If you’d never heard of Reddit before 2021, you’ve almost certainly heard about it now. In January, the popular discussion website made headlines when a group of users (a.k.a. “Redditors”) on the r/wallstreetbets subreddit shook up the entire stock market. (I’ll spare you the details, but here's a good explanation of the situation.) There are a lot of opinions going around about the group’s actions and goals, but one pretty consistent remark I’ve heard is how extraordinary it is that a group of amateur traders could band together and send the entire stock market into a state of flux.
While Reddit is largely known for hosting discussions on topics ranging from politics to technology—as well as bringing fame to many a meme—it’s also home to one of the largest public forums for physical therapists. Recently, a discussion thread regarding the multi-layered physical therapy branding problem rose to the top of the r/physicaltherapy subreddit—and it caught my attention. The original post (or “OP” in Internet lingo) posed the following question: “Who is to blame for the general public’s lack of awareness for PT?”
The responses were many and varied, and some of them aligned with my own feelings about the PT brand problem—which I’ve voiced extensively in years past. For that reason, I wanted to dig into some of the Redditors’ posts and offer my perspective on this persistent issue.
1. Patients view physical therapy as too much work for too little immediate reward.
Interestingly enough, the most highly-upvoted response in this discussion came not from a physical therapist, but a patient. Speaking from the perspective of a client, the commenter noted that most people “want a quick fix, and a chiropractor takes care of that for most people. PT, on the other hand, takes time and work, and people want instant results.”
This perception poses a complicated dilemma with no easy solution, and it’s tied up in many of the other issues I’ll discuss further down. But to address the problem at face value, I think there’s one important thing to note: once patients actually give physical therapy a shot—and work with a talented PT—they’re hooked, which is something another former patient noted under the thread. So, while that doesn’t solve the problem of getting people over that initial mental hurdle, we know that it’s absolutely possible to change hearts and minds.
Addressing the “DC vs. PT” Fallacy
That said, I know many of us look at the way DCs have branded themselves in the last few decades and feel a twinge of resentment—why can’t that be us? But I don’t think the “us versus them” mentality many PTs have toward chiros is particularly helpful, especially when there is ample opportunity for our professions to collaborate and amplify one another. DCs mostly specialize in back-related complaints, and the ones who adhere to evidence-based practice use a combination of targeted manipulation, adjustment, and rehabilitative exercises to address these issues. Likewise, physical therapists focus on the body as a whole and address patient complaints using similar evidence-based modalities. At the end of the day, PTs and chiros have the same goals, and finding ways to collaborate can only benefit both of our professions.
The bottom line: Patients want to feel better—and fast. Providing treatment on the first visit that will improve pain complaints is key for new PT patients unfamiliar with our services and modalities.
2. Physicians—and patients—don’t fully understand what we do.
However, part of what holds us back from creating collaborative care teams and partnerships is a lack of understanding about what physical therapists actually do. As Redditor u/angelerulastiel pointed out, “physicians tend to be a little undereducated on physical therapy. There [are] a lot of physicians who don’t believe in physical therapy, maybe because they had a bad experience or just because they don’t know enough to know what it is.” Another comment from a PT patient mentioned that the patient’s primary care provider never once suggested seeing a physical therapist, despite the patient experiencing many issues that a PT certainly could have addressed. And that is a massive—and all-too-common—problem.
Like I mentioned above, this isn’t the first time I’ve discussed physical therapy’s branding problem in my monthly founder letter—and I doubt it will be that last, unfortunately. Physical therapy is a broad and varied discipline, and physical therapists are educated and equipped to address the full spectrum of neuromusculoskeletal diseases and complaints. Furthermore, there’s a huge variation in treatment methodology and patient experience from one PT to another depending on a variety of factors—including the setting. The treatment approach provided by a physical therapist working in inpatient rehab may be completely different from a PT who works in outpatient orthopedics. And yet, if you ask the average person what a physical therapist does, you’ll probably hear something along the lines of, “they help people recover after serious injuries like a car accident.” Yes, that’s certainly accurate for many PTs, but it’s only a tiny sliver of our service repertoire.
Campaigning for Change
The discussion on this particular topic pointed a lot of fingers at the APTA. After all, they are our national advocacy group—should this not be a major part of their responsibility? I do believe they are working hard and have gained a lot of ground in representing and promoting our profession. But, for the branding problem to truly be solved, we need concerted efforts at every level—every physical therapist must be an advocate for the profession. Individual PTs should be reaching out to physicians and building rapport. There’s nothing stopping you from shooting an introductory email to local physician offices and asking to schedule a time to speak with them—even over the phone, for now—about all the ways physical therapy can help their patients.
Look, I’m not saying the APTA is off the hook. As our only national advocacy group, they wield the power and influence required for such a massive undertaking, but I don’t believe this challenge can be overcome by a single entity or with a single ad campaign. Rather, I think we need to collaborate with physician advocacy groups and other provider organizations (such as the AMA and ACA) to get more providers on board with movement-based treatment. Moreover, I think it’ll require buy-in from every PT, advocacy group, and national brand—and yes, that includes WebPT and other physical therapy EMR and product providers. This is so much bigger than any one business or organization, and if we all put our heads together to devise a united strategy, I have no doubt we’ll start a real movement.
3. Prescription requirements create a mental—and financial—barrier.
When it comes to advertising PT services, I know there’s still a lot of hesitancy to market directly to patients, thanks in part to murky direct access laws. But this is truly a great way to promote our profession—and your clinic’s brand. Remember, patients wield a lot of power—even if they can’t walk directly into your practice off the street. They can be the ones asking for PT from the physician who may not be aware of our benefits—and most importantly, they can ask for a referral specifically to your practice.
Of course, there can be other barriers: one Redditor provided an anecdote about their clinic’s regional manager declining to advertise because their state didn’t have direct access: “Even now that we have direct access, still so many insurances require [a prescription], including Medicare,” which makes clinics hesitant to advertise and thus, only deepens the branding problem.
These prescription requirements also create a financial barrier. As another commenter pointed out, some states still require a physician’s referral beyond the initial examination, which means a patient has to pay for a doctor’s office visit, only to then shell out a PT copay—which is often costly thanks to PTs’ specialist designation—multiple times a week for several weeks. That adds up fast.
In my opinion, there’s still a ton of work to be done on the direct access front. Yes, patients now have direct access to PTs in all 50 states, but many states’ direct access laws come with a lot of caveats. We also have our work cut out for us when it comes to payers’ perception of PTs. We’ve been designated as “specialists” thanks to our intensive focus on musculoskeletal diseases and interventions, but unlike most other specialists, a patient usually sees a PT two or three times a week, which makes it a decidedly expensive choice for the patient. Ironically, physical therapy tends to be a relatively low-cost intervention on the payer end—especially compared to surgery or prescription meds—so payers end up shooting themselves in the foot by creating these additional barriers to physical therapy. Again, patients have a lot of potential influence when it comes to assisting in the direct access conversation, and including them will be key to future changes.
Making the Case for Conservative Therapies
That said, a few payers have started wising up. A 2017 study conducted by Boston University and jointly sponsored by UHC/Optum and the APTA found that patients were more inclined to choose conservative treatments such as physical therapy when they had lower levels of cost-sharing (e.g., lower copays and deductibles). The study also found that increased use of conservative therapies led to lower healthcare spending overall.
So, why is this important? Well, UHC used that objective data to justify its new policy to waive copays and deductibles for a beneficiary’s first three physical therapy sessions. This is only a first step, but the last thing I heard from David Elton—Senior Vice President of Clinical Programs at Optum—is that UHC/Optum is also considering improving reimbursement rates for physical therapists based on patient outcomes. With all of the payment cuts we have endured lately, it still remains to be seen whether this will come to fruition—but it’s positive nevertheless.
4. Physical therapy is not financially lucrative for the “big wigs.”
Finally, let’s tackle the elephant in the room: Big Pharma. We know that the pharmaceutical industry holds tremendous sway over the healthcare industry at large, and as one commenter put it, “PT is better for patient outcomes, but as a result, isn't good for profits.” But who’s truly profiting if insurance payers have to cover expensive, ongoing treatments or hiked-up prescription costs? We know physical therapy is an effective solution to addressing chronic pain and debilitating diseases, but preventive PT is also effective at keeping people from getting sick or injured in the first place. As the Optum study found, by providing patients access to conservative therapies, insurance payers end up saving money in the long run—I just don’t think most of them realize that yet.
The opioid epidemic has gotten everyone’s attention and has brought even more attention to finding root-cause solutions to patients’ pain issues—we now must take advantage of this opportunity to promote our PT services.
Tracking Outcomes Data
As I read through the rest of the comment I referenced above, one line, in particular, jumped out to me: “When Purdue Pharma, the Sackler family, and McKinsey Consulting were implicated in the actions that lead to the [opioid] epidemic...that seemed like a watershed moment for physical therapy to rise up as an alternative primary course of action for anyone in pain.” I completely agree, but unfortunately, that didn’t materialize—or, at least, it hasn’t yet. While the opioid epidemic has prompted promising research such as the Optum study I cited, it’s going to take more than one research paper to prove to payers—and patients—that conservative therapies are the answer. It's going to take strategic marketing efforts, discussions on social media, and—most importantly—widespread patient outcomes tracking in order to position ourselves as the primary providers for neuromusculoskeletal pain.
To be clear, I believe we’re headed in the right direction, but I also think patients, providers, and advocacy groups need to keep the pressure on. We know physical therapy is effective, and if PTs are tracking patient outcomes, we have the data to prove it. But the data is meaningless if we’re not willing to share it with payers, patients, other healthcare providers, and even lawmakers—and demand that physical therapy be made more accessible to the patients who could benefit from it.
Looking at the PT branding problem head-on feels a bit like standing alone at the base of Mount Everest without the proper gear—or team—to climb it. I imagine that before January 2021, many of the Redditors on r/wallstreetbets felt the same about changing the stock market. But if anything, they proved that collaboration and unity on a singular purpose within a community can work. The physical therapy brand is in desperate need of a shakeup, but if we can ally ourselves under a united purpose (i.e., proving the efficacy of physical therapy and the versatility of physical therapists), there’s zero doubt in my mind that we can’t do the same thing.