As 2018 draws to a close, it’s a good time to look back at some of the hottest topics and trends from the year. Some topics, like cash-based practice and pain science, have been in the spotlight for years—while others emerged only within the last few months.  

Here are 11 of the hottest physical therapy topics from 2018:  

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1. Burnout

Burnout certainly isn’t unique to physical therapists. In fact, in recent years, we’ve seen countless reports chronicling the burnout experienced across a wide swath of medical professionals. But, in the case of physical therapists particularly, the last few years have seen many practitioners—from new grads to experienced therapists—sharing their personal stories of burnout. In fact, our own Heidi Jannenga tackled the topic in Becker’s Hospital Review just a few months ago. And even the APTA is listening, with the House of Delegates discussing the burnout problem this past June. The key to beating burnout is knowing the signs—and taking steps to address it, rather than sweeping it under the rug.

2. Cash-Based PT

As reimbursement rates continue to stagnate or even fall, many therapists are turning to a cash-based practice model. While not exactly a new trend in the PT world, cash pay is certainly a growing one. More and more physical therapists are flying solo, opening fully cash-based practices or dabbling in specialty offerings that focus on everything from cycling to dancing—as well as working with niche groups of patients like young moms, athletes, and even dogs!

3. Compliance, Billing, and Reimbursement

With stories of insurance fraud regularly making the headlines, compliance has become ultra-important in the physical therapy world. While some PT clinic owners are finding themselves in legal hot water for billing fraudulently, others devote time and resources to ensuring they practice by the books. And speaking of the books, let’s run through a few notable recent changes.

The Demise of FLR

Ding-dong—the witch is dead! Okay, that’s a bit extreme, but many physical therapists are celebrating the demise of functional limitation reporting (FLR), a cumbersome and ineffective program that required PTs to submit data on each Medicare patient’s primary functional limitation and related therapy goal. PTs reported this information using G-codes, corresponding severity modifiers, and therapy modifiers, and they were required to report at certain intervals and encounter types (e.g., evaluations and reevaluations). Otherwise, they would not receive reimbursement. Thankfully, the folks at the Centers for Medicare and Medicaid Services (CMS) came to their senses and realized that this extra burden was not impacting care, and they ultimately decided to discontinue FLR at the end of 2018.

The Dawn of MIPS

While rehab therapists aren’t technically part of the Merit-Based Incentive Payment System (MIPS) until 2019, people have certainly been talking about it enough in 2018 for it to make our list! MIPS assesses the merit of a therapist’s interventions by considering the following four factors: quality, improvement activities, promoting interoperability, and cost. MIPS dictates that eligible providers submit their relevant data to CMS at the end of each calendar year. Then, they will receive a MIPS score falling somewhere between 0–100 points. This score will determine the payment adjustment—either positive or negative—each participating provider will receive two years after the reporting year. (So, a provider’s 2019 score will affect his or her 2021 adjustment.) To learn more about PT participation in MIPS, be sure to check out our recent MIPS and final rule webinar.

4. #GetPT1st Movement

GetPT1st is a grassroots initiative intended to open the general public’s eyes to the many benefits of seeing a PT first for musculoskeletal complaints. The movement is not a money-making endeavor, as there are no advertisers on the site—nor any products sold or specific treatments or companies endorsed. The mission is to inspire physical therapy professionals to share their (HIPAA-compliant!) success stories and other inspiring content to motivate the general public to consider physical therapists before turning to more invasive treatments. Operating as both a movement and a true community, the GetPT1st website also features a “find a PT” section, where therapists can enter their information into a database.    

5. Non-Clinical and Alternative Careers

With burnout running rampant in the PT world—partially as the result of crippling debt loads and low salaries—it’s no wonder that many physical therapists are looking beyond traditional patient care for career satisfaction. PTs are finding they can leverage their skills and education as clinical or rehab liaisons, compliance specialists, healthcare recruiters, clinical content writers, and utilization reviewers, just to name a few. With The Non-Clinical PT offering courses and educational content about non-clinical career options—and the PT Outside the Box podcast putting the spotlight on prominent non-clinical therapists—the stigma attached to leaving patient care is slowly fading away. There’s even a Facebook group devoted to creating a non-clinical special interest group (SIG) in the APTA.

6. Pain Science

For years, manual therapy was the golden child of the PT world. We were taught to use our healing hands for just about everything. This practice certainly does produce results, but it often comes with the unwanted side effect of patients relying upon us for pain relief, rather than having agency over their own health. Now, PTs are embracing the complex relationship between movement and pain, and leaning into the importance of our roles as educators. With more and more PT influencers discussing pain science—and physical therapists taking on prominent roles at gatherings like The San Diego Pain Summit each year—pain science will likely remain a hot topic long into the future.

7. Pelvic Health

Women’s health has been a popular topic in PT for a while now, but the broader “pelvic health” specialty has garnered a lot of attention recently. People have been more openly discussing the challenges that men, as well as women, face with pelvic floor dysfunction, and this has led to more educational courses for therapists—ones that focus on the full scope of pelvic health challenges that women, men, and even children face.

8. PT Day of Service

While PTs technically serve others every day at work, PT Day of Service takes a new spin on  the concept. Each year, a single day is selected (usually in October), and physical therapists across the world are encouraged to perform some sort of service to their communities or to others. Some therapists opt to offer pro bono treatments, while others participate in activities like park cleanups. PT Day of Service is a wonderful way to build community outside of the workplace, and the movement is expected to continue growing.

9. Telehealth

Many medical professionals have been using telehealth for years, and physical therapists are finally starting to catch up. While telehealth technically includes HIPAA-compliant HEP tools and text-messaging services, PTs are now delivering remote care in both live and store-and-forward forms. With companies like Reflexion Health providing a full spectrum of teletherapy in both inpatient and outpatient settings (and demonstrating reduced rehab costs and receiving awards in the process), we are all hoping that it won’t be long before Medicare reimburses for PT teletherapy—and more third-party payers follow suit. Even for PTs who wish to operate outside of the insurance world, there are plenty of opportunities to launch cash-based practices on a consultative or full-time basis. And with the ever-growing PT Compact, it’s easier than ever to treat across state lines (provided you’re licensed to do so!).

10. Travel Therapy

Travel therapy is another physical therapy topic that’s not exactly new, but continues to catch fire in our profession. With the cost of the DPT skyrocketing—and salaries lagging far behind—more and more physical therapy graduates are pursuing the high-paying travel therapy path. Not only can therapists make great money as travelers, but they can also gain experience  in multiple settings, learn new skills for their resumes, build a solid professional network, and hone skills that can help them land non-traditional physical therapy jobs down the road.

11. #VitalsAreVital Movement

How many PTs do you know who check patients’ blood pressure at the beginning, middle, and end of each therapy session? The answer is probably “very few.” But, knowing your patients’ baseline vitals—and being able to observe how activity affects those numbers—is key to preventing adverse reactions to PT, and to ensuring that you practice in a manner that proves PTs are musculoskeletal specialists who take their direct access privileges seriously. The result of this important movement—which has gathered steam on social media through success stories—is that many more clinicians are incorporating basic vitals screens into their daily practice.


These are the hottest topics I’ve seen in physical therapy during the last year. What do you think? Did I miss anything? And what do you think the trends will be for 2019?

Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways.

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