Why I Left Clinical Physical Therapy: Part 2

I mentioned in Part 1 that I found the demands for productivity to be unsustainable long term, the census for home health was decreasing, I wanted better work/life balance and I was finding the future of Medicare reimbursement challenging at best. Many other reasons factored into my decision to leave clinical physical therapy, including:

Didn’t like my other options remaining as a clinician

I have been fortunate to generally be in good health most of my life. However, there have been times when I would have discomfort, often times when performing a lot of manual transfers. Despite “safe handling techniques” being recommended all of my career, there remains an unavoidable amount of manual lifting required in most physical therapy settings. I do believe pain to be complex and involve many factors. However, I was also recognizing that it would be unlikely to be able to tolerate the physical demands of the job until I would retire.

Wanting to learn a different skill

I looked at what else I could do as a clinician because I have enjoyed helping people get better. I honestly thought I would remain a clinician until I retired since there are few things in life that are more rewarding than to be sincerely thanked by clients and family members for how their life has changed because of what interventions I selected.

I could go more in depth of all the options and why they were not appealing, but I will touch on a few. The 1st that has become very popular involves “Cash Pay PT.” In fact, I even bought a course to start my own Cash Pay PT business. As I went through the course and joined other Facebook groups of therapists doing Cash Pay, I was seeing many factors that made this unappealing. Here are the Top 2:

1. There is a lot of debate about whether or not someone with Medicare can be treated for medically necessary Physical Therapy via Cash Pay. I became Board Certified in Geriatric Physical Therapy in 2020. Almost all of my clients would be under Medicare. I am not here to debate why or why not someone with Medicare can pay cash for Physical Therapy. What I noticed was that there would be a possible ongoing ethics issue.

2. There is a lot of debate about whether or not someone with Medicare can be treated for medically necessary Physical Therapy via Cash Pay. I became Board Certified in Geriatric Physical Therapy in 2020. Almost all of my clients would be under Medicare. I am not here to debate why or why not someone with Medicare can pay cash for Physical Therapy. What I noticed was that there would be a possible ongoing ethics issue.

Limited ability for advancement

As I said before, I spent most of my career believing I would be a clinician all of my life. I had entertained the idea of going into academia, especially now that I had my board certification. Being a professor was appealing but that would be difficult to enter full-time and comes with it’s own set of problems. I didn’t see much option for being a manager with the company I was with and honestly saw management as a less appealing option to being a clinician. Sure, I could own my own practice, but there was a lot of risk to that. I know that many therapists have felt “stuck” because they would like to do more but the opportunities would remain limited as a treating clinician.

Difficulty improving clients

Some of the most rewarding experiences have come from successfully treating “difficult” clients. Difficult clients can mean a lot of things: uncommon presentation for the diagnosis, rare diagnosis, symptoms that fluctuate to treatment, poor adherence to recommendations, past failed attempts with therapy, and many more. However, though the reward can be high when improving a client, the despair can be just as low when the pressure to help someone to get better leads to failure. There were a lot of words in that last sentence that have implicit and explicit meanings, but ultimately seeing many people not get better despite best effort was discouraging. With the pressures of productivity and revenue from the employer combined with the pressures of clients and their family, it was a frequent battle of disappointing one or the other.

Look out for the 3rd and final post on this series soon!

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