At no level alongside his three-year path to incomes a level in bodily remedy has Matthew Lee fearful about getting a job.
Being able to make a living off that degree? That’s a different question — 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.
“There’s definitely a shortage of PTs. The jobs are there,” said Lee, a student at California State University-Sacramento who is on track to receive his degree in May. “But you may be starting out at $80,000 while carrying up to $200,000 in student debt. It’s a lot to consider.”
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 was 17%.
Wait instances are usually lengthy throughout the nation, as sufferers inform of ready weeks and even months for appointments whereas coping with ongoing ache or post-surgical rehab. However the crunch is especially acute in rural areas and locations with a excessive price of dwelling, like California, which has a decrease ratio of therapists to residents — simply 57 per 100,000, in contrast with the nationwide ratio of 72 per 100,000, in line with the affiliation.
The explanations are multifold. The trade hasn’t recovered from the mass defection of bodily therapists who fled as practices closed in the course of the pandemic. In 2021 alone, greater than 22,000 PTs — nearly a tenth of the workforce — left their jobs, in line with a report by the well being knowledge analytics agency Definitive Healthcare.
And simply as child boomers age right into a interval of heavy use of bodily remedy, and COVID-delayed procedures like knee and hip replacements are lastly scheduled, the economics of bodily remedy are shifting. Medicare, whose members make up a major share of many PT practices’ shoppers, has minimize reimbursement charges for 4 years straight, and the encroachment of personal fairness corporations — with their bottom-line orientation — means many practices aren’t staffing adequately.
In accordance with APTA, 10 corporations, together with publicly held and personal equity-backed corporations, now management 20% of the bodily remedy market. “What 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,” mentioned James Gordon, chair of the Division of Biokinesiology and Bodily Remedy on the College of Southern California.
There’s a scarcity of bodily therapists in all settings, together with hospitals, clinics, and nursing properties, and it’s prone to proceed for the foreseeable future, mentioned Justin Moore, chief government of the bodily remedy affiliation. “Not only do we have to catch up on those shortages, but there are great indicators of increasing demand for physical therapy,” he mentioned.
The affiliation is making an attempt to cut back turnover amongst therapists, and is lobbying Congress to stop cutting Medicare reimbursement rates. The Facilities for Medicare & Medicaid Providers plans a 3.4% reduction for 2024 to a key metric that governs pay for bodily remedy and different well being care providers. In accordance with the affiliation, that will carry the cuts to a complete of 9% over 4 years.
A number of universities, in the meantime, have ramped up their packages — some by providing digital lessons, a brand new method for such a hands-on area — to spice up the variety of graduates within the coming years.
“But programs can’t just grow overnight,” mentioned Sharon Gorman, interim chair of the bodily remedy program at Oakland-based Samuel Merritt College, which focuses on coaching well being care professionals. “Our 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’m not just trying to take in more tuition dollars.”
All of this additionally comes at a time when the price of acquiring a bodily remedy doctorate, which generally takes three years of graduate work and is required to observe, is skyrocketing. Pupil debt has develop into a serious challenge, and salaries usually aren’t sufficient to maintain therapists within the area.
In accordance with the APTA’s most recent published data, median annual wages vary from $88,000 to $101,500. The affiliation mentioned wages both met or fell behind the speed of inflation between 2016 and 2021 in most areas.
A challenge underway on the College of Iowa goals to provide PT college students extra transparency about tuition and different prices throughout packages. In accordance with an affiliation report from 2020, a minimum of 80% of current bodily remedy graduates carried instructional debt averaging roughly $142,000.
Gordon mentioned USC, in Los Angeles’ city core, has three PT clinics and 66 therapists on campus, a number of of whom graduated from the college’s program. “But even with that, it’s a challenge,” he mentioned. “It’s not just hard to find people, but people don’t stay, and the most obvious reason is that they don’t get paid enough relative to the cost of living in this area.”
Fewer therapists plus rising demand equals lengthy waits. When Susan Jones, a Davis, California, resident, skilled ache in her again and neck after slipping on a moist flooring in early 2020, she went to her physician and was referred for bodily remedy. About two months later, she mentioned, she lastly bought an appointment at an outpatient clinic.
“It was almost like the referral got lost. I was going back and forth, asking, ‘What’s going on?’” mentioned Jones, 57. As soon as scheduled, her first appointment felt rushed, she mentioned, with the therapist saying he couldn’t establish a difficulty regardless of her ongoing ache. After yet another session, Jones paid out-of-pocket to see a chiropractor. She mentioned she’d be hesitant to attempt for a bodily remedy referral sooner or later, partly due to the wait.
Universities and PT packages graduate about 12,000 therapists a yr, Moore mentioned, and representatives of a number of colleges informed KFF Well being Information they’re finding out whether or not and how you can broaden. In 2018, USC added a hybrid mannequin by which college students be taught principally on-line, then journey to campus twice a semester for a few week at a time for hands-on instruction and observe.
That bumped USC’s capability from 100 college students a yr to 150, and Gordon mentioned lots of the hybrid college students’ skilled abilities are indistinguishable from these of scholars on campus full time.
Natalia Barajas acquired her PT doctorate from USC final yr and was just lately employed at a clinic in close by Norwalk, with a wage of $95,000, a signing bonus, and the chance to earn extra in incentives.
She’s additionally managing lots of debt. Three years of tuition for the USC bodily remedy program involves greater than $211,000, and Barajas mentioned she owes $170,000 in scholar loans.
“If it were about money alone, I probably would have shifted to something else a while ago,” Barajas mentioned. “I’m OK with my salary. I chose to do this. But it might not be the perfect situation for everybody.”
This text was produced by KFF Health News, which publishes California Healthline, an editorially impartial service of the California Health Care Foundation.
