In part one of my two-part recap of the 2016 Graham Sessions, I divulged the first half of my recipe for PTs to take over the world—and, in the process, made everyone really, really hungry for roasted marshmallows. To continue with the s’more theme, if yesterday’s post was the top graham and the warm, gooey, slightly charred ’mallow, then today’s article is the bottom cracker and the smooth, melty chocolate. (Yep, that’s drool on your keyboard, isn’t it? Oops. Sorry about that.)

Before you run to the kitchen to feed your s’more snack attack, nourish your mind with the rest of my Graham Sessions-inspired to-dos for all of those superhero physical therapists who have their sights set on world domination—the healthcare world, that is. (Reading this post requires less patience and concentration than making a perfectly golden-brown marshmallow, I promise.)  

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1. Support and encourage the leadership aspirations of women physical therapists.

There are a lot of compelling statistics floating around that speak to the dearth of women in PT leadership positions. One of the most commonly cited: Women make up roughly 70% of the physical therapy profession—but they fill only about 30% of leadership roles. And while those numbers certainly are concerning, one attendee—who happens to be the CEO of a very successful multi-clinic company—raised a lot of eyebrows when she shared one of her own personal stats: in her decade-long career as a business leader, she’s never had a woman come back to negotiate an initial salary offer—something she said men do all the time. That anecdote begs the question: is the industry holding women back from rising to the positions they want and deserve—or are women inadvertently holding themselves back? Is women’s reluctance to negotiate for higher salaries a byproduct of the same social conditions that keep them from advancing their careers?

In any case, as several attendees pointed out, this is not an issue unique to the PT community. “This is societal,” one speaker noted. “It’s not like PTs are bad at this.” And as in other industries, women’s traditional role as family caregivers often influences their career decisions and goals—which isn’t necessarily a bad thing. As one speaker cautioned, “We need to be careful about how we’re defining success.” In other words, success could be running four PT clinics or raising four children—and it’s not fair to judge one person’s idea of success against another’s.

Still, many participants in this discussion agreed that those in positions of leadership could do more to keep women in the profession even after those women have started families. As one attendee put it,  “We need other options besides ‘lean in or get out.’” Some leaders have already taken the initiative to create those options: “To me, it’s worth it to find a way to keep good employees in the workforce,” said one attendee. “Yes, it’s a short-term pain point for me as a business owner, but in the long-term, it’s well worth it.”

2. Teach student PTs how to think, not what to think.

If physical therapy education were a puzzle, it’d be one of those 1,000-piece mega-puzzles. And while most PT programs are pretty good at providing all of the pieces, many students feel like they graduate not quite knowing how all of those pieces fit together. In other words, they have all the skills they need to be an excellent PT, but they’re unable to apply those skills—at least in a comprehensive manner—right off the bat. In one attendee’s words, “We get so caught up with the diagnosis on the page that we don’t see what else is on the table.”

Another new-grad attendee added that, in his opinion, one of the least-taught—and most crucial—skills is the simple ability to form a relationship with the patient in front of you. “In school, we’re hit so hard with skills—I think this time would be better spent learning how to make eye contact,” he said, adding that something as simple as looking a patient in the eye can make or break that person’s investment in his or her treatment. “People don’t build trust with their doctor or their services; they build trust with a person who is a doctor.”

But the gap between school curricula and real-world practice isn’t limited to what happens inside the treatment room; new grads also tend to feel a bit out of their league when it comes to the non-clinical aspects of the PT profession—namely, business and leadership. The cry for more business content in DPT coursework is nothing new. But this year’s Graham Sessions attendees questioned whether adding content hours to current curricula would truly eliminate the education shortfall students are experiencing. Instead, they proposed, why not integrate a wider range of skills into each existing course? For example, one attendee suggested, orthopedic instructors could incorporate the business side of this discipline by teaching students about the market for orthopedics and how to bill for those services.

Finally, students, new grads, and industry veterans all agreed that clinical instructors (CIs) must play a much bigger role in student education. They must go beyond merely exposing student PTs to real patients and real clinical practice; they must nurture students’ ability to think critically and provide them with experience in all aspects of daily clinic operations—from having conversations with insurance representatives to billing for the appropriate type and number of service units. And if that means pursuing policies that would allow CIs to receive some sort of compensation for their time, then that’s the direction the industry—and the APTA—should be looking to. After all, as one attendee commented, “What they [students] get taught, we deal with later.”

3. Know your value.

The topic of value permeated virtually every discussion at this year’s Graham Sessions—and with good reason. Historically, PTs have struggled to define their value in a meaningful way—one that patients, payers, and other members of the healthcare community can understand and appreciate. In some cases, even therapists themselves have trouble recognizing the value they provide: “When I talk to [therapists who work for me], they don’t seem to know the power of their value,” one attendee noted.

That’s a huge problem for a profession trying to make itself relevant in a rapidly changing healthcare environment—especially considering the nationwide shift to a value-based payment paradigm. Of course, value isn’t just about the dollar amount patients and payers are willing to give in exchange for physical therapy services; it’s also about the quality of care patients receive—and the effect that care has on the health of the overall population. “The PT industry focuses too much on what we’re paid instead of what we’re being paid for,” one attendee commented.

Multiple attendees referenced “unwarranted practice variation” as one of the industry’s biggest hurdles in the pathway to establishing a clear, universally accepted value proposition. Their argument: for patients and payers to value physical therapy, they must be able to expect a certain standard of quality—with regards to treatment, results, and overall experience. And therapists must have the tools necessary to hold themselves accountable to that standard. Furthermore, they must be able to objectively demonstrate that accountability—and the resulting care consistency—to the parties responsible for writing the checks. As one attendee put it, “They’ll pay us for our product if we can demonstrate it’s the same product and that [patients] have reasonable prognosis of meeting their goals.” All of that boils down to data—and the ability to leverage and articulate it in a way that the rest of the healthcare community can’t ignore. After all, as one attendee pointed out, “We’re saving the system tons of money, and we’re not out there telling anyone about it.”

4. Embrace team-based care models.

Together everyone achieves more. It’s not just an acronym for cheesy middle school gym posters; it’s the mantra driving healthcare reform in this country. As one speaker noted, “One of the overarching themes of the Affordable Care Act is the notion of a team-based future.” To push healthcare providers toward achieving the Triple Aim—that is, the nation-wide call to improve the health of populations, increase the quality of care, and decrease healthcare costs—the ACA opened the door to team-based care models like accountable care organizations (ACOs) and patient-centered medical homes. The idea behind these models is to not only move patients and providers toward a coordinated—rather than episodic—mode of care delivery, but also promote the provision of continuous care. That way, when an individual experiences a medical problem, he or she will go directly to the appropriate medical specialist—instead of directly to the emergency room. For team-based care to work the way it is supposed to, though, each team member must bring something different—and valuable—to the table.

To illustrate this concept, one attendee described the philosophy of team-based care models in terms of basketball: every play is different, and while sometimes the ball handler’s best option is to shoot and score alone, that approach won’t always work. Sometimes that player needs to pass the ball to the person who has the best chance of scoring in that particular situation. Furthermore, not every player will play every game; some will sit on the bench, and that’s okay, as long as they’re subbed in if and when their skills are needed. Essentially, to achieve optimal outcomes, each team member “has to know the strengths and weaknesses of everybody else on that team,” this attendee explained. “Everybody has to be ready to play, but not everybody plays every single play.” But for that to happen, physical therapists must overcome one very big challenge: effectively educating the rest of the team members about who they are, what they do, and why they are valuable members of the roster. Furthermore, they must ensure the rest of the team understands when “the ball should be in the physical therapist’s hands,” because in those cases, if the primary care physician gets the ball, “he’s going to dribble it around and burn up the play clock and not be able to get off a shot.”

The other challenge PTs face: getting a spot on the roster in the first place. But according to another attendee, there’s no need for therapists to sit and wait for a recruiting call. There’s plenty of opportunity out there to provide team-based care—and it’s up to PTs to go out and seize it. In fact, that attendee started a successful interprofessional practice that features a membership-based business model in which members gain access to medical, dental, psychology, and rehab therapy services. And the way she sees it, physical therapists across the country can easily do the same by partnering with various types of healthcare providers that already exist within their zip codes.

It’s a lot to think about, and as another attendee pointed out, “Integration and collaboration for the sake of integration and collaboration doesn’t make sense, just because it’s in vogue. It’s not for everyone in this room.” In some cases, though, it absolutely does make sense, and considering that fee-for-service seems to be on its way out—with pay-for-quality hot on its heels—it’s definitely something PTs should keep on their radar. Because the fact of the matter is that, as another speaker stated, “The demand for coordinated, team-based care is not going away.”


There you have it, folks—a complete recipe for success in the modern healthcare world, inspired by the incredible ideas brought forth at this year’s Graham Sessions. At this point, you’re probably so full on knowledge that you’ve completely forgotten about your hankering for a delicious campfire treat. But, just in case you’re still jonesing, here are a few to-die-for s’more variations. Bon appétit!

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