Physical therapists are all about action. They spend their days helping patients set and reach their therapy goals. They are fixers, doers, movers, and shakers—not philosophizers. That’s what makes the Graham Sessions so different from any other PT industry event. Now in its eighth year, this annual summit started when a small group of physical therapists decided to get together and have a real, honest conversation about the issues facing their profession. Over the years, that group has grown in size, but the basic format of the meeting has stayed the same. It’s not about creating action items; it’s about sharing ideas and perspectives in an atmosphere where titles and procedural protocols do not exist. As one of this year’s attendees put it, it’s basically a PT “think tank.”

This year, I had the distinct privilege of travelling to Savannah, Georgia, to sit in on the Graham Sessions, where WebPT Founder and COO—and physical therapist—Heidi Jannenga and dozens of other PT industry leaders converged for a day and a half of passionate, insightful discussion on the hottest topics in the PT space as well as the healthcare world at large. One of the most important ground rules at the Graham Session is that, outside of the room where the meeting takes place, no one will attribute specific comments to individual speakers. With that in mind, I’ve compiled a list of the 10 quotes (unattributed, of course) that I feel best capture the thoughts, feelings, and opinions shared during the 2015 Graham Sessions. Here are the first five. (Be sure to tune in tomorrow to see the second half of the list.)

1. “Physical therapists are facing a major identity crisis.”

The physical therapy profession has advanced considerably over the course of the last 50 years. Just a few decades ago, PTs were graduates of a certificate program. These days, they are doctorate-level medical professionals. Talk about a drastic change.

Way back when, physical therapists practiced according to physician orders, and the referral system has further perpetuated that sense of dependence. In fact, it has become so ingrained that even in states with a high level of direct access to physical therapy, PTs are continuing to rely on physicians to send them patients. Why? Because for years, there was an invisible lock on the door of every physical therapy clinic, and potential customers needed the right key (i.e., a physician referral) to get in—and the industry built a business model around that. Other types of providers—most notably, chiropractors—never had those historical barriers to getting patients through their doors, so learning and implementing traditional business principles was an educational focus from the get-go. That allowed them to truly own their roles within the healthcare spectrum—something physical therapists are still struggling to do.     

2. “PTs are not defined by the interventions they provide.”

Aside from the perceived risk of breaking free of the referral model, one of the most significant components of the PT identity crisis is the fact that physical therapists can’t effectively define what they do—at least not in terms of value. For example, imagine this: An average consumer is sitting next to a physical therapist on an airplane. The consumer asks the physical therapist to explain what he or she does. In this situation, there’s a good chance that the PT would respond by listing various physical therapy interventions. But physical therapy isn’t ultrasound, manipulation, or therapeutic exercise. Those are just tools. What makes them “physical therapy” is the fact that a physical therapist is using them—not a physician, not a chiropractor, not a massage therapist. As one speaker put it, “Playing with clay doesn’t make someone an artist.”

When PTs explain their profession in terms of tools and tasks, they contribute to the widespread misconception that the value of physical therapy lies in the things PTs do rather than the PTs themselves. Interestingly, this problem doesn’t seem to exist in other healthcare fields. You’d never hear someone say “I did my dentistry today” or “I’m going to ophthalmology.” Instead, you’d hear “I’m going to the dentist” or “I saw the eye doctor today.” That difference in phrasing means a lot, because it places the value on the person providing the service—and the customer’s relationship with that person—instead of the service itself.

3. “Autonomy doesn’t mean what we want it to mean.”

For years, those in the PT industry have clung to the word “autonomy.” Their intentions were good—to encourage and allow PTs to claim total ownership of their profession. In one attendee’s words, “autonomy” originally meant that “nobody is going to tell us what to think.” Unfortunately, other players in the medical community have misinterpreted this term to mean that PTs “don’t play well with others.” That assumption has made other providers a bit standoffish toward physical therapists. And by continuing to emphasize autonomy in their vision for the future of the profession, PTs will only perpetuate the misconception that they refuse to collaborate with—or simply do not need—anyone else. But while we all believe that early PT intervention is the most efficient model of care for the vast majority of musculoskeletal issues, we have to remember that in some cases, physical therapy patients would benefit from other services. So, in the interest of providing their patients with the highest level of care—and, considering the expected transition to episodic-based payment models, in the interest of merely staying in business—PTs must project an aura of willingness to partner with other professionals. Of course, that doesn’t mean they can’t practice independently—in fact, “independent” might be a more appropriate descriptor than “autonomous.” It’s not about practicing in a bubble; it’s about asserting your position as a doctorate-level professional and using your expertise to help patients achieve the best possible outcomes.

4. “It’s time to start thinking like a businessperson.”

It’s no secret that most physical therapy education programs are sorely lacking in the business department, and perhaps that speaks to the larger problem of codependence with both physicians and third-party payers. To break out of that paradigm, PTs must shift their mindset—and in many cases, that means taking the reins to educate themselves on the principles of business. Yes, barriers to direct access have made physical therapists late to the supply-and-demand party, but they’ve got to stop using that excuse as a crutch. According to one of this year’s speakers, the market for health club services—including things like personal training, yoga instruction, and massage therapy—is a $22 billion industry. And that’s almost exclusively cash-pay. When you look at it that way, it’s tough to justify the claim that people won’t pay out-of-pocket for physical therapy. Consumers are voting with their dollars, and it’s pretty clear that they are willing to pay for outcomes that meet their expectations.

So, how can PTs get a slice of that market? One attendee’s suggestion: Stop thinking of all these ancillary health and wellness providers as competitors or usurpers, and start thinking of them as colleagues and potential referral sources. In other words, if PTs want to play in this game, they’ve got to play smart—and they’ve got to play nice. Then, once PTs start to get people through their doors, their next step is figuring out a way to leverage their unique skills and expertise to, in another speaker’s words, “do something awesome”—that is, something no one else can do. If they can do that, then they’ll be able to establish value at the consumer level.     

5. “There is a difference between what we value and what our patients value.”

Value was a recurring theme at this year’s Graham Sessions—and one that I’ll touch on again in tomorrow’s post. This particular observation—the disconnect between a PT’s definition of value and a patient’s perception of value—sparked a lot of conversation and debate. Most physical therapists would argue that their value comes with the quality of care they provide and the factors that go into producing that quality—namely, education, experience, and evidence-based practice. Customers, on the other hand, place value on feeling better. That’s the outcome they want, and if their spending habits are any indication (see #4 above), they’re clearly willing to pay for it. That’s not to say that PTs aren’t focused on outcomes; it’s just that they tend to think more in terms of functional improvements—things that are measurable. But to be competitive in the direct-to-consumer market, they might have to start thinking of ways they can use their skills to deliver the value their customers want and expect.


As you can probably tell, the idea stream was flowing—actually, more like rushing—nonstop throughout the 2015 Graham Sessions, and there’s more where that came from. Be sure to check back tomorrow, when I’ll round out the last five items on my ten takeaways.