Tara Manal is a Senior Vice President at the American Physical Therapy Association (APTA). She joined us on an episode of the Therapy Matters podcast to talk about the physical therapy workforce shortage and the impact this is having on PT practices and outpatient therapy clinics across the U.S.
We’ve pulled out some highlights from the conversation, where Manal spoke about the dynamics shaping the PT workforce, and what the therapy community at large can do about it.
What's Driving the Physical Therapy Workforce Shortage?
When assessing the labor shortage in PT—and in the broader healthcare landscape—there are many factors to weigh, including graduation rates, demand for services, and the number of clinicians who have left the field of practice.
PT School Enrollment and Graduation Rates
To start, graduate program enrollment and graduation rates can be indicative of the future health of the profession.
In this case, however, Manal says there have actually been small increases in the number of people graduating from physical therapy programs over time. Although the growth is small, it is still growing, so that is likely not a factor that’s driving the staffing challenges.
Demand for Physical Therapy Services
The challenge to meet demand for PT services is very real. As the U.S. population ages, there are increasing numbers of people with musculoskeletal problems and other conditions that need physical therapy.
“The idea that [underserved patients] could start getting the care they need is a good thing,” Manal notes. That’s a metric where the industry wants to see demand increase.
Retirement and Attrition
“A Definitive Health study suggested that as many as 22,000 physical therapists may have left the field in 2021,” says Manal. If that figure is accurate, it would represent a significant blow to the overall field of physical therapy.
However, Manal reminds us not to take the numbers at face value, but to look at the trends over time. “The idea that people left the field—and whether or not they returned—is something that we’re going to have to watch, to find out if that was a temporary or permanent change.”
How Can Physical Therapy Practices Address Burnout?
Many physical therapists who left the field may have been influenced by burnout, which is a very real issue that APTA is looking at. Even as recently as 2023, many healthcare providers have not fully recovered after the COVID-19 pandemic and its aftermath, Manal notes.
So, how can physical therapy industry switch from surviving to thriving?
Easing the Transition Back Into Practice
Just as patients need to transition back to life after an injury, physical therapists will need to transition back into the workplace and to patient care.
Physical therapy practice leaders, Manal says, are “trying to really reignite the workforce that may have either left or reduced their workload.” Some of the changes needed to facilitate that transition may include increased flexibility and new modes of staff support. Other solutions may include the automation, streamlining, or outsourcing of burdensome administrative tasks.
Flexible or Reduced Schedules
PTs who have returned to practice may find that the workplace itself has changed, becoming more flexible and responsive to the scheduling needs of its staff.
Observing physical therapist and physical therapist assistants’ preferences shows that some “are more interested in working—not full-time 40 hours a week—but a lower amount … maybe 34, maybe 38, maybe 32 [hours].”
Those extra hours of personal time per week can help PTs who are feeling burnt out, but the trend can cause hiring challenges of its own. “If four or five people do that,” Manal observes, “you’re losing an individual … The hours add up to another whole human.”
Supportive Services and Benefits
Another thing that employers are looking at now, post-pandemic, are benefits and accommodations that physical therapists might need, that were previously not available across the profession.
“That can be mental health services,” says Manal, as one example. “It can even be apps. Some employers are providing calming apps to their therapists as a perk or things like that, that we could do to reset ourselves so that we have that energy, compassion, and that depth that we need to draw on.”
Reducing Administrative Burden
Some of the most pressing challenges for providers take place beyond the typical flow of appointments. It’s the rest of it: documentation, prior authorizations, preventable denials, and burdensome systems that can put a drag on physical therapy clinics’ productivity.
“We had done a study on administrative burden in the field, and what we found was between 77% and 83% of front desk [staff] take more than 10 minutes per individual patient just on prior authorizations, per individual,” Manal says. “If we could reduce those [administrative tasks], you are giving [providers] more time.”
Student Debt and the Challenges Facing Physical Therapists
Of course, we can’t ignore the (expensive) elephant in the room.
Student loans and their impact on physical therapy workforce shortages are an ongoing paradox. If physical therapy salaries were higher, the debt burden would be lowered. If the debt burden started getting lower, then salaries in the industry could be lowered for those just starting out.
Despite the complexity, Manal says the industry needs to get the student loan debt ratio to a healthier place to address the staffing crisis.
“[Therapists] can never quite make enough,” says Manal. “That’s where some of the gig economy that we see is coming [from]. Some of the youngest therapists are working extra nights and weekends so that they can gather extra money to pay off that debt.”
Reducing the Burden of Debt From the Start
The side-hustle or “grind” culture isn’t a sustainable solution, however. In the end, sacrificing work-life balance and working long hours to pay down debt will only hasten the onset of burnout. Instead, part of the solution may start at the beginning: offering more financial incentives and opportunities to PT and PTA students.
Manal points out that many PT programs are looking at how to increase scholarships and reduce educational costs, so that physical therapists can start their career with a lower student loan debt burden.
Federal Loan Repayment Programs
Another idea is to include early-career physical therapists to participate in the National Health Services Corps (NHSC). The NHSC offers a loan repayment program for those involved in rural or underserved care.
“It’s $50,000 of loan repayment for two years, to work in rural and underserved areas, which as you can imagine, is a double win, right? We assist with the student debt, but we also bring excellence and care to those who are not receiving the care that they need and deserve right now,” says Manal.
Looking Ahead: Surviving the Physical Therapist Shortage
The insights shared by Tara Manal, Senior VP at the APTA, have shed light on the challenges facing the physical therapy occupation, and underscored the urgency of taking action to address this critical issue.
For practices that hope to survive and thrive in the coming years, Manal highlights the importance of:
- Proactive measures to address the provider experience.
- Physical therapy-focused advocacy and legislation to support PTs and PTAs.
- Flexibility and support within the profession.
- Technology and workflows to reduce administrative burdens.
Of course, no single outpatient physical therapy practice or clinic will be able to solve the PT shortage on its own. As a final takeaway, Manal emphasized the importance of collaborative efforts and advocacy within the PT community.
“There are so many places where physical therapists can connect and get involved in order to fight for what they need and deserve,” she says. “We need all of those voices in order to be successful.”
