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Here's your host, Jimmy McKay.
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Now imagine...
You're in a DeLorean.
But instead of checking the time circuits,
you're scanning tuition statements,
burnout rates.
The year on the dashboard,
twenty twenty six and the dashboards
flashing red.
Something's wrong in the timeline of PT
education.
It's bloated.
It's broken.
And it's barreling towards a cliff,
or maybe we went over one already.
So three longtime disruptors,
part educators, part entrepreneurs,
part Doc Brown with spreadsheets,
grab the keys and hit eighty eight miles
an hour.
Together, they founded programs,
launched companies,
taken on the APTA and lived to tell
about it.
And they're back not just to warn the
profession.
but to rebuild it.
This is Back to the Future, part one,
the radical proposal to save physical
therapy through a five-year DPT redesign.
Let's welcome in the show, Tim Flynn,
Larry Pence, John Childs.
Gentlemen,
how was my Back to the Future intro?
Was it DeLorean-worthy?
I would say it was Rivian worthy.
Rivian worthy.
There you go.
Now, I got to tell you,
I started this podcast by accident ten
years ago when I was still a student.
And I remember.
A couple,
and I think it was John walked by
and you were having a conversation with
someone and I said, who's that?
And I remember someone saying, oh no,
you don't want to talk to that guy.
He does crazy stuff.
And I remember hearing about you guys
because I was still in school and hearing
about you guys over the years going,
all the crazy stuff they're doing feels
like it makes sense.
Am I the crazy one?
So let's start out with this.
What year would you set the time machine
back to?
When did PT education go off the rails?
If we were going to go back in
time to sort of change it before it
sort of forked, when was it okay?
And then when did Biff Tannen show up
and ruin everything?
Well,
I'll just start off with a lighthearted
comment.
I should defer to my elders,
Larry and Tim.
They have more of the history than I
do.
We live the history.
In fact,
we graduated pretty close together,
Tim before me, so he should go first.
All right, Tim, when did we mess up?
Well,
I started as a bachelor's and actually
with a bachelor's was teaching people like
Larry who was getting a master's at Army
Baylor.
So I guess I am the oldest.
So I think from my perspective, probably,
and I think I was part of the
problem just when I look back at the
time.
But it was really when we went to
the DPT,
when you look at how that came about,
the the conversation around that time was
such that none of the universities are
going to buy buy this you know it's
going to be such a heavy lift to
really go from a master's degree because
the ninety it went to the masters to
the doctorate and but what was fascinating
uh literally you know within about five
years everybody went there and i as you
look back you go hmm
You sit around the university and at the
board of trustees or even down below.
So let me get this right.
You want to go from two years to
three years and with the same number of
faculty.
So you basically we get another years of
tuition with really little cost.
Yeah, we should do that.
We should do that.
So basically all these universities went
from zero to sixty and all of a
sudden we have seven years of education.
but i'll defer to my my junior colleague
uh dr benz here because he he really
has the most uh detailed perspective i
think yeah so i think there's a couple
surprises here and when i talk about this
sometimes people look at me kind of
strange but let's rewind the clock to how
the profession looked at it by the
profession i mean apta international
organization because
they led and carried the banner.
And you also have to remember CAPT is
to an extent intimately tied to them.
So, you know,
when I was in graduate school,
in nineteen eighty four, Tim,
you were getting out probably nineteen
eighty five.
You got up right at the beginning of
eighty six.
And so Tim is correct.
He actually was one of our clinical
instructors while he had a bachelor's.
I chose a master's program.
in part because it was the Army Baylor
program and it was subsidized,
but also in part because it was one
of the few master's programs that was
available then.
Again, think about that.
In nineteen eighty-four,
there weren't many master's programs.
So what drove the master's degree?
What drove the master's degree was our
profession.
APTA said by nineteen ninety,
and I think it was nineteen ninety,
I'm going to be directionally correct
here,
All one hundred and eight programs at that
time, whatever the number was,
need to be at a master's level with
whether they're both private or public.
And obviously the privates exceed the
public's because they have the flexibility
and the autonomy to do so.
Unfortunately,
it wasn't until likely the last master's
program probably hung around until the
late nineties.
We could look this up.
but um there were a few laggards and
lo and behold by the time the last
master's program actually complied with
the regulations by the way ot tried to
do this very unsuccessfully just a few
years ago it didn't work for them they
tried to do it to the dpt or
to the otd but in any event our
profession said the body of knowledge is
worthy of a master's degree
Not everybody complied on time.
And even though the mandate was,
let's say, nineteen ninety,
it took another ten years.
Unfortunately,
it only took a few years to convert
from master's to DPT.
And why was that?
As Tim alluded to,
it was driven by higher education.
It was driven by the desire to get
more bites of the apple in the tuition
dollar from students.
It just affect PT.
It affected almost everything.
They call that academic creep.
Accounting went through it by way of
example.
Pharmacy went through it.
Speech and hearing went through it.
OTD obviously did as well.
Many others did.
And so that's a really fundamental thing
we have to remember.
At some point then the profession,
Creighton I believe was the first program
to go to a DPT level.
And again, private schools exceeded,
many states had to pass things within the
regulatory bodies of their state's own
higher ed to get
physical therapy to a doctorate education.
But the point,
main point being is that it transitioned.
It didn't take, let's say,
fifteen years to go from bachelor's to
master's.
It was supposed to take ten.
It only took about five.
It was like,
it just absolutely exploded because the
tuition went crazy.
So much so that when I have lots
of friends and when I first started to
employ PTs, we used to actually pay,
we were still out of undergraduate
programs when I was first in business,
we used to actually pay scholarships.
for PTs to get their bachelor's degree and
then come work for us.
Obviously by the time I got to a
master's and certainly a DPT,
who's gonna be able to afford three and
four years of tuition dollars.
One last point, I'll let John speak.
We should not let higher education
continue to dictate our profession because
our profession has migrated.
We'll talk about COVID and the impact it's
had on quality and types of education and
hybrid and all that kind of stuff.
But we have the control.
We have the ability to retrain this and
go back to the future if we want
to.
It will take some regulatory changes.
It'll take some gnashing of the teeth.
But it really is going to take our
profession to go back to commanding
control of itself like it did from the
bachelor's to the master's.
Yeah,
I think the primary comment I would have,
and this is being as a critic to
some extent of higher ed,
I'm absolutely convinced if there was
enough demand for a ten-year DPT program,
higher ed would absolutely support it and
move in that direction tomorrow.
Now, that's a little bit facetious,
but the reality is to some extent we
are a victim of our own success.
There is such demand for our services
and a lack of therapists that are out
there, that there's this motivation,
obviously,
to produce more and more therapists as
needed.
And the demand is so high and the
willingness of the federal government to
subsidize these loans,
higher ed is just sitting on this heyday
of extended academic creep, as Larry said.
And again,
that might be a little bit of an
overly cynical view,
But I think back to the time when
I was in PT school in the Army
Baylor program, similar to Larry,
it was a master's program.
And at that time,
every program was a master's program,
and most every program was two years in
length.
You know,
we were being sponsored by the Army or
the Air Force, in my case,
who was incredibly interested in getting
us out of school as soon as possible.
Right.
The motivation is entirely different.
They're paying us salaries as lieutenants
and captains to sit in a classroom and
be relatively unproductive.
Right.
We're not seeing patients.
We're on a pathway to get a degree.
So the motivation was acceleration.
The motivation was motivation.
full time class, you know, eight to five.
The motivation was no summers off.
And so the Army Baylor program,
even when I was there,
was eighteen months.
I mean,
it was six months shorter than the
average, quote unquote, two years master.
And so
you know,
I think even with the master's program,
we saw academic creep because there were
at least some models where the incentives
were different,
where the time from inception to
graduation was significantly shorter.
All right.
So now we fast forward and we've got
regulations that are coming into play.
So that rise rule, which everybody read,
but they didn't read it.
They read the abstract and panicked or
they read it and said, well,
you guys are the guys who actually read
and understand this stuff.
The rise rule could change everything.
Are we about to see the federal government
make DPT education impossible or is this a
good thing?
Help me read these tea leaves here.
Let me comment on a couple of things
before we go there a bit because there
are some monumental inflection points in
our profession.
Um, two thousand one
And the teaching point here is that we've
never tried to control for supply demand
or volume of PTs.
And when the profession has tried to,
they've been grossly wrong.
So in two thousand one at that time,
there were about ten thousand new graduate
new PTs per year,
ten thousand in two thousand one,
five thousand American graduates of
schools that would take their exam.
And most of them,
if not all of them,
would practice clinically.
At that time,
there would be ten thousand foreign
trained therapists that would come in the
US.
Half would pass the exam statistically.
So another five thousand would become
employed in the US.
Now,
up until about a year or two ago,
we're now graduating about twelve
thousand,
although not all twelve thousand are
practicing clinically,
not all of them are passing the exam.
But we are literally now in two thousand
twenty six,
roughly where we're at in two thousand one
in terms of the same numbers.
That is when we should have made a
decision on PT education because we needed
more PTs.
Surprisingly, though,
the academic community actually predicted
that we were going to have this huge
surplus.
And that huge surplus caused this pushback
for developing not only programs,
expanding programs or innovation.
Those three things,
when you halt program development,
you halt innovation,
and you halt the expansion of programs,
you literally are trying to restrict PTs
in order to be able to get the
number that we need.
And now what we have is literally
Seventy to eighty percent of people who
apply for a PT education somewhere are
going to get accepted.
We have seats that are open.
Who would have ever predicted in my
monologue to this week's post,
which will come out tomorrow or Wednesday,
who would have ever predicted there'd be a
time where anybody could become a PT?
The qualifier is actually quite low.
That has its own unintended consequences.
So when we talk about rise here,
we need to also, of course,
correct the quality of students,
coupled with those who are passionate and
really want to become a PT,
coupled with the ability to do it,
the affordability and student loans,
all those things.
So we have to really kind of address
all the challenges simultaneously,
but we're going to keep pushing on one
part of the sweater and another part is
going to get a flaw in it.
I sat in a room with two hundred
ninety nine other applicants.
They had narrowed it down for how many
applications to three hundred in-person
interviews,
three one hundred person sessions for
thirty eight seats.
And I remember doing the math when I
walked in going, man,
I got it for every ten person,
people that walk in.
I got to be one of them.
Sorry, I'd be nine of them.
I got to be the one.
And that gets a little intimidating.
And now you hear some of the application
rates falling through the floor.
which is again,
shocking in that short time span.
Again, that was twenty thirteen for me,
twenty twelve.
All right.
So where do we go next?
Do we go do you want to fast
forward to the to what's happening now or
is there still some context?
Well, I'll take briefly the rise question.
It's obviously still out for comment.
I think we're all hopeful that PT is
going to get its due recognition as a
profession, so to speak.
It's to some extent,
I don't know if it's humorous and or
sad, probably some of both,
that many other disciplines not to be
named here are considered professions when
we're not.
But if we go down the path of
sort of this worst case scenario where all
of a sudden graduate loans are
significantly curtailed, right,
wrong or indifferent,
it will absolutely force innovation in PT
education.
We will overnight see programs getting
shorter, faster, more innovative.
I'm not saying that's necessarily the path
I wanna see us go down,
but smaller under-resourced programs that
have big buildings and lots of fixed costs
they're all of a sudden, I mean,
if you don't have more than fifty to
sixty students in your program,
you're going to go away.
You simply don't have enough revenues at
that level to support the cost of running
a program.
And so I think what we'll see in
that worst case scenario is the strong
getting stronger.
And boy,
there will be a third of DPT programs
that will immediately start to struggle
and or, you know, at some point,
you know, disappear.
Now, having said that,
I've been predicting this, you know,
third of PT programs going away for ten
years,
and it's just not happening at the pace
at which I thought.
So I'm guilty of, you know,
maybe early forecasting,
but certainly a significant change like
we're talking about with some of the RISE
regulations would absolutely force that,
you know,
those smaller under-resourced programs to
rethink whether they want to be in the
PT business.
And you guys are going to go into
detail with a series of articles,
as I'll mention in the show notes.
We'll give a link to that as well.
So let's get to the solution.
I mean,
I think people are pretty familiar with at
least some, if not all the problems.
So great.
As my research professor in PT school said
with a great Irish accent, we know what?
now what i'm sorry what so what now
what break down that five-year dpt
proposal is this the hoverboard
everybody's been waiting for you know what
how does it look what does it do
to solve some of the problems we're we're
currently in have at it well i'll i'll
speak to that and um
to say that really,
all of us here probably had many
undergraduate courses that really didn't
prepare us to be excel and PT.
And what I would mean by that are
certain we're certain heavily on certain
courses that just didn't translate.
So but just as we've accelerated the DPT
from three to two, at the bottom line,
our
our entry into the PT world should be
quicker.
I mean,
three years as a three-year bachelor's
degree,
heavily focused on the skills of
healthcare professionals so that the
skills really are.
Yes, a strong liberal arts background,
actually, but liberal arts,
it's applied to those skills that make you
great at communicating with others.
You know,
those skills that actually translate
across all the health care professions.
So whether you go into a DPT or
an OT program,
a PA program or to medicine,
You essentially have the background of the
people skills.
And that three-year bachelor's should
include credit for
people that are working in the health care
industry already that are in people
focused business or even people focused
business.
I often say, you know,
I've always felt that bartenders and
servers and waiters and waitresses are
some of the best people to come into
our profession because you basically have
to think on your feet.
You have to look people in the eye.
You have to communicate with people.
And when shit goes wrong,
You have to think on your feet and
pivot and make things right.
That to me are a skill set that
people should have credit for as you go
into health care professions.
To me, you know,
there's heavily on the the sciences that
are focused to what we need in PT
and heavily on the humanities side of it,
but also with practical skill sets that
are people facing.
And just one last comment.
The thing that comes back always is, oh,
you know, that's higher ed, you know,
it's, you know,
they're not going to pivot.
And like we've said,
people pivot immediately,
like we did in COVID,
when the situation requires it.
But that's how I had probably started.
I'll start on that kind of the entry
point side.
Just a couple observations.
One on RISE,
I'm going to predict that it's not going
to end up being anything of significant,
even if it stays intact,
it'll get kicked down the road many years
before it actually gets implemented.
Again, this is just my opinion in part,
not because of PTs, but because nurses,
nurses usually win.
They have strong advocates, advocacy.
The reality is healthcare shortages are
not in dispute.
And, you know,
putting forth an old reg on new student
loan limitations doesn't make any sense
for anybody.
You think we have one of the lowest
diversity percentages in PT would only get
worse under those scenarios of rise.
I think brighter minds will prevail.
Having said that, regardless,
we need more innovation in PT.
The best example I'll go back to is
nursing.
You could get a nursing at an RN
level, a BSN, MSN,
a doctorate and nurse practice now.
And we have to have some tools to
do that.
So I do like the three-year bachelor's
into a two-year DPT.
But I also like other flavors too.
I like the idea of graduating in two,
you know, baccalaureate for four even,
two years in a DPT.
Okay, that's an additional year,
but then you would get a master's and
you'd get paid.
The reason why that's you get your license
and you get masters,
that's critical because we have horrible
regulations that basically say if you
treat a Medicare patient that is in,
you know, life threatening Part A,
you can do so independently without
supervision.
But in Part B,
you can't get billed or reimbursed unless
you are consuming the same oxygen as a
licensed PT standing next to you.
And so that regulation,
we're not going to change.
We failed at every Medicare regulation
change.
We take shallow victories and things that
don't matter and things like direct access
and things like the regulatory supervision
requirements,
eight minute rule and student supervision.
We're not going to win, in my opinion.
And so let's play the game and say,
let's give them a license two years or
halfway through PT school.
So that way their billing will count.
They will not be as productive.
They do not have to start as a
full time salary.
Residents and interns don't get full time
salaries either in the medical model.
And that can become a pathway when you
complete that time frame of a year,
whatever it is,
then you can get your DPT.
So my point being is I think we
have to develop a multitude of pathways,
all of which uphold the rigor of academic
and the competency and the knowledge base.
But to Tim's point,
what scares me the most is we will
oftentimes default to too much technology,
and then you're going to lose all tacit
knowledge skills.
You're going to lose collaboration and
teamwork and empathy and compassion.
And the things that really, you know,
we're a victim of our success because we
have the hands-on skills,
we have the quantitative skills,
but we also have the qualitative parts to
our profession as well.
And I'd hate to see that also be
sacrificed for efficiency purposes.
Yeah,
I don't have a whole lot to add
other than I do think nursing is a
good example of, I mean,
they have their own, you know,
issues with so many accreditors and some
of those kinds of things,
but they've certainly been innovative in
having lots of different pathways to all
sorts of variations of
master's degrees, bachelor's degrees,
doctoral degrees to specifically equip you
for the role that you're going to play
in the nursing ecosystem.
And at least in PT at this point,
we sort of have a one-size-fits-all kind
of an approach.
And I would say I think the good
news is we've got a lot of room
to innovate.
I mean,
if you go back to the four-year bachelor,
there was a time where there was
I don't know if it was ever a
third, a third, a third,
but you'd be working in the same clinic
with bachelor PTs, master's PTs,
and doctoral PTs.
Everybody would be in the same.
And as you looked around at each other,
I don't think any one of us would
say, well,
I'm a better PT than you are,
or you're a better PT than I am.
You've just had a different degree.
Right.
And now we're in a situation where there's
probably few to there's probably still
some,
but there's probably very little bachelor
PTs that are still practicing.
And it's a mix of mostly doctoral PTs
and some and some masters.
My point in saying all that is we've
got we've got like three years of room
to kind of play with.
Right.
We went from four years all the way
up to seven years.
And so surely there are some innovative
opportunities to bridge that gap.
I think about it from the perspective of,
you know,
when we went from the master's degree to
the DPT, you know,
if you really look at it at its
most foundational level,
you have to ask yourself, OK, well,
what else are PTs going to be learning
in order to go from this master's degree
to the DPT?
At the end of the day,
it was like diagnostic imaging,
some primary care, medical screening.
Think all things that would prepare us for
direct access, right?
Most programs were two years in length and
higher ed, again,
found a way to justify that that amount
of content deserves an entire another year
of education.
When in reality, I mean,
if we're really honest with ourselves,
could we have done that in three months?
Could we have done it in six months?
For sure,
we could have done it in six months.
And so, you know,
I don't think we have to get rid
of the DPT and go back to the
masters.
I don't think anyone thinks that's really
the path we're gonna take,
but we can absolutely create these
milestones along the way,
like Larry alluded to, where, you know,
we get a,
a bachelor's degree,
whether it's three years or four years,
we go to a master's where we become
licensed and we have the opportunity then
to complete our, our DPT on the backside.
And so there's just,
there's a lot of opportunity,
but we do have to have a regulatory
body and a professional association that
will embrace that, that innovation.
If we continue to just
You know,
hit the hit the nail with the hammer
and say it's a, you know,
seven year DPT program.
You know, we're never going to get there.
Right.
So who decides this or who needs to
be the person that says this has to
happen or else?
Right.
There needs to be consequences.
It's a nice thing to have or it's
a need to do.
Who's in charge of that?
Yeah, so just to allude to this,
but employers of PTs are severely
underrepresented in this argument.
We grouse, we complain,
but we seldom have any voice or influence.
And so we have to have employers banding
together and locking arms with our
academics and our higher education with
our regulators around this.
You know,
there's this other interesting phenomenon
that sort of happened,
I refer to as the post-COVID hangover.
And that is the reality that during the
COVID time period,
things were incredibly relaxed
regulation-wise,
which allowed people to do remote
learning.
We were deemed heretics by our own
profession for trying to do a two-year
hybrid PT program.
And we had decent number of years,
even prior to COVID launching.
COVID launched,
our phones were ringing off the hook with
people, how do we do this?
Because we suddenly had academics,
particularly in our own profession, said,
never, ever,
ever over my dead body will I teach
online.
Now, wanting calling and saying,
how do I teach instructional design?
How do I learn?
and do things online.
All good.
Things have changed.
There are a lot more programs.
That's a step in the right direction,
but it hasn't cured anything.
And the reality is, as an employer,
I can tell you that PTs are coming
out with less reps.
They're coming out with less clinical
confidence and less clinical readiness.
That's not an old fogey saying, you know,
they're not as good as they were when
we were there.
That is well documented amongst the
employer groups.
So what do we have to do?
We have to even put more resources
into the training of new pts that have
suddenly paid for six or seven years of
school and aren't clinically ready now
this just isn't a pt phenomenon i work
in dentistry now it's the same thing there
it's the same thing in primary care it's
the same thing across because the regs
relaxed enough were enough reps enough
clinical experience so we do have to go
back to a more lengthier
you know,
time period and on the clinical side and
regain that.
Is it a less quality student?
I don't know.
I'm not willing to go there necessarily,
other than the failure rates seem to seem
to suggest a correlation there.
But I want to get a better clinical
education,
which we've
collectively referred to as the big black
hole.
And we have some strong opinions about how
to correct that.
But I'll let Tim comment on the regulatory
side,
how we can figure out a way amongst
the key stakeholders to get this thing
turned.
Well, thanks for that, Larry, I think.
Part of it is...
As the most current practicing academic,
I thought you might have some ideas on
how we can do that.
Maybe not.
Well,
I was always offended when I was called,
and I still am.
called an academician.
And I mean,
I just have always felt that I'm a
clinician and I never fit in the world
of academia because it just,
it's an area where, and again,
I have wonderful colleagues in academia,
but the difference between sitting around
a table for an hour and a half
and discussing things
and debating things that just,
you can't do that when you're actually
trying to make payroll.
I mean, that just, it just doesn't happen.
Unfortunately, you know, you think about,
you know,
academia being liberal thinking and out
there new ideas,
and I would argue it is not.
It is very much
rooted in, you know,
tradition and the threats of, you know,
something doing something different.
And that's just so I don't think
unfortunately,
universities are where we're going to look
to see change happen.
And and when it comes to regulatory
bodies, you know, that's that's again,
you know,
rigid
hard to push through hard to do anything
innovative i really think the change
happens unfortunately through the through
a crisis is what we're seeing you know
as we see you know this huge demand
for our services but not able to create
a product out there that that
can meet that demand.
So I'm more hopeful that, you know,
our business leaders and our actually work
areas will be able to
change and partner with higher ed in a
way that other businesses have to say this
is what we need and we're willing to
come and partner with you to create this
if you know we know that you're gonna
feed us a quality person to work in
our in our in our field so that
I guess my sense is it's going to
be
going to be hard but the second thing
is with the this quote-unquote educational
cliff I think the bachelor's thing isn't
going to be that difficult because there's
so fewer students that everybody's
competing for and that bachelor's level
that those that are innovative there
I think we'll be able to scale up
and have larger programs,
especially if they really focus like some
of these private, dare I say,
for profit institutions that are actually
responsive to a bottom line to say, hey,
we can scale up and get more people
through a bachelor's program in three
years and feed into all these different
health care programs that we all need kind
of a similar skill set, I think.
Whoever does that,
and maybe some people are,
but it's definitely not common.
Whoever does that quickly,
I think can rapidly fill seats and be
able to help that side of the workforce
and roll them into DPT.
So that was a long-winded answer to say
I'm not real hopeful that I can see
disruption happening
anytime soon but maybe i'm curious what
larry's thoughts are actually because you
always have those uh oh go ahead john
Well, no, I was going to say,
I'll just add one anecdote that sort of
touches on sort of the resistance in
higher ed and amongst accrediting bodies.
And in our case, that's CAPTI.
I mean, this is ten years ago,
but I will never forget the moment that
we sat across the site visitors.
This was the very first hybrid two year
DPT program at South College.
This was probably I don't know if it
was twenty thirteen,
something around that time frame.
This was the hybrid model where all the
didactics were going to be done online,
synchronously, asynchronously.
Then when they came onto the campus,
it was going to be eight,
nine hours a day on your feet,
getting all those reps in.
This idea that psychomotor practice over
and over and over,
you know,
over a seven to ten day period,
you know,
maybe those skills could be retained in a
more effective way than this sort of
lecture lab,
lecture lab model that's very inefficient
in a lot of traditional programs.
And I will never forget when one of
the site visitors looked across from me
with this sort of blank stare and said,
but John,
by having them in labs all day long,
you're going to exhaust these students.
And I'm sitting there and I'll never
forget my reaction.
I had a really hard time not almost
lashing out.
I mean, I wanted to be like,
that's exactly what we do as clinicians.
We stand on our feet going from patient
to patient.
I mean,
it's a marathon in the day of the
life of a clinician.
And so my point is,
is that you have these sort of incumbents,
dare I say gray hairs,
that have not been in practice for many
years,
who've completely lost perspective with
what a clinician does every day.
And so, you know,
we have to get the perspective of
clinicians to Larry's point,
employers have to band together, you know,
without employers,
we don't have clinical sites,
employers have far more
potential influence than I think we've
realized as employers.
So I think employers are a bright spot.
Nursing, again,
we've talked about nursing.
They have so many different pathways.
In part,
that's because they have so many different
accreditors.
And so those different accreditors have
sort of different flavors of kind of risk
appetite for innovation.
And it depends on the state you're in.
I personally think we should have more
than one accreditor.
Right now we have one in CAPTI.
The problem is individuals have looked at
starting other accrediting bodies,
but I'll forget how many states it is,
but in let's call it twenty to thirty,
it might even be forty states.
CAPTI is specifically named in the
practice act as you have to graduate from
a
CAPTI accredited program,
not just an accredited program, right?
And so in order to compete,
so to speak, with CAPTI,
you'd have to literally change practice
acts in all these states,
which would take fifty years to do and
it may never happen.
So, you know,
at the at the end of the day,
we need more competition and we need more
willingness to accept really innovative
practice models or educational models.
What happens if it doesn't change?
And we mean we need more
Well,
part of the unintended consequence of all
this is, you know,
physical therapy tuition in the higher ed
level, I'll start there,
has been unabated relative to their
increases in cost and tuition factors.
And so as that has exceeded inflation for
so many years,
it's finally starting to have, you know,
some counterbalance in it because of some
other disruption that's going on.
I'm not talking about PT,
I'm talking about higher ed in general.
But the reality is who would go into
the profession for the ROI that you get
at this particular stage?
That is our selfish motivation for wanting
to correct this.
We want our best and brightest to go
into it.
There is absolutely, in fact,
the way you can tell the ROI is
so bad is only about on an FTE
basis,
only north of of all licensed PTs practice
PT, okay, on a full-time basis.
What other profession can you name in
health care that has that obstacle?
What other profession, period,
health care, unrelated to health care,
can honestly say we've had less
productivity today than we had ten and
fifteen and twenty years ago?
I don't know of any other occupation in
America that can say that.
But PT, we have.
So the issue is we are overregulated.
And unless you get a combination of
decreased regulations and or enhancement
of reimbursement,
certainly don't see that coming.
You're gonna have a degree that has priced
itself out of competition for the souls
and the minds of young people.
I think the other issue is you have
to get, you know,
the problem is the states are relatively
the easy ones.
They basically say to get a license,
you have to graduate from accredited
program.
I think we can get the ones that
say CAPTI reverse with probably opening up
that practice act.
But, you know, it's an obstacle,
but they're the easiest.
The more difficult one is CAPTI.
And CAPTI is intertwined, co-located,
and housed by APTA and needs to respond
to its constituents,
which are PTs and employers and
academicians.
And we failed the first two times to
try to get a hybrid PT program.
We failed at it because it was
unacceptable in the view of the
accreditors.
I don't know if that's public knowledge.
I don't even know if I'm allowed to
say that, John.
But it's absolutely because they could not
handle that type of innovation.
Now you've got highbrow universities doing
two-year hybrid programs.
And we have to go down that same
route, unfortunately.
But what we can't do,
we thought within a few years of the
first hybrid program that there would be
imitators.
It didn't take till post-COVID.
until, you know, two thousand twenty two,
two thousand twenty three.
These other programs came out.
Meanwhile, we've got, I don't know,
fifteen or seventeen of these.
And now it's becoming more and more
normalized.
That's a good thing, but it's not enough.
We need multiple pathways,
but we've got to get the creditors in
a room with employers and academicians.
And like we said,
the States are the easiest ones I think
to overcome.
And then you've got to get,
you've got to get some pioneers out there
and it's probably going to come from the
for profits because they tend to be the
most innovative and flexible.
You cannot name great innovation with the
exception of maybe Arizona state,
not on the PT side,
just talking generally,
there are not a lot of high innovators
on the public side that
private side or even fewer.
And so it's the for-profits that got to
say,
we'll do a bachelor completer program in
three years and get you ready for a
PT program that you can do a three
plus two model.
I think there's a pathway there and
there's an opportunity,
but it's going to take probably a younger
set than Tim, Tim, John, I,
and Rob Wainer to get it done this
time.
Maybe not.
Follow along in the series as these guys
keep writing about it.
I'll share the link in the show notes.
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If we don't change the timeline...
If nothing changes,
what does twenty thirty look like if there
if Marty can't lose?
Right.
There's no tension in the story.
People won't pay attention.
I mean,
I'm guessing if there if there isn't some
consequence on the line,
which we can see very clearly,
even someone like me who's an amateur at
this can see there's consequence.
If we don't change the timeline,
what does twenty thirty look like for the
profession?
And then we'll do parting shots.
Looking at you, Tim.
Okay, well, I guess if nothing changes,
we'll continue to see fewer seats filled
in DPT education.
The type of applicant that we'll get
probably in no shade here,
it'll be people that love it.
the profession,
but probably have a trust fund or
something else that allows them to go
through higher ed without debt,
but also probably would rather work
part-time on the outside of it.
We'll continue to see people doing it as
more of a hobby, if you will.
Again,
more and more people working less
full-time
doing other things and having side gigs in
the profession.
And what fills the gap?
Then it's just every other flavor of body
worker will fill the gap out there.
And the health of our society,
I firmly believe will go down.
As a physical therapist that sees over and
over the failure of our system
I'm not it's going to get a lot
worse in terms of health care outcomes in
our society.
All right, Larry, John,
anything he missed there is going to get
harder as we go along because he's covered
a lot of bases.
Anything you'd want to add to that?
I'll just sort of, I think,
amplify what Tim said.
We'll see less diversity in PT.
It'll be largely Caucasian, affluent,
passionate people that maybe had a real
positive experience in PT and debt to
income sort of ratios.
They don't even think about what that
means for them because they have no debt.
I think we'll see certainly a contraction
in the number of
of PT programs.
There's just no way these smaller
under-resourced programs will be able to,
you know, I think, you know,
survive in that scenario.
So, you know,
I'm always a glass half full.
I think the crisis is in front of
us, like literally as we speak.
So I'm hopeful we can, you know, really
you know hopefully eyes are opened uh even
amongst the the those that are that have
been most resistant to change and realize
um uh you know without significant reform
you know our profession is in uh some
amount of of peril yeah all right larry
no pressure but twenty thirty nothing
happens yeah just a
Well,
I expect if you think there's twenty to
thirty thousand shortage of PTs now,
that'll increase five to seven thousand
per year,
notwithstanding because you have less
graduates that actually practice clinical
PT than ever.
We will have less clinicians per year than
we had prior to two thousand one,
which is actually quite scary given the
demand for PT.
But the unfortunate thing is that PT will
continue to be highly undifferentiated.
Digital front doors and digital exercise
will be conflated with PT,
as will at-home remote therapeutic
monitoring and YouTube.
And so there'll be this bifurcation.
If you've got money and you're young and
you're healthy,
you'll be able to access PT.
But if you're sick and you're elderly,
your access points for PT, my goodness,
if you're in a long-term care setting or
a home health setting,
even in acute care setting,
certainly neuro rehab,
you're going to have a hard time accessing
hands-on PTs and pediatrics is probably on
that list as well.
So the specialties are really, really be,
be bludgeoned in terms of numbers.
Those who are getting PT that are more
into longevity and health and fitness and
wellness are generally musculoskeletal.
They'll fake their way into a conflated
PT.
That'll be a combination of a digital
front door and YouTube.
Yep.
All right.
Last thing we do on the show is
called the parting shots.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
Pressure there.
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Tim,
you've done this before with me a bunch
of times.
You get to lead off.
So what's your parting shot?
Final thoughts, soapbox statement,
what do you got?
okay well i still love this profession and
i still feel like from a societal
perspective we have so so much to offer
and despite the gloom and doomed said
today uh i i still believe the future
is bright and we just need to accept
what's in front of us and just like
you know we we have rehabilitated people
We can rehabilitate our system.
And so I'll leave it with that.
It's time for some serious,
deep rehabilitation.
Love it.
John,
what do you got for your parting shot
today?
Yeah,
I think I would just end with a
little bit of optimism.
There are some, you know,
when I look at all the engagement on
the initial post that both Larry and Tim
did, there's some really well-informed,
smart,
younger entrepreneurs in our profession.
that are probably hell bent and have ideas
we haven't even thought about in making
change.
And, you know, that's where we were ten,
fifteen, twenty years ago.
And I'm very optimistic that those
individuals are not going to take no for
an answer.
And they're going to you know,
they're going to couple themselves with
some mentors,
whether it be us or many of the
other
you know,
leaders in the profession that have done,
you know,
contributed to some significant reforms.
And so, you know,
hopefully that energy and youthfulness,
you know, will thrive in a way where,
you know,
we'll see progress perhaps in a way that
us gray hairs ourselves, you know,
may not even be able to see ourselves.
So, you know,
so to any of those young entrepreneurs in
PT, whether you're an academician,
a clinician,
you know,
dare to dream and don't take no for
an answer.
All right, Larry, no pressure.
You got to wrap this up.
Well, while I share in my friends,
colleagues and partners empowerment
message that we do in fact have the
ability to course correct here,
I am also bothered by a serious data
point.
How many,
if you just look at Tim and I,
our kids are all older, John,
your kids may still be in a way
that they can,
but how many will become physical
therapists?
And the reality is that most PTs when
interviewed,
do you want this career for your children?
Absolutely unequivocally say no.
The same thing happens for physicians as
well.
And so my parting shot would be a
question.
If the answer to your question is,
do I want my children to become a
physical therapist?
If that answer is no, what action,
what activities and what do we need to
do and what are you willing to do
and help so that you can answer that
question in the affirmative?
Wow.
Yeah.
Bold questions.
We'll put the link to the series of
articles that are going to be dropping
throughout the next couple of weeks.
Thanks for the insight, guys.
We appreciate it.
And thanks for setting a little optimism,
then also putting some tension in the
story because no pressure, no diamonds.
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
or crank up the next episode.
Want to go deeper?
Hit us at pgpinecast.com or find us on
YouTube and socials at pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
Bullshit!
See, Keith?
We read the script.
Happy now?