like you are not doing the highest level of stuff that you can, you end up doing some technician type work. You're doing treatments and other things that are probably not the highest and best use for that person.
Marla: So you're saying the evaluation really doing that is doctoring and then potentially seeing the patient multiple times and doing more of that tech level work in addition to the evaluations.
Drew: That's exactly right. If you look at any other doctoring profession, right? The doctors are doing that evaluation and there are some very specific things and skills that those, other doctors and parallel things do. But they are not responsible for every single thing from start to finish and that patient encounter that happens in the office.
And that's where the PT profession has struggled with that, that the PT assumes everything, sometimes even from check-in to every moment with that patient. And some of this is the the architecture that was put in place by clinicians where it was very valuable to have one-on-one care for an hour, right?
This concept of you and me in an hour of time is the gold standard. And that gets troublesome because you can't scale it. You then are responsible for every single moment of that patient care episode. And it gets difficult to stay in your highest and best use when that was the setup and kind of the way that people looked at, that's the most value you can provide.
Marla: So talk to me a little bit about being a primary care provider and how that could fit into where you're talking about the therapist doctoring and really being at their highest level.
Drew: Yeah. Physical therapists functioning in a primary care, musculoskeletal role has been done and is proven. The research has already been done as proven, the efficiency of a physical therapist.
For example, ordering imaging studies, right? When there's a great study that was done that showed the only person more accurate in ordering imaging studies was an orthopedic surgeon, but then it was a physical therapist, closely followed, and then everybody else was far behind when it came to musculoskeletal problems and ordering imaging studies.
Kind of showing that physical therapists understand the need and that when it's appropriate to do those advanced tests and staying in that doctoring role that I was talking about. So we know that it's not only capable of being done, but that is viable and the research supports it.
And I think a physical therapist can step into that larger role. Like we know, for example, that there is a declining, rapidly declining number of primary care providers in this country, right? There are less people enrolling in med schools to begin with. And primary care as a residency is not super sought after.
And the reason for that, some of it is financial. Because if you go to primary care, residency, you're gonna make X, but I could do the same time in a derm residency and make Y right? Completely different responsibilities. So that's one aspect of it. The other aspect of it is, it becomes more and more complicated for physicians who have to then, if you're running primary care, are running a lot of aspects of the entire practice.
So it becomes difficult for them to fulfill that role. And PTs in not only right in settings where it's been proven like in the Department of Defense, or even in countries like Australia, where PTs fill that role and they fill it well, and we know that we're capable of doing it, but it also requires the profession to step up and own the certainty that you can fulfill that role, that you can provide that care to the patients, and that you can fill that gap that's getting wider and wider in the healthcare system.
Marla: So what do you recommend for the profession to get then to that level of a primary care provider, or how can we put ourselves in that space and take over that space, as you said, we are the best equipped to do.
Drew: I think that there's a couple of things. I think that A PTA right now is pushing forward with a primary care specialty.
So I think that will help people understand the scope and scale of kind of what it means to fill that role. I think that programs need to start understanding that as their students are going to be going out into placements and as they're coming into their programs, that this is going to be a future placement site, a future expectation of the profession, and they're going to need to prepare for that.
Industry is going to need to accept that. We're going to have to figure out other ways of interacting with insurance companies for billing. We're going to have to figure out other ways of providing scale and support networks so that if a physical therapist is billing that primary care, musculoskeletal role, then all the other things that the physical therapist used to do, we need to make sure we have solutions that those things continue to happen.
Whether that's front end, front office stuff, whether that's care stuff, whether that's executing treatment plans, all those things, right? You're going to have to figure that out and make sure that those systems get put in place so that the physical therapist can continue to fill that role.
Otherwise, what's going to happen is we're going to step into the role and without all the support network and all the things put in place, it'll just fall right back to whatever was most comfortable.
Marla: Got it. So there's been a couple bills passed already.
Drew: That's right.
Marla: Can you tell us about some bills that have really helped advance us towards that primary care model?
Drew: Yeah, so for example, like Utah had just passed a bill, putting physical therapists allowed to in this primary and musculoskeletal role. And so while that's weight and very exciting, it's also that chicken and egg conversation, right? So it’sallowing direct access, which 20 years ago physical therapist didn't have, and now it's available in all 51 states.
But just because you have direct access, you still have to educate the public. You have to make sure that clinicians understand what the left and right limits of that are. Understand what they can do as a clinician, right? So even though we've seen these expansion of the role of physical therapists before, we also have to put all the things in place to support it as we go along.
But for example, with this in Utah, allowing PTs to step into this role. The one thing that people will struggle with is they believe that it's going to be met with resistance, right? And we have great research where we've done with primary care physicians that are happy, thrilled for PTs to step into that role.
Because the primary care physician who has a couple of weeks maybe on musculoskeletal stuff, can focus on doing the other things that primary care does. All those other systems. That PTs aren't going to step into kind of manage. And so primary care is happy to do it, right?
The other thing is in my experience working with orthopedic surgeons want to do surgery. They're not super interested in non-surgical cases, right? So if PT rate is offloading non-surgical cases, they're thrilled. Because then they could spend their time seeing people who are good candidates for surgery and doing surgery.
Filling, again, that niche and that role where we are contributing to the bigger healthcare system will just make PTs much more valuable. And to your point earlier, I think it will put PTs in the right role where they're very satisfied with what they're doing. I am being utilized every day.
I am looking at things that are difficult, complicated, right? And I'm helping people in ways that prevent surgical intervention or prevent pills and potions and injections. And then, there's a great saying that like people are compensated for the difficulty of problems that they solve, right?
So the more difficult or complicated a problem is if you can solve that, you are compensated more because it's not everybody can do it. And I think if physical therapists really start to embrace this role and look at it you'll see an expansion in the role and the scope of what a physical therapist does, and then I think that there will be a financial impact as well.
Marla: And you are in the military, so you actually acted like a primary care provider for quite some time. For the audience, can you explain to us what that looked like? What we have day to day, what you do? So day to day, in various settings where physical therapy was the initial point of entry for anything musculoskeletal.
Drew: You know, the way it works is healthcare is free in the military. Everybody just, if you need something, you just go to the clinic, right? And people would show up with whatever their concern or problem was and somebody would screen them and go, oh, your back hurts. Oh, your foot hurts.
Oh, your shoulder hurts. Alright we'll put you with the physical therapist. And I would see them that day or the next day if I was overwhelmed with so many people. But almost immediately, you were seen and evaluated and the onus on the physical therapist in that system is you make the decision about what the right level of treatment is for that patient.
So if that patient was a barely a grade one ankle sprain, I would do a lot of education. I would give them some home exercise and I would give them some modification of their activities. That's all I do. Their case was done. I didn't even do anything else. And they did not need advanced imaging.
They didn't need an appointment, they didn't need a bunch of rehab appointments. I was the one managing that case. And then if they had a problem, they'd come back and see me. But if somebody came in and they're, for lack of a better word, like the being on their dropped foot, right?
W need to go see somebody right now. This is a problem. So you take those, that level and you elevate it, right? You consult for the imaging studies. I could order any imaging study I wanted to, I could consult them to any provider I needed to. And if it was an emergency, I'd get on the phone and I'd talk to neuro, I talked to their primary care, I'd let them know, Hey, your patient, we need to do something right now.
So understanding that it was everything from, very simple things to super complicated and understanding that your role as the manager of the musculoskeletal stuff was to be that person that if it was not a surgical intervention, you were the one who owned it.
And that really, it really resonates in that setting because your patients don't go away, right? So that you're there with your patients the entire time. So if you are not there to manage them, they're gonna keep showing up, right? So if you are not providing that definitive care you're not into managing and helping them understand what their limitations are or what needs to be done, they're just gonna show up again with somebody else, right?
Beccause the patient won't go away. So your role is that manager of that musculoskeletal problem is really important.
Marla: So you really are the first point of access. You see that patient versus through the musculoskeletal injuries, you're able to give them the home exercise program, potentially follow them if they need it, or potentially pass them off if they need somebody else to just monitor their exercise program.
Drew: Absolutely. The other thing is a lot of times you'd see somebody who, look, it's a it's a demanding profession and people will get at their problems, issues, bumps and bruises and whatnot. And I can tell you that of all the patients that would come in to see me, anybody that needed a rehab my very capable physical therapy assistance, right?
We're always the one executing the treatments, right? I was not ever going to be doing split squats with them. Making sure, like looking at their their field on an exercise, my team would manage that. And I would continue evaluating people, reevaluating people.
There were some skills that like I would take on, whether that was a manipulation or a dry needling. So those things that like was really in my skillset, that wasn't part of the rest of the people on my team. But for the most part, I relied immensely on my team to, to execute those treatment plans and they would let me know, “Hey, look, this guy's been in here three, four times.
He's doing great. I don't, I think he's ready to go. Can you do a re-eval? Great.”There was never this onus to we gotta bring him in two to three times a week for four weeks because we're just clocking in the treatment appointment. That's not the approach. The approach was get these people back to doing whatever it is that they do.
And we do that in the most efficient manner that you can. Using the evidence, using the guidelines, following those things that help us manage those patients. But making sure that the rest of the team was doing their portion so that as the primary care musculoskeletal guy or gal, like you are the one doing that portion of it and letting other people do the.
Marla: So you really were doctoring, you were doing the diagnosis, you were doing the plan of care, you were passing off where necessary, whether if it was to the orthopedic surgeon or whether it was to the tech doing the exercise program and carrying it out.
And that's pretty similar to the models they have in dentistry, the models they have the in your orthopedist. They have sometimes the NP come in and carry out the plan that was created by the doctor, or you have the dental hygienist come in, carry out the plan that was created by the dentist. So that's the primary care model that you potentially envision us moving towards.
Drew: Absolutely. And there's also been another advancement that has happened this model where not only does PT oversee the rehab. But the physical therapist also has some other disciplines under that are working with PT, whether that's nutrition with dietitians, whether that's occupational therapy.
Whether that's leveraging strength coaches or athletic trainers in the right settings. But the physical therapist assuming the overarching role in that setting where you are not only supervising the rehab portion, but you're also all these other dimensions of that person's care, are part of the performance team, that the physical therapists leading.
And if you think about realistically, like anybody who has their musculoskeletal problem, like yes, there's the injuries, the things like that just happen. But a lot of times the confounding factors are absolutely portions of their nutrition. It's absolutely portions of their activities that they're doing, right?
There's other confounding factors that if you are trying to manage humans and you're trying to fit in a primary care role, you need other teammates and other people to work on with, and that model has been amazingly successful. So it's just another way of the physical therapist stepping into that doctoring role.
Marla: Great. And so that's the PT/PTA tech model that you've seen in the past. Talk to me a little bit about the financial aspect of that. Because I know a lot of our listeners, clinic owners, clinicians might fear that and say we know PTAs now have a modifier and they don't get reimbursed as well.
Drew: Let's start with this. Let's start with the fact that physical therapy assist in supervision. Was just changed January 1st, 2025. So we went from direct to general supervision. And so that means that you no longer have to be staring right at the PCA, which is exactly how practice should be, right?
They're a licensed clinician. They have expertise and you should be able to leverage and use them as such. That was a absolute problem. And that barrier has been taken away due to some lobbying and efforts that have been done on behalf of the entire profession.
So now that, that's set aside, like you said, the question becomes when a PTA is doing a 97110 code or a 97112 or 6 or whatever, like there is a differential, right? That's correct. And that's because we haven't had that. It was more important to get the supervision in fixed first, before you go after fixing the differential.
So so my point to that is yes, it exists, but it probably won't exist forever that takes some efforts to change that. But if you just look at it and think about it like this, what is the reimbursement rate or a thorax code? A thorax code or a gate training or whatever, and what is the reimbursement rate for an evaluation?
Or a reevaluation code, like they're completely different. Like they're exponentially different. So why would I have my highest paid employee constantly doing my lowest reimbursed codes? It's just a question you need to ask yourself, right? In any business model, ever, in any world, why? Why would you do that?
So you have to start there. Yes, you have to do the math and all these conversations, but also to the point of if your physical therapist isn't sitting in that role where they're evaluating, doing the high level things. If you're using them as a technician, are they happy? Are they satisfied?
Is that the best business model for you to go for? Is that a sustainable business model moving forward, knowing that, if your plan is to always have Medicare reimbursement go up, you are not going to be in business forever. That's just, that is not the way that the government works.
That's not the way the system is working is ever going to work. So yes, you can lobby, yes you can change it, but that can't be the premise of your model that you're working on
Marla: And being a primary care provider and doing that higher level work, doing the evals, really following that model you just described.
Is there ever a way where now PTs could be part of the primary care codes?
Drew: Ah, that's an excellent point. So there is a whole category of non-physician providers, right? Physician associates, nurse practitioners that fill in a different system, than CPT codes. And could PTs fall into that role?
You certainly have the education for it. We certainly have the research showing that we can do it. Part of it is, we do we have the fortitude and the willingness as a profession to assume that responsibility and step into that? And that's a hard question. That means changing some dogmas that we've put in place, some taking away sort of sacred cows and moving to this model, right?
One of the things that every time I ask a PT like, why wouldn't you spend your time evaluating reevaluating? Inevitably, what it comes down to a lot of times as physical therapists tell me “I really like doing the rehab.
I really enjoy doing, yellow therapy and clamshells.” And my answer to that is that's amazing. That's what my physical therapy assistant does. That's not what a physical therapist a doctor should be doing. So we are gonna have to get away from that concept that you are responsible for everything within the episode of care, right?
And that you need to be doing the things that you are best suited for. And when you have highly trained, competent, licensed people on your team, they should be doing the best things that they can do as well.
Marla: And this may solve the demand issue because we don't have enough PTs coming out, or we're not retaining enough to grow some of our clinics or grow our areas that have a lot of patient demand. So we're just stuck in this right gray area.
Drew: And then there’s also the bias that physical therapists have that we believe as it's me speaking as a physical therapist, that I'm the best person to do those treatments on the table when reality is probably not.
Your physical therapy assistant probably is better at it than you are because that’s all that they do, right? That is their highest and their best use, and it's a just a portion of what you do as a clinician, whereas it is the majority of what they do as a clinician. Again, we've got to move into that.
And also let's just–I'm just gonna say the thing out loud, alright? The entry into being a physical therapy assistant is much lower than being a PT, but the cost of becoming a physical therapy assistant is probably, I don't have the number, but it's probably six or eight times less than becoming a PT, right?
So that you can build that workforce very dynamically. You can pull those people and then what tends to happen is your physical therapy assistants ome from and relate to the communities from which they graduated, their programs and where they live. So it's very reflective, right? So then you start becoming more and more a pinnacle in a portion of the healthcare in that community.
And again, like what are we really trying to do? And that's what we're trying to do as providers, then why will we steer away from that?
Marla: Got it. So our PTAs would be almost as a PT is acting right now. They're following all the exercise programs. They're doing that and they’re getting paid what we get paid currently from per se.
The PTs are gonna be more of our primary care providers, as you call it, the non-physician primary care providers, and hopefully could then get into that higher codes, higher reimbursement, seeing more evals, and the demand gap is, we'll have more clinicians to be able to do this in. In a partnership.
Drew: Yeah.
And again this is this is not gonna roll out tomorrow. But if you're saying to me, what would be the strategic plan for the profession? What would be impactful? How could we meet the mission, right? Of improving the lives of the people that we serve, how can we help them the most?
I think that elevating everybody is the way to do that. Everybody kind of leveling up, if you will. Meets that demand so much more than staying with our current practice model and just continuing to do it because we found success there.
Marla: Yeah, absolutely. And I think that leveling up and you said it in the beginning, clinicians come out really wanting to do that.
They want to be a doctor. They got their white coat in school.
Drew: Yeah, absolutely.
Marla: I loved the day I got my white coat. We had a white coat ceremony and we want to come out. We're proud. And we want to act and treat that way.
Drew: And I think again, it's the fulfilling the role that you're best suited to be at.
But it's going to take some energy and some efforts from not only the clinicians but the industry as well as the insurance companies. It's going to take a lot of effort to really push this up.
But when you ask yourself like what's the alternative? What else? What else? What would be the alternative that you would suggest? I'd love to, if somebody's got a great idea, I'd love to hear it Hit me up. Let me know what it is. I don't know that there's a better way forward than looking at this and looking at PTs stepping into that more primary care, musculoskeletal role to meet the demands of the entire healthcare system.
Marla: And that area right now is, it's for the taking. It's there, it's open, you have potentially chiropractors doing it. You've got NPS doing it, primary care doctors. We really fit that spot. And we just had the fall risk assessments come out. And I think that is another support for this model. So tell me more about that.
Drew: Yeah. I think even importantly is just understanding that the measures that we have as a society have done for healthcare.
One of the basic tenets is HEDIS measures, right? Understanding that there are some things that we measure. And that's how we are garnering success. So for a great example, hypertension. What's that look like, for cholesterol? What about for your lipid panel, right?
What are these hard measures and numbers that we gauge success in? When you look at these HEDIS measures, there are several things that absolutely fall into the realm of a physical therapist. Falls risk is one of them.
Moving an activity in older patients is another. Imaging studies from, in low back pain, like these things are written for the physical therapy profession.
There is no other provider who is better suited to manage and control these measures that we've as a society have said these are important for the healthcare of people. And so again, like you said, it's just there and if we don't step into it, somebody's going to.
And what does that look like? I'm not sure. I don't know who that would be. But the physical therapy profession needs to understand, like you said, like when these opportunities come, like with falls risk, like we need to make sure that we are ready to step in and then execute when these things happen.
Marla: So what do you recommend that we take these little steps to get there? What can a enterprise organization, a small PT practice or clinician do to move forward with the primary care provider model?
Drew: So the first thing I would say if I'm an, if I'm a clinician. Or I'm an enterprise.
The first question I would have for you is, what are you called at work every day and how do you introduce yourself to your patient? So in the like you said, I was a prior military guy, right? And I never introduced myself as colonel. Never say I'm Colonel Contreras. My introduction to my patient was always, hello, my name's Dr. Contreras. I'm your physical therapist today.
Every single time, right? And they knew exactly what my level was and they knew exactly what I was doing. I was never like, I'm Dr. Contreras, your primary care doc. I'm Dr. Contreras, your orthopedic surgeon. Or oh, I'm just Dr. Drew. No, it was always, I'm Dr. Contreras, your physical therapist.
And I think that number one, when you start, that starts putting you mentally in the right role. Understanding that and all those things you learn about that therapeutic alliance, right? That, like where do you sit in the power seat compared to your patient?
Understanding that like they're looking at you and there is an expectation that when they come to see me, that I have a certain level of competence, right? So if you are not doing that as a clinician, my first question to you would be, why? Why are you not right? What's stopping you from doing it?
And if you are not as an enterprise saying your appointment is right. With Dr. Contreras today, or, oh, your followup's gonna be with Dr. So-and-so. Like, why are you not? That would be the first thing I would say is that this imposter syndrome, whatever we want to call that, where people feel like, oh, I'm not really a doctor, right?
I'm never had my dentist not be called, Dr. Such-and-such, I've never had my optometrist not be called Dr. Such-and-such. I don't understand when you went through the rigor that it takes to become a doctor of physical therapy, why you shy away when no other doctoring profession does?
Marla: Yeah, and then I would say, then the next question I would ask myself is, or ask clinicians or clinic or owners, what are you doing in that session and what value are you giving them every session? That's also how they're gonna look at you. And that eval, that's impactful. You're diagnosing, you're recommending if then each session is a check-in. Let me see your exercises move on. Then they're start to not consider you as much of a doctor. So I do think introducing yourself as a doctor and giving value at every single session and allowing the other parts of the model. To carry out some of the other pieces.
Drew: Yeah. And I think that like it, it sounds so basic right. It just doesn't even, like when I say it out loud, I'm like, really? Like this is it? But if you don't start there, none of the other stuff can happen, right? So again, this is the acceptance of a doctoring level profession, accepting that, yes, I'm a doctor and you should hold me to that standard.
I should be the person that you're expecting when you come in to see me. I should fulfill that role. When I go see any other doctor for any problem that I have an expectation of what that person is going to be providing during our interaction. And I think that's the easiest thing for us to just start there.
There's a whole lot of other things. And there's a whole lot of things that we have to talk about with programs and residencies, fellowships, and ongoing things. There's a million things. But the most basic level is just understanding your value. That you have earned that title and role.
Nobody gave it to me. And you've earned it. And then accept that to be the provider, that the person that you're with that day is expected.
Marla: So it's almost like we have to start internally with ourselves, the clinicians, our companies, and almost defining physical therapy again, we have to redefine and make sure everybody's aligned.
We say we're doctor of physical therapists, but redefining to make sure people truly then are acting on that.
Drew: Yeah. And I get it, the legacy system was not a doctoring profession and there's still a lot of people and places that haven't moved into that to this mindset. I understand that.
I absolutely understand it, but I also understand that like anything, if it chooses to not innovate or move forward, it won't exist much longer. We saw that during COVID with restaurants who refuse to give takeout. I bet 90% of those restaurants are not in business. Like you have to adjust when the situation demands it and to the point.
The healthcare system is struggling with having enough providers at the doctoring level to meet the demands of patients. And speaking of post COVID, people now, more than ever, are owning a portion of their healthcare journey. They seek people out when they have problems, because they realize that nothing else really matters if your health is awful, right?
If you can't function healthy like you can't really do anything, right? So people are starting to understand that and that's why you see the growth in the fitness industry, the health industry, everything with GLP-1s, people trying to get their weight under control.
People are starting to understand that they have a big portion of play in managing their healthcare. And when all people eventually will have movement trouble, that is the nature of the human experience someday, you're gonna wake up and something's not going to move well. That’s going to happen for every human being on this planet.
And who's the person that they're going to seek out when that happens? Like the worst thing I ever hear is like when people are like, I hurt myself sleeping. Like I got up and I hurt. Like I didn't do anything, right? Because eventually, the human body right, is designed to move.
And when it doesn't move the way you've expected it to move, you're going to seek help. And PTs are the people should be stepping in.
Marla: Yeah. And that should be our identity, that primary care musculoskeletal provider, we should be that role. We're the ones they think of and come to. And I know that one of the ways I recommended to my own clinicians that I've mentored or to my patients as well is I've always said, once you graduate, I don't like discharge. I say graduate. Once you've graduated from this care. I'm your provider for life. You're my patient for life.
Drew: So you're right. I have had the the pleasure of working with, a couple of presidents of the United States. And I'm, I still work with them, and that's because I'm their PT.
You are their person and and when people struggle with this. I look at it like I, my lovely wife, right? Who is a redhead by the grace of her colorist. So like she has a person that she sees and she who takes care of her hair, her hairdresser, right? And she has a person, right?
And I get, I'm being a little flippant about it, but the point is like she has identified a person who helps her with one aspect that is important to her and my patients identify that with me and all the time, like I'm not looking to see them every day all the time, right? I'm absolutely here to help you when this thing pops up and if we're good, go about your business.
Once you become somebody's physical therapist and they understand the value that you bring, they're just going to come back eventually, or you're going to see their spouse or their cousin, or their kids or their neighbors, right? You become that, that expert, just oh, this is my dentist.
Oh, you need a dentist. I love my dentist. Oh, I got an optometrist. That guy's amazing. So it becomes, like you said, you fill that doctoring role in the communities in which we live and serve and stepping up into,
Marla: And that's it. I'm your provider for life.
You're my patient for life. You're going to come back to me first. You don't need to go to any other physician when you have a musculoskeletal injury, I am your doctor to see that.
Drew: Yeah. And so part of that too is understanding what does the reevaluation / discharge look like? What does that mean as you're taking care of these people?
I'm always in the, like you said, I'm in the like, good, we're done with this thing, because I always have some sort of objective that we're going for, right? Whether that’s “I'm struggling with my shoulder or my golf swing.” Alright, can you play golf again? Yeah, I could play golf again. It's not perfect, but but you know what to do.
You know how to work on this. Great. Alright, good. We're good. But I'm here for you when it comes back or when it becomes your back and not your shoulder or when you decide it's a new problem. So understanding that reevaluation kind of sets path a forward for continued engagement with patients, not just a great, you were here for 12 sessions, you did your stretchy band exercises, you're done.
Goodbye. Like you said, understanding that you have this relationship and role as a doctoring profession, just any other person.
Marla: I love it. I think this is, obviously it's nothing new. This is something we've been talking about for years, but it's how are we implementing it? How are we really making it our identity and taking hold of it and moving the needle.
And I love how your first step was just for you to call yourself doctors, your clinics to call new doctors. The marketing to say doctors.
Drew: It's not complicated, right? But, I also recognize that our colleagues that will see, hear this and say, what does, ah, it doesn't matter.
You could think that, right? But I really hope that there's somebody who's going to hear this, who's going to latch onto that and understand that as they move forward with their profession and their practice, or maybe they become practice owners, right? That this becomes part of the ethos of the profession.
Because otherwise right, you're, it's never going to
Marla: And do you think this part has to happen first before we get the higher reimbursement rate as that non-physician primary care provider? Or what can be happening concurrently, or how do we get that?
Drew: I think that, like with any strategy, there are multiple things happening at once. But to the point imagine this. So we get we have this conversation with Medicare about PTs being in the non-physician provider role, right? Same as nurse practitioners, physician associates. What do you want that person sitting in front of Congress?
What do you want the nameplate in front of them to say? Mister? Or doctor? Doctor, right? Yeah. Start there. To get to the pinnacle and get to where you can actually move the needle. All these things have to happen, they have to be worked on simultaneously and in multiple fronts. And to not accept that is just it's just being silly.
You have to accept, like you said, that yeah, these changes have to occur if you want to accept the bigger responsibility. And like I said, you want to solve more complicated problems. You want to get reimbursed for doing more complicated things, that's fine. But I expect a certain level out of you when I come into to see you and you start off with, hi, I'm Dr. Contreras, your physical therapist.
Marla: And you also really highly recommend that clinic owners and clinicians partner with those PTAs and keep that model going.
Drew: Absolutely right. Because there's no way to do this without the scale and without having the team in place to keep, it's just like any sport, any team. Like you can't just have a point guard and win a basketball game, right? You've gotta have everybody out there doing their roles. You have to have everybody out there doing the things that they should be doing.
And everybody has different rules and responsibilities, and that's the way that effective team works. Just like when you go in for your annual visit with your physician, right? There are numerous people doing different portions of that encounter. Why are we not just accepting that's a portion of a doctoring profession?
Marla: Yep. Great. And any last minute advice or just takeaways of something that you would say tomorrow, go back and this is what I want you all to talk about amongst each other, or to start and implement.
Drew: I’ll say this, so I’m a big dog person, right/
And so the thing I see sometimes it's be the person that your dog thinks you are. So like I think about that and I think about whenever you're in the clinic. whenever you're seeing patients or whenever you're just coming to work or whatever it is you're doing, if you’re in management, if you’re in the C-suite, if you’re the owner, like whatever position it is, understand that it's hard to fulfill the role of the position that other people think that you should be doing. It's a lot, right? And it's a lot of meeting those expectations. But if you truly want to, be successful it starts there.
It just starts with be the thing that you're supposed to be, whatever that is, right? If that's a PTA, if that's a PT student on a clinical rotation, if that's a clinic owner. Step into that role, and accept the responsibility of it. And if you're a PT, accept that if you're a doctor of physical therapy, that your name should start with doctor.
Just accept the role.
Marla: And how far out do you think we are from PTs being able to prescribe imaging?
Drew: I think that the acceleration is going to come faster than people realize.
And I’d like to think that,
In the 2030s we will be looking at this maybe, you and I are at a conference somewhere and be like, remember that conversation in 2025? Did you think it was gonna happen this fast?
Everything is so accelerated now. There was a great quote that I heard once that like the speed of change today is fast, but it will never be as slow as it is today. Tomorrow will always be faster.
Implementation of AI tools, of just technology implementation, of just your ability to process information is going to accelerate everything. The world's gonna demand more and more. So it's always going to get faster, exponentially. So I think that a decade from now I'd love for you and I to be laughing about this conversation and be like, I didn’t think it was gonna happen that fast, but here we are.
Marla: I hope you're right. I really look towards that because PTs are some of the strongest individuals. They just have all the knowledge it could have when it comes to musculoskeletal movement analysis. When it comes to what I should be doing to work on, as you said, the geriatric falls, any of the medical histories going on right now, the, all of that ozempic that's happening, right?
The muscle loss. We are the providers that should be treating and seeing all of that,
Drew: Right? And again, we just have to accept that, yeah, we're the right people for that role. And it doesn't mean right that you do everything. Because that's the side that starts, you start stepping into rules that like, and we're not, we are not best suited for everything. But this is where we can have the most impact.
Marla: Awesome. Awesome. Drew, this has been a pleasure. I am excited to share this with everybody and hopefully they've taken some really good points and we'll put it into action tomorrow.
Drew: Absolutely. Thanks for having me.