Goodbyes are never easy, especially when they’re directed at patients who haven’t yet reached their physical therapy goals. Even if you’re dealing with a difficult patient, cutting him or her loose goes against everything you’ve been taught as a healthcare provider. And if you’re a practice owner, losing a patient probably seems contradictory to your business goals. After all, more patients equal more money, right? Not necessarily.

Unfortunately, this belief—no matter how well-intentioned—can result in wasted time, energy, and resources for patients and providers alike. That’s why it’s important to recognize situations in which saying goodbye might actually be a good thing. With that, here are some common scenarios when it’s okay to lose a patient:

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1. Your schedule is overstuffed.

Today’s physical therapists are operating under a lot of pressure—pressure to do everything from completing documentation in a timely manner to delivering outstanding outcomes. On top of all that, PTs often feel obligated to cram as many patients as they can into their daily schedules in order to help their practices stay financially solvent amid shrinking reimbursements. That’s a tough balancing act. After all, if your schedule is too jam-packed, it could keep you from devoting enough time to each patient to give him or her the proper one-on-one care he or she needs—and that can directly affect therapy outcomes. And with many payers shifting to value-based payment models, poor outcomes could mean poor reimbursements.

Don’t get me wrong, losing patients due to an overstuffed schedule isn’t ideal. Instead, physical therapy practices should focus on matching patients with the right providers—ones who aren’t overworked. Doing so will:

  1. take some pressure off of therapists who are already spread too thin,
  2. ensure that each patient receives the care and attention he or she needs, and
  3. guarantee that the workload is spread evenly across all providers on the team.

2. The patient's diagnosis falls outside of your scope of knowledge.

Let’s say you’re a physical therapist who specializes in sports rehabilitation, but you’ve received a referral for a diabetic patient suffering from peripheral neuropathy. As a sports PT, you could probably help this patient alleviate his or her neuropathy pain, but chances are, there’s a provider out there who’s better suited for the job. In cases like this, it’s good to have a network of providers you can turn to so you can ensure the patient gets to the physical therapist with the right experience and know-how. Plus, identifying these patients—and referring them to the right provider—is crucial because it:

  1. minimizes excess healthcare spending, and
  2. helps the patient return to full health faster.

(As a side note, to prevent these situations from occurring in the first place, make sure your practice website and marketing materials clearly communicate which conditions you specialize in and the types of services you offer.)

3. The patient isn’t responding to therapy treatment.

I’m sure I don’t have to tell you how valuable physical therapy is, but every once in a while, therapy alone just isn’t enough. As Christie Downing, PT, DPT, Cert. MDT, ICLM, discusses in this article, physical therapists can be instrumental in identifying patients who would be better candidates for surgery than physical therapy intervention. By using your own diagnostic methods, paying close attention to the patient’s medical history, and establishing good lines of communication with physicians, you can make sure the patient gets the right care at the right time. As an added bonus, if you’re open and honest with a patients when they’re not the right fit for physical therapy, you’ll earn their trust. And should those patients need PT services in the future, they likely will return to you.

Losing a patient isn’t always a bad thing, but that doesn’t mean you should turn a blind eye to patient dropout. Ready to increase your clinic’s revenue—and produce better patient outcomes in the process? Download our free guide to patient retention.

4. The patient has the wrong mindset for physical therapy.

Let’s face it: physical therapy is hard. You know it, and I know it—but do your new patients know it? When a new patient walks into your practice, he or she won’t always know what to expect. It’s important that patients know their success with therapy hinges on their participation in, and adherence to, their home exercise program. That’s why it’s important for therapists to have an expectation-setting conversation with every patient at the start of care. That said, some patients—no matter how much you want to help them—just won’t be prepared to put in the work. It can be difficult to accept, but when patients have the wrong attitude for therapy and aren’t willing to be your healthcare partner, they’re wasting their money and your time. When that happens, you may need to offer them alternative options until they’re ready for therapy.

5. Your practice is too far away for the patient.

Finding the perfect location for your physical therapy practice requires research—and strategy. Even if you’ve scoped out a beautiful space with ample parking and little-to-no competition in the surrounding area, some patients might consider it too far to be worth the trip. This can be especially true for new patients. While loyal, long-time patients are more likely to go out of their way to see you, new patients—especially those who are new to physical therapy in general—might be more inclined to skip their appointments (or find a provider closer to them). Even when a patient is highly motivated and committed to therapy, if he or she lives too far away, you may start to see a pattern of consistent tardiness and cancellations—both of which hurt your practice’s bottom line. (Pro tip: If you practice in a rural area where most of your patients must travel substantial distances to see you, you might want to invest in telehealth technology or an interactive home exercise program tool like WebPT HEP. That way, you can always stay connected to patients, even when they can’t make their appointments.)


They say that parting is such sweet sorrow. But, when you and a patient go your separate ways, it doesn’t necessarily have to be a sad occasion. Whether you’re passing the torch to the right provider or mitigating financial waste, splitting up might be the best course of action. After all, if you do your best to do right by the patient, it might not be “goodbye”—just “see you later.”

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