At no point along his three-year path to earning a degree in physical therapy has Matthew Lee worried about getting a job.
Being able to make a living off that degree? That鈥檚 a different question 鈥 and the answer is affecting the supply of physical therapists across the nation: The cost of getting trained is out of proportion to the pay.
鈥淭here鈥檚 definitely a shortage of PTs. The jobs are there,鈥 said Lee, a student at California State University-Sacramento who is on track to receive his degree in May. 鈥淏ut you may be starting out at $80,000 while carrying up to $200,000 in student debt. It鈥檚 a lot to consider.鈥
As many patients seeking an appointment can attest, the nationwide shortage of PTs is real. According to survey data collected by the American Physical Therapy Association, the job vacancy rate for therapists in outpatient settings last year .
Wait times are generally long across the nation, as patients tell of waiting weeks or even months for appointments while dealing with ongoing pain or post-surgical rehab. But the crunch is particularly acute in rural areas and places with a high cost of living, like California, which has a lower ratio of therapists to residents 鈥 just 57 per 100,000, compared with the national ratio of 72 per 100,000, according to the association.
The reasons are multifold. The industry hasn鈥檛 recovered from the mass defection of physical therapists who fled as practices closed during the pandemic. In 2021 alone, more than 鈥 almost a tenth of the workforce 鈥 left their jobs, according to a report by the health data analytics firm Definitive Healthcare.
And just as baby boomers age into a period of heavy use of physical therapy, and covid-delayed procedures like knee and hip replacements are finally scheduled, the economics of physical therapy are shifting. Medicare, whose members make up a significant percentage of many PT practices鈥 clients, has cut reimbursement rates for four years straight, and the encroachment of private equity firms 鈥 with their bottom-line orientation 鈥 means many practices aren鈥檛 staffing adequately.
According to APTA, 10 companies, including publicly held and private equity-backed firms, now control 20% of the physical therapy market. 鈥淲hat used to be small practices are often being bought up by larger corporate entities, and those corporate entities push productivity and become less satisfying places to work,鈥 said James Gordon, chair of the Division of Biokinesiology and Physical Therapy at the University of Southern California.
There鈥檚 a shortage of physical therapists in all settings, including hospitals, clinics, and nursing homes, and it鈥檚 likely to continue for the foreseeable future, said Justin Moore, chief executive of the physical therapy association. 鈥淣ot only do we have to catch up on those shortages, but there are great indicators of increasing demand for physical therapy,鈥 he said.
The association is trying to reduce turnover among therapists, and is lobbying Congress to . The Centers for Medicare & Medicaid Services plans a for 2024 to a key metric that governs pay for physical therapy and other health care services. According to the association, that would bring the cuts to a total of 9% over four years.
Several universities, meanwhile, have ramped up their programs 鈥 some by offering virtual classes, a new approach for such a hands-on field 鈥 to boost the number of graduates in the coming years.
鈥淏ut programs can鈥檛 just grow overnight,鈥 said Sharon Gorman, interim chair of the physical therapy program at Oakland-based Samuel Merritt University, which focuses on training health care professionals. 鈥淥ur doctoral accreditation process is very thorough. I have to prove I have the space, the equipment, the clinical sites, the faculty to show that I鈥檓 not just trying to take in more tuition dollars.鈥
All of this also comes at a time when the cost of obtaining a physical therapy doctorate, which typically takes three years of graduate work and is required to practice, is skyrocketing. Student debt has become a major issue, and salaries often aren鈥檛 enough to keep therapists in the field.
According to the APTA鈥檚 , median annual wages range from $88,000 to $101,500. The association said wages either met or fell behind the rate of inflation between 2016 and 2021 in most regions.
A project underway at the University of Iowa aims to give PT students more transparency about tuition and other costs across programs. According to an association report from 2020, at least 80% of recent physical therapy graduates carried educational .
Gordon said USC, in Los Angeles鈥 urban core, has three PT clinics and 66 therapists on campus, several of whom graduated from the school鈥檚 program. 鈥淏ut even with that, it鈥檚 a challenge,鈥 he said. 鈥淚t鈥檚 not just hard to find people, but people don鈥檛 stay, and the most obvious reason is that they don鈥檛 get paid enough relative to the cost of living in this area.鈥
Fewer therapists plus growing demand equals long waits. When Susan Jones, a Davis, California, resident, experienced pain in her back and neck after slipping on a wet floor in early 2020, she went to her doctor and was referred for physical therapy. About two months later, she said, she finally got an appointment at an outpatient clinic.
鈥淚t was almost like the referral got lost. I was going back and forth, asking, 鈥榃hat鈥檚 going on?鈥欌 said Jones, 57. Once scheduled, her first appointment felt rushed, she said, with the therapist saying he could not identify an issue despite her ongoing pain. After one more session, Jones paid out-of-pocket to see a chiropractor. She said she鈥檇 be hesitant to try for a physical therapy referral in the future, in part because of the wait.
Universities and PT programs graduate about 12,000 therapists a year, Moore said, and representatives of several schools told 素人色情片Health News they鈥檙e studying whether and how to expand. In 2018, USC added a hybrid model in which students learn mostly online, then travel to campus twice a semester for about a week at a time for hands-on instruction and practice.
That bumped USC鈥檚 capacity from 100 students a year to 150, and Gordon said many of the hybrid students鈥 professional skills are indistinguishable from those of students on campus full time.
Natalia Barajas received her PT doctorate from USC last year and was recently hired at a clinic in nearby Norwalk, with a salary of $95,000, a signing bonus, and the opportunity to earn more in incentives.
She鈥檚 also managing a lot of debt. Three for the USC physical therapy program comes to more than $211,000, and Barajas said she owes $170,000 in student loans.
鈥淚f it were about money alone, I probably would have shifted to something else a while ago,鈥 Barajas said. 鈥淚鈥檓 OK with my salary. I chose to do this. But it might not be the perfect situation for everybody.鈥
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