physical therapist surplus??

[j0hn]

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it seems like there will be a surplus of pharmacists in the near future because of the number of pharmacy schools (about 120). will there be a surplus of physical therapists in 5-10 years? there are currently 206 pt programs, but pt programs tend to have smaller class sizes than pharmacy schools.

 

[markelmarcel]

wow 206 programs!

 

[TheOx777]

This is something I have been trying to assess as well. The bls projects there will be ~242,000 physical therapists by 2018. That's seven years from now, but I would only be practicing for 4 years(Class of 2014) by that time. I don't know how this whole health care landscape will play itself out, but let's hope that the demand for PTs remains high!

 

[atstudent]

The clinic I work for has been trying to hire more PTs and PTAs for awhile. I know we have at least 3 PT schools within an hour and two or three PTA programs in that same area. Our clinics also host PT students for clinicals a few times a year. If there's so many, I have to wonder where they are all going? We have one PT going on 20 years besides the owner. A couple of PTs have been here for 4-5 years and then a couple who have less time that that. It's not like the employees are getting run off...

 

[TheOx777]

The clinic I work for has been trying to hire more PTs and PTAs for awhile. I know we have at least 3 PT schools within an hour and two or three PTA programs in that same area. Our clinics also host PT students for clinicals a few times a year. If there's so many, I have to wonder where they are all going? We have one PT going on 20 years besides the owner. A couple of PTs have been here for 4-5 years and then a couple who have less time that that. It's not like the employees are getting run off...

Interesting point. Why do you suppose there is a lack of PTs/PTAs in your area(your clinic in particular)? Do you think it has to do with location; for example not being in a popular metropolitan area? Do you have any knowledge on compensation in your area for PTs? Those seem to be two areas(location and compensation) that a lot of pre-PT and new DPT grads take into consideration.

 

[markelmarcel]

A family friend of mine recently graduated (last June) and was hired immediately upon graduation at a hospital. He said since then he has received 4-6 calls per month on full-time positions since graduating.

Also, a clinic near my house has been looking for a 2nd PT for over 3 years; they keep getting PTAs who end up jumping ship after 6 months-2 years, and want to replace the "flaky" PTAs with another DPT. Just hasn't happened yet. (The owner is a family friend, but I have no desire to live in the area where her clinic is, boohoo- they told me as soon as I was thinking about going to either PTA or DPT they'd hire me when I was done 😉 )

 

[atstudent]

I don't know what it is. We're just outside of St. Louis so there's plenty of people around. I know what I make as an athletic trainer, but I have no idea about our PT staff. I think we only have one or maybe two DPTs currently. A couple with MPT and at least one who was only a bachelors.

 

[markelmarcel]

wow 206 programs!

This is something I have been trying to assess as well. The bls projects there will be ~242,000 physical therapists by 2018.

Say the average program accepted 40 students and let's say all 40 students graduate... that is just over 8,200 students per year graduating!

So, it's 2011-- 2018 is 7 years away (as Ox stated) so that is just under 58,000 PTs who will be "new" to the field, plus all the PTs that are already in practice. APTA says there are "more than 175,000 physical therapists" in the field today. (Another quote said more than 185,500 in 2008).

Interestingly enough I also found this from BLS (dated Dec 2009)

• Job opportunities should be good.

good is defined as "rough balance" between job opportunities and job seekers.


I'm wondering why all the data on BLS is either from 2008 or 2009 when it states that the outlook handbook is for 2010-2011....

 

[j0hn]

actually there are 206 programs that offer DPT, 7 that offer MPT, and 15 developing programs. 228 total programs in total. im a freshman in college so i'm curious how the job market will look for pt's in 6 years.
http://www.apta.org/AM/Template.cfm...MPLATE=/CM/ContentDisplay.cfm&CONTENTID=45221

 

[PT Dad]

I wouldn't worry to much about a surplus. There are 77 million in the baby boom generation, born between 1946 and 1964, that are entering retirement over the next 20 years.

 

[markelmarcel]

actually there are 206 programs that offer DPT, 7 that offer MPT, and 15 developing programs. 228 total programs in total. im a freshman in college so i'm curious how the job market will look for pt's in 6 years.
http://www.apta.org/AM/Template.cfm...MPLATE=/CM/ContentDisplay.cfm&CONTENTID=45221

Ah, didn't realize that there were still MPT programs out and just left out developing programs in the chance that they wouldn't be accredited for some reason, but good to note.

And I also do agree with PT Dad, there's going to be LOTS of people needing the services!

 

[puppypaws]

The pharmacy field seems to be pretty close to saturation while the PT field isn't saturated (yet). I think in 5-10 years PT could be saturated, but probably to a lesser scale than pharmacy will be.
Pharmacists can quickly count out the pills a patient needs while a physical therapist spends a good deal of time working with each of their patients. Even though a lot more people probably need medications than physical therapy, the larger amount of time physical therapists spend with their patients could account for a reason for why a larger amount of physical therapy schools may not have as much of an impact as a large amount of pharmacy schools.
For pharmacists though, their career is probably more overall stable, especially with health care reform. Only pharmacists can sign of pills, while physical therapy assistants can also provide physical therapy services.
If you’re a patient and only have enough money/insurance coverage to choose between your drugs and physical therapy, most people will probably chose their drugs, if not for any other reason than that they need them to stay alive.
Those are just my thoughts…

 

[PT Dad]

Am I the only one who notices that in most pharmacies such as Walmart, CVS, and Rite Aid, the pharmacists are all foreign born. Most likely they are not US citizens but here on work visas They are recruited to work in the US by the big pharmacy chains and are willing to work for less than your typical graduate of a US pharmacy school. This is how the big chains can keep their labor costs low while screwing US citizens. I've seen the same in hospitals with Filipino nurses taking up many nursing slots. It will happen eventually in PT also. Hospitals and clinics will recruit foreign trained PTs who will work for less. Politicians from both parties pay a lot of lip service to job creation and protecting the middle class. Well here's a novel idea: no work visas for foreign trained pharmacists, doctors, PTs, nurses, etc. Why don't the professional organizations protect their membership on this issue?

 

[puppypaws]

Am I the only one who notices that in most pharmacies such as Walmart, CVS, and Rite Aid, the pharmacists are all foreign born. Most likely they are not US citizens but here on work visas They are recruited to work in the US by the big pharmacy chains and are willing to work for less than your typical graduate of a US pharmacy school. This is how the big chains can keep their labor costs low while screwing US citizens. I've seen the same in hospitals with Filipino nurses taking up many nursing slots. It will happen eventually in PT also. Hospitals and clinics will recruit foreign trained PTs who will work for less. Politicians from both parties pay a lot of lip service to job creation and protecting the middle class. Well here's a novel idea: no work visas for foreign trained pharmacists, doctors, PTs, nurses, etc. Why don't the professional organizations protect their membership on this issue?

I'm two sided about that. Politicians should definitely be protecting americans' jobs and cut down on the visas, but a lot of foreigners could be finding a better life here than elsewhere, so I can't personally blame them for coming. I'm more sympathetic towards the the international college students because by the time they finish their degree here, some of them opt to work for a while to pay off their debt because the currency at their country may not be worth enough in comparison to the american dollar to pay off what they owe. But especially in these economic times, the fact that jobs have been drastically outsourced, and are also being insourced into the positions that can't be oursourced, leaves us the question of where to go for a secure job.

 

[j0hn]

The pharmacy field seems to be pretty close to saturation while the PT field isn't saturated (yet). I think in 5-10 years PT could be saturated, but probably to a lesser scale than pharmacy will be.
Pharmacists can quickly count out the pills a patient needs while a physical therapist spends a good deal of time working with each of their patients. Even though a lot more people probably need medications than physical therapy, the larger amount of time physical therapists spend with their patients could account for a reason for why a larger amount of physical therapy schools may not have as much of an impact as a large amount of pharmacy schools.
For pharmacists though, their career is probably more overall stable, especially with health care reform. Only pharmacists can sign of pills, while physical therapy assistants can also provide physical therapy services.
If you're a patient and only have enough money/insurance coverage to choose between your drugs and physical therapy, most people will probably chose their drugs, if not for any other reason than that they need them to stay alive.
Those are just my thoughts…

can a physical therapy assistant provide therapy without a physical therapist supervision? pharmacist also have assistants (pharmacy techs.) that can do most of the things they do.

 

[markelmarcel]

Am I the only one who notices that in most pharmacies such as Walmart, CVS, and Rite Aid, the pharmacists are all foreign born. Most likely they are not US citizens but here on work visas

Can't say that I see that in my area AT all. Not one foreign person in any of the pharmacies in my town... In fact my pharmacist is a white male and the other two pharmacists are white females, USA home-grown.

I'd imagine this is more prominent in cities??

 

[superCOTA]

I would agree with the post that the baby boomers are aging into their golden years, which will help with hips and knees...👍

And in peds.. there is an increase in cases of kids on the spectrum ... 👍

BUT

on the other hand ... many states like NY are cutting the RATE and MAX VISITS (look that up in ADVANCE..scary) ....in anticipation of baby boomers. The new national health care plan may not be too much of the hope and change you wanted ... 😡

SO

GOVERMENT has forseen all of this already, so I think since they wont PAY for much services, too much longer, we are in for a big problem sooner than later. 😡

 

[puppypaws]

GOVERMENT has forseen all of this already, so I think since they wont PAY for much services, too much longer, we are in for a big problem sooner than later. 😡

I agree, and that's what scares me about going into physical therapy...🙁

 

[FitnessDoc2012]

yeh that is an uncertain issue for sure...however, what other careers out there do you think have more growth than PT except software engineering? there aren't many at all...i think getting worried about the job market for PT is pointless b/c numbers don't lie and every statistic shows that there will be more and more people needing rehab....there are really not many options when considering what careers are in high demand...why do you think there are soooo many applications for PT school each year? this is b/c as the economy gets worse and worse, people start to look where there are jobs, everyone knows there is a ton of work for PTs....

 

[jesspt]

I think many of you are asking the wrong questions. There is no doubt that as the Baby Boomers age, many would benefit from PT. A better question is who will be paying for the service? Will it be Medicare, with it's significant reduction in reimbursement rates, private insurance with ever increasing restraints to patient access (referrals/authorization for HMOs, high co-payments and deductibles for PPO plans) or will it be a cash-based clientele?

All the patients in the world won't make the profession secure if our reimbursement for our services drops precipitously.

 

[TheOx777]

I think many of you are asking the wrong questions. There is no doubt that as the Baby Boomers age, many would benefit from PT. A better question is who will be paying for the service? Will it be Medicare, with it's significant reduction in reimbursement rates, private insurance with ever increasing restraints to patient access (referrals/authorization for HMOs, high co-payments and deductibles for PPO plans) or will it be a cash-based clientele?

All the patients in the world won't make the profession secure if our reimbursement for our services drops precipitously.

JessPt,

With you being a licensed therapist who has been practicing for some time, do you see this as a legitimate concern for PT in the future? Are you trying to "warn" us about the profession and do you think reimbursement rates will dramatically affect the profession as a whole?

 

[puppypaws]

reimbursement rates lowering concerns me, but also if the amount of people who go see a PT will lower. I know there are a lot of baby boomers who could benefit from physical therapy, but they don't need physical therapy. Especially if they'll have to fight with insurance companies to get their PT covered, they might just chose to not go to physical therapy. My grandma, for example, was recommended PT for her knee surgery, but she passed it by because she didn't think it would be worth it. PT is important, but not needed, and I think a lot of people don't really understand how PT would benefit them, so they may just bypass it as insurance regulations become too strict.

j0hn: this is one way where pharmacy is overall more stable than PT, even if it may be more saturated. People need their drugs, so insurance companies can never cut that out or cut too much of it out. PT is another story, it can drastically improve lives, but not necessarily save lives.

 

[mtm34]

With respect to an aging population- PT prevents surgeries and falls which end up costing HUGE amounts of money. A hip fracture to someone over 65 costs 20,000 throughout the continuum and has a very high mortality rate. There is no doubt the future for PT is good, the only thing that is shaky is reimbursement and middle man intervention but you have to understand this happens in all careers throughout time and needs to be forged through.

 

[TheOx777]

reimbursement rates lowering concerns me, but also if the amount of people who go see a PT will lower. I know there are a lot of baby boomers who could benefit from physical therapy, but they don't need physical therapy. Especially if they'll have to fight with insurance companies to get their PT covered, they might just chose to not go to physical therapy. My grandma, for example, was recommended PT for her knee surgery, but she passed it by because she didn't think it would be worth it. PT is important, but not needed, and I think a lot of people don't really understand how PT would benefit them, so they may just bypass it as insurance regulations become too strict.

j0hn: this is one way where pharmacy is overall more stable than PT, even if it may be more saturated. People need their drugs, so insurance companies can never cut that out or cut too much of it out. PT is another story, it can drastically improve lives, but not necessarily save lives.

I think you make some valid points, but I have to strongly disagree with the notion that people "need" drugs. In many cases this is true, especially for those who are extremely ill. However, many people who are on meds don't necessarily have to be on them. If we as a country are truly interested in transitioning to more of a preventative system then services like PT could be more helpful and maybe ppl wouldn't have to be on so many meds.

 

[FitnessDoc2012]

good point OX....I just dont see the field of PT hurting in the future, the reimbursements are an issue but the need for PT will continue to increase as more and more evidence comes out on the benefits of PT.....I would think there would be a time when insurance companies start supporting preventative PT so people need less surgeries and therefore insurance companies don't need to pay as much..also, just look around online...there are a TON of pt jobs around...more than any other profession I have seen....

 

[TheOx777]

good point OX....I just dont see the field of PT hurting in the future, the reimbursements are an issue but the need for PT will continue to increase as more and more evidence comes out on the benefits of PT.....I would think there would be a time when insurance companies start supporting preventative PT so people need less surgeries and therefore insurance companies don't need to pay as much..also, just look around online...there are a TON of pt jobs around...more than any other profession I have seen....

Yea. I can't lie to you and say I don't wish I had a crystal ball that gave me insight 30-40 yrs into the future. There is uncertainty in all health care fields. You don't need my word. Just check out the MD/DO, Pharm, Dental, Vet, and Podiatry forums. They are having a lot of the same "money worry" problems that we have in the DPT forums. You are right, I see countless PT job openings everyday, let's just hope that is true for many many years to come.

 

[jesspt]

JessPt,

With you being a licensed therapist who has been practicing for some time, do you see this as a legitimate concern for PT in the future? Are you trying to "warn" us about the profession and do you think reimbursement rates will dramatically affect the profession as a whole?

Of course reimbursement rates will "effect" the profession. It's how we make $$$$. Do I think that reimbursement rates will drop so precipitously in the next five to ten years as to make earning a comfortable living as a PT impossible? No.

I just get a bit tired of hearing about all these baby boomers that are going to be walking/limping/crawling through my doors. The last thing I want to see (if I am trying to make money) is a caseload made up of a high percentage of patients with Medicare.

 

[jesspt]

good point OX....I just dont see the field of PT hurting in the future, the reimbursements are an issue but the need for PT will continue to increase as more and more evidence comes out on the benefits of PT.....I would think there would be a time when insurance companies start supporting preventative PT so people need less surgeries and therefore insurance companies don't need to pay as much..also, just look around online...there are a TON of pt jobs around...more than any other profession I have seen....

Not sure why you think that insurance companies will start paying for preventative care. They haven't really done it in any meaningful way in therapy, and only do this a little in medicine.

Besides, we have virtually NO data that suggests that PT helps to prevent falls, surgery, etc. These things are commonly spoken about on this message board, but the claims are unfounded.

 

[mtm34]

Jess- No data to support PT as an effective alternative to surgery? No data to support PT prevents falls in the elderly? I know you are far more versed in the literature than I am but I have read many studies that support both these claims.

 

[j0hn]

thank you for all of the insight. after much research, it seems like all health professions will face uncertainty. i think a career as a physical therapist will fit me best because i have the opportunity to study what i love and help people too. i hope their isn't a surplus if i become a physical therapist in 6 years. hopefully physical therapists will make more $$ by then too hehe.

 

[atstudent]

Not sure why you think that insurance companies will start paying for preventative care. They haven't really done it in any meaningful way in therapy, and only do this a little in medicine.

Not quite the same, but some insurances are now paying for fitness memberships. There is a program called Silver Sneakers where certain health insurances will cover a basic gym membership for elderly individuals...

 

[jesspt]

Jess- No data to support PT as an effective alternative to surgery? No data to support PT prevents falls in the elderly? I know you are far more versed in the literature than I am but I have read many studies that support both these claims.

They might be out there and I just haven't been made aware of them. If so, let's see 'em.

 

[mtm34]

I'm kind of shocked- What about PT for an ACL tear instead of reconstruction? PT for hip OA instead of THA? PT for LBP instead of discetomy? PT for Rotator Cuff tear instead of RCR? I really don't feel like digging up these articles now but I'll get them tomorrow heres a few quick ones for fall related issues.

fall prevention-
http://www.ncbi.nlm.nih.gov/pubmed/21044715?dopt=Abstract&otool=upittlib
http://www.ncbi.nlm.nih.gov/pubmed/20167644?dopt=Abstract&otool=upittlib

 

[jesspt]

I'm kind of shocked- What about PT for an ACL tear instead of reconstruction? PT for hip OA instead of THA? PT for LBP instead of discetomy? PT for Rotator Cuff tear instead of RCR? I really don't feel like digging up these articles now but I'll get them tomorrow heres a few quick ones for fall related issues.

fall prevention-
http://www.ncbi.nlm.nih.gov/pubmed/21044715?dopt=Abstract&otool=upittlib
http://www.ncbi.nlm.nih.gov/pubmed/20167644?dopt=Abstract&otool=upittlib

You're talking about something different than prevention now. You're talking about PT instead of surgery. Those are not the same thing. We have no data that shows that PT prevents ACL reconstruction. We do have research that shows that it may be an effective option for those who wish to pursue it. In fact, I believe there was a recent study that shows it may be just as effective as surgical intervention. Same thing with discectomy. You're probably referring to the SPORT trial which has soem methodological flaws (namely too much cross-over between the surgical and nonsurgical groups) but failed to show any statistically significant difference in patient outcomes when comparing non-surgical intervention to discectomy.

These are not the same things as prevention.

The first study you reference looks good. The second looks to be a study that assesses PT perturbations on variables that may contribute to falls, but I am not aware that they have been shown to have a correlation with falls. It should also be noted that I practice in outpatient ortho and don't see many patients for falls prevention, so am not as up on that literature as resesarch that pertains more specifically to the ortho realm.

 

[puppypaws]

I think you make some valid points, but I have to strongly disagree with the notion that people "need" drugs. In many cases this is true, especially for those who are extremely ill. However, many people who are on meds don't necessarily have to be on them. If we as a country are truly interested in transitioning to more of a preventative system then services like PT could be more helpful and maybe ppl wouldn't have to be on so many meds.

I agree that not everyone on drugs needs the meds. If we as a country practiced prevention we could definitely cut down on the needed meds, but prevention isn't a very dominant force in medicine in my opinion, so medication is a big thing that patients need. They would probably choose getting their meds over PT if they had to make a choice. If preventative medicine was big, we would see nutritionists playing a much more integral part in the hospital and much more time advising patients, MDs would learn a lot more about nutrition and exercise, and the obesity rates in america would be lower. The FDA would keep all of those crazy chemicals out of food and what not. I agree that prevention helps a lot, but overall what I've seen in the medical system hasn't been prevention but treatment, so that's just what i think would be affected less from the healthcare system reform, unless prevention does become a much bigger thing, and I've heard of small private changes with that, but not big ones.
that's just my view on things though...and I'm only one person

 

[markelmarcel]

You're talking about something different than prevention now. You're talking about PT instead of surgery. Those are not the same thing. We have no data that shows that PT prevents ACL reconstruction. We do have research that shows that it may be an effective option for those who wish to pursue it. In fact, I believe there was a recent study that shows it may be just as effective as surgical intervention. Same thing with discectomy. You're probably referring to the SPORT trial which has soem methodological flaws (namely too much cross-over between the surgical and nonsurgical groups) but failed to show any statistically significant difference in patient outcomes when comparing non-surgical intervention to discectomy.

These are not the same things as prevention.

Thumbs up, JessPT!


Also, I just wanted to add in (did I say this already? I can't remember) that a family friend recently graduated last June with his DPT and said he gets around 3-5 calls per month about full-time jobs, even though he already a full-time employee at a hospital. The jobs are there.

Furthermore, a PT professional that I trust stated that she didn't forsee troubles for the profession for quite some time, that maybe in 10 years the students starting school then may have some difficulties, but that the outlook now seemed good for me and others in my shoes. She owns her own clinic (as well as works some other part-time travel gigs) and was telling me about how she is trying to convince one of her daughters to go to PT school to take over the business... Too bad her clinic is in an area that I have no desire to live in, or I could work with her when I was done. 😉

 

[PTtoBe]

Besides, we have virtually NO data that suggests that PT helps to prevent falls....

I seem to remember that I often agree with your posts, but I think this statement is unfounded and somewhat sweeping in nature.

Smaller RCT (34 subjects > 70 y/o), the control group had nearly 3x more falls than the exercising group:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20854564

Another one found that a year after their intervention study, 75% of falls occured among the nonregular exercises, while 25% were by the regular exercisers:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20718386

Another in which people with a history of falls were placed in a 3-mo. home exercise program, and results presented statistically significant score increases in the FES, Berg and DGI:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20705683

And that's not even a quarter of the way through the results of a single PubMed search, before I even start delving into other databases like APTAs Hooked on Evidence or PEDro. I think one of the many PT responsibilities include publicizing this kind of research to their clients and the public in general to encourage adherence to prescribed exercise, and thus help keep them safe by reducing the likelihood that they'll fall.

At any rate, as far as I'm concerned people have free license to preach PT fall prevention, because that is indeed what the evidence suggests.

 

[jesspt]

I seem to remember that I often agree with your posts, but I think this statement is unfounded and somewhat sweeping in nature.

Smaller RCT (34 subjects > 70 y/o), the control group had nearly 3x more falls than the exercising group:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20854564

Another one found that a year after their intervention study, 75% of falls occured among the nonregular exercises, while 25% were by the regular exercisers:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20718386

Another in which people with a history of falls were placed in a 3-mo. home exercise program, and results presented statistically significant score increases in the FES, Berg and DGI:
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/20705683

And that's not even a quarter of the way through the results of a single PubMed search, before I even start delving into other databases like APTAs Hooked on Evidence or PEDro. I think one of the many PT responsibilities include publicizing this kind of research to their clients and the public in general to encourage adherence to prescribed exercise, and thus help keep them safe by reducing the likelihood that they'll fall.

At any rate, as far as I'm concerned people have free license to preach PT fall prevention, because that is indeed what the evidence suggests.

I'll have to look up the full text of these articles, but the 34 subjects in the first study certainly leaves me underwhelmed.

I looked at this topic about a year or so ago, and admittedly have not kept falls prevention research on the forefront of my mind, as it makes up virtually none of my current caseload. As of that time, I don't remember any research that I found overly compelling, but perhaps I overlooked some.

If so, keep posting them. I am always eager to informed of applicable PT related research.

Also, PTtoBe:

I can't access any of your links, as they just take me to a UW portal that I can't log into. Any chance you can just post the titel and author of hte study and I can look them up that way?

 

[PTtoBe]

I can't access any of your links, as they just take me to a UW portal that I can't log into. Any chance you can just post the titel and author of hte study and I can look them up that way?

Sorry for the bad links. Here's some brief summaries...

PT Journal: Nov, 2010
Improved Fall-Related Efficacy in Older Adults Related to Changes in Dynamic Gait Ability
Who: PT professors from universities and medical centers (University of Florida, Borwn University, VA Medical Center, and others)

Limitations: no control group used.

After screening out 11 subjects due to ineligibility, 63 subjects (mean age 76 y.o.) with a h/o at least 2 falls in past 12 mo. enrolled in a 3-mo. exercise program. The exercise was tailored to their deficits (strengthening targeted platnar-flexors, dorsiflexors, quads, etc. as needed; others would receive endurance training, etc.). Each HEP progressed as the patient was able to. Berg, DGI and FES were used to evaluate them monthly. Significant improvements were noted in all measures on average (for example, Berg postintervention score was a little over 5 points higher on average).

------------------------------

Australian OT Journal (can view on CINAHL database)
LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults
(Various professors
Subjects: 34 who had 2 or more falls in past year.

Limitations: Larger randomized trial is needed.

Applied a "Lifestyle approach to reducing falls through exercise (LiFE)" which is a progressive program focuses on balance and strength training (5 home visits, 2 "booster visits") that the authors created.

Results: 12 falls in intervention group, 35 in the control group in 6 month follow up.

------------------------------------

Journal of Geriatric PT:
Impact of participation in a wellness program on functional status and falls among aging adults in an assisted living setting.
April 2010

Limitations: No control group of nonexercisers, small sample size.

Investigated 36 adults (mean age 85 years old) categorized as either "regular" or "nonregular" exercise participants…19 and 17 respectively) during 12 mo. of participation in a multimodal wellness program. Berg, 6-min walk test, and a couple other tests were used in evaluation. Falls over this 12-mo period were noted. At 12-mo reassessment, regular exercisers scored slightly higher than the nonregulars in all measures. 75% of the falls that occurred were by the nonregular exercisers, 25% by the regulars.

------------------------
The American Geriatrics Society additionally lists a long falls prevention guidelines list, and topping their list is "direct interventions tailored to the identified risk factors, coupled with an appropriate exercise program," and they note that "good evidence was found that the intervention improves health outcomes and the conclusion is that benefits substantially outweigh harm."

For PTs who work sometimes or frequently with geriatrics, it's noteworthy.

 

[superCOTA]

Re: Paying for Preventative PT...
NY Governer Cuomo is seriously looking at his committe's proposal to limit medicaid treatements to 20 visits a year for PT/OT/Speech. Basically the more complex cases will stop getting services when needed, and become homebound... This is how some will trip sooner than later b/c they didn't heal, just makiing the need for services worse and possibly Nursing facilities packed, costing the Gov't more in the long run...

... but as long as it saves money on HIS shift 😡.

People are strapped and while preventative is good, PT's cost alot more than a personal trainer or 'coach' at the Y. It's not happening for the next decade. It's gonna be a bumpy ride.

 

[jesspt]

Sorry for the bad links. Here's some brief summaries...

PT Journal: Nov, 2010
Improved Fall-Related Efficacy in Older Adults Related to Changes in Dynamic Gait Ability
Who: PT professors from universities and medical centers (University of Florida, Borwn University, VA Medical Center, and others)

Limitations: no control group used.

After screening out 11 subjects due to ineligibility, 63 subjects (mean age 76 y.o.) with a h/o at least 2 falls in past 12 mo. enrolled in a 3-mo. exercise program. The exercise was tailored to their deficits (strengthening targeted platnar-flexors, dorsiflexors, quads, etc. as needed; others would receive endurance training, etc.). Each HEP progressed as the patient was able to. Berg, DGI and FES were used to evaluate them monthly. Significant improvements were noted in all measures on average (for example, Berg postintervention score was a little over 5 points higher on average).

------------------------------

Australian OT Journal (can view on CINAHL database)
LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults
(Various professors
Subjects: 34 who had 2 or more falls in past year.

Limitations: Larger randomized trial is needed.

Applied a "Lifestyle approach to reducing falls through exercise (LiFE)" which is a progressive program focuses on balance and strength training (5 home visits, 2 "booster visits") that the authors created.

Results: 12 falls in intervention group, 35 in the control group in 6 month follow up.

------------------------------------

Journal of Geriatric PT:
Impact of participation in a wellness program on functional status and falls among aging adults in an assisted living setting.
April 2010

Limitations: No control group of nonexercisers, small sample size.

Investigated 36 adults (mean age 85 years old) categorized as either "regular" or "nonregular" exercise participants…19 and 17 respectively) during 12 mo. of participation in a multimodal wellness program. Berg, 6-min walk test, and a couple other tests were used in evaluation. Falls over this 12-mo period were noted. At 12-mo reassessment, regular exercisers scored slightly higher than the nonregulars in all measures. 75% of the falls that occurred were by the nonregular exercisers, 25% by the regulars.

------------------------
The American Geriatrics Society additionally lists a long falls prevention guidelines list, and topping their list is "direct interventions tailored to the identified risk factors, coupled with an appropriate exercise program," and they note that "good evidence was found that the intervention improves health outcomes and the conclusion is that benefits substantially outweigh harm."

For PTs who work sometimes or frequently with geriatrics, it's noteworthy.

Thanks for providing the summary. I will look them up on Cinahl.

 

[DPT2DO]

I think an important thing to consider is that, in the past, every attempt to predict the future landscape of any health care profession has failed miserably. There are swings and trends in employment and salary which wax and wane every 5 years. You can look back at predictions for PT's, anesthesiologists, family practitioners, etc etc, and see that none of the foreseen changes lasted very long or had an impact at all.

While we should be strong advocates for our services, the thought of a surplus should not deter anyone from entering a profession that they love, because, as I said, predicting the future landscape 10, 15 or 20 years out is impossible.

In the Greater Boston suburban area where I currently work as a home care PT, we are absolutely struggling to find PT's in an area that you would think would be saturated. We offer a hefty salary and benefits as well. I receive near daily calls from employment agencies and have for years. My mailbox fills with postcards and letters from companies desperate for PT's. While this scenario may not last forever, I feel that it will be more or less the same for the next 20-30 years, simply due to demand for necessary services. Additionally, the length/expense of our schooling in relation to the pay keeps our numbers relatively low compared to the demand. I think you'll see more of the same going forward.

Also, I'll be leaving the profession in about 5 months (for med school 😀) so that's 1 spot that's up for grabs!

 

[puppypaws]

Also, I'll be leaving the profession in about 5 months (for med school 😀) so that's 1 spot that's up for grabs!

May I ask why you chose to leave PT for med school? Just curious, as I'm trying to definitely decide on which career path I'm choosing.

 

[DPT2DO]

May I ask why you chose to leave PT for med school? Just curious, as I'm trying to definitely decide on which career path I'm choosing.

I realized that I am looking for more of an experience: something with more commitment mentally, greater scope of practice, more responsibility and autonomous/independent practice.

Entering PT school, I was on a fast track and wanted to finish school as quickly as possible. I figured I enjoyed working in health care, and with PT I would earn a doctorate which would be nice. As an athlete I had my sights set on sports medicine and orthopedics. I quickly realized that, while I enjoy PT, particularly the day to day interactions with patients, I am constantly frustrated by limitations in scope and lack of scientific applications in practice. I enjoy learning about physiology, biochem, pharmacology, and I prefer to be the "quarterback" of the team, so to speak.

In retrospect, I should not have decided on PT simply because it was the path of least resistance. I should have went all out and put my efforts towards medical school, but at the end of undergrad all I could think of was finishing grad school quickly.

PT is an excellent profession, just not for me. I am happy to look back on my PT years though, and will be proud to slap that DPT at the end of my name even as a future physician. My advice: investigate your choices thoroughly, and do not choose a profession simply due to time constraints or financial limitations.

 

[Quenchaid]

All your worries about surplus and reimbursement etc. can be solved with 1 word, marketing.

The product is good. 7 years of college level education (including some summers) and a solid amount of scientific articles to back up what we do and how it helps people, but none of it means anything to the public unless we market ourselves properly. There will be lots of PT's that gripe about politics yet don't support APTA lobbying on their behalf. PT's complaining about reimbursement, but not marketing their trade properly.

Any computer geek will tell you Apple's computers are not the best spec. wise but how many of them will diss Apple's marketing strategies... Any audiophile will tell you Bose doesn't make the best speakers but the public is willing to pay $300 for high fidelity speakers that could be had for a Benjamin... Recession or no recession, Ipads and Ipods are selling and you are having trouble selling 7 years of training, give me a break.

I'll leave you with this:

I bargained with Life for a penny,
And Life would pay no more,
However I begged at evening
When I counted my scanty store;

For Life is a just employer,
He gives you what you ask,
But once you have set the wages,
Why, you must bear the task.
I worked for a menial's hire,
Only to learn, dismayed,
That any wage I had asked of Life,
Life would have paid!​

-Jessie Rittenhouse​

One Love,
Quenchaid​

 

[jesspt]

All your worries about surplus and reimbursement etc. can be solved with 1 word, marketing.

The product is good. 7 years of college level education (including some summers) and a solid amount of scientific articles to back up what we do and how it helps people, but none of it means anything to the public unless we market ourselves properly. There will be lots of PT's that gripe about politics yet don't support APTA lobbying on their behalf. PT's complaining about reimbursement, but not marketing their trade properly.

Any computer geek will tell you Apple's computers are not the best spec. wise but how many of them will diss Apple's marketing strategies... Any audiophile will tell you Bose doesn't make the best speakers but the public is willing to pay $300 for high fidelity speakers that could be had for a Benjamin... Recession or no recession, Ipads and Ipods are selling and you are having trouble selling 7 years of training, give me a break.

I'll leave you with this:

I bargained with Life for a penny,
And Life would pay no more,
However I begged at evening
When I counted my scanty store;

For Life is a just employer,
He gives you what you ask,
But once you have set the wages,
Why, you must bear the task.
I worked for a menial's hire,
Only to learn, dismayed,
That any wage I had asked of Life,
Life would have paid!​

-Jessie Rittenhouse​

One Love,

Quenchaid​

While I certainly believe that our profession could market itself more effectively, I think you're comparing apples to oranges. Health care is not a free market, while consumer electronics most assuredly is. Additionally, Apple is marketing a thing-a-ma-jig, while PT is marketing a service.

 

[Quenchaid]

While I certainly believe that our profession could market itself more effectively, I think you're comparing apples to oranges. Health care is not a free market, while consumer electronics most assuredly is. Additionally, Apple is marketing a thing-a-ma-jig, while PT is marketing a service.

Forgive me for seeming crass, but cosmetic surgeons don't seem to be doing to bad a job on the marketing a service front. Some and I dare say most of what they do is not even covered by medicare/insurance. They sell their services and I guess they have a few product lines namely botulism toxin, saline, silicone, vegetable oil etc. (any idiot can critcize... I know I'm guilty here but hear me out).
But when I hear cosmetic surgeon however, I think artist with a scalpel. Facial reconstruction, skin grafting, these people are miracle workers. When I think of someone who's had some form of cosmetic/reconstructive surgery and had their quality of life improved... asked them if they could put a price on the service they recieved? What do you think their response was.

Jesspt I know you have more experience than me, but sometimes it takes backwards optimistic naive type logic/I'm listening to you intently but pretending like I'm not hearing you to change things... If that made sense.

 

[jesspt]

Forgive me for seeming crass, but cosmetic surgeons don't seem to be doing to bad a job on the marketing a service front. Some and I dare say most of what they do is not even covered by medicare/insurance. They sell their services and I guess they have a few product lines namely botulism toxin, saline, silicone, vegetable oil etc. (any idiot can critcize... I know I'm guilty here but hear me out).
But when I hear cosmetic surgeon however, I think artist with a scalpel. Facial reconstruction, skin grafting, these people are miracle workers. When I think of someone who's had some form of cosmetic/reconstructive surgery and had their quality of life improved... asked them if they could put a price on the service they recieved? What do you think their response was.

Jesspt I know you have more experience than me, but sometimes it takes backwards optimistic naive type logic/I'm listening to you intently but pretending like I'm not hearing you to change things... If that made sense.

It is precisely that reason why you are still comparing apples to oranges. Cosmetic services have never been reimbursed by insurance, so the public has always understood that if they want these services, they had better come with their checkbook.
PT, on the other hand, has traditionally been covered by insurance, so patients are typically reticent to pay out of pocket, or to attend regularly if they have a large co-payment, co-insurance, or deductible,as they feel they are already paying an insurance premium which should include physical therapy services. Those patients with good coverage in regards to therapy are much less likely to be discerning consumers, as they aren't paying for the service with their hard earned cash, so there is minimal financial penalty for going to an ineffective PT. It is this third party payor system that creates an artificial market, that does not resemble a free market even remotely.

Also the PT product you speak of is not actually in practice in the vast majority of clinics. PT still lives in a primarily "old school" world, where modalities and the same four stretches and strengthening exercises for patients with LBP rules the landscape. So, you're right, the PT product that is read about in press releases and in scientific journals is good, but it is rarely what the consumer receives.

So, do we need to market ourselves better? Of course. In fact, we need to do what Apple did with the iPad - create a market. One where potential patients are aware of the services we provide, the efficacy of those services, the benefit of those effects, as well as the value of those effects both in the short term and the long term. Cosmetic surgeons have it all over us in this regard.

Additionally, our practice patterns must continue to get better. We can't provide a PT treatment from 15 years ago to the patient of today and expect them to be happy with the product.

 

[Quenchaid]

Touché

 

[jles]

Only pharmacists can sign of pills, while physical therapy assistants can also provide physical therapy services. -

FYI, PTAs provide physical therapy services while supervised under a PT, who examines and evaluates the patient, establishes a PT diagnosis and develops the plan of care. Level of supervision varies according to the setting.