This is a precarious time for the physical therapy profession. We’re walking a tightrope spanning unparalleled professional development and scope of practice—and the burnout and crippling debt burden that are threatening to drive many therapists away from the profession altogether.

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It’s the best of times and the worst of times.

On one hand, the DPT is now standard for entry-level physical therapy graduates in the United States. PTs are graduating with more knowledge—and a wider scope of practice—than ever before. In fact, there has even been talk of increasing entry-level practice requirements by making residency training mandatory. Many of us have embraced the title of “doctor,” and direct access enables us to, in many cases, treat our patients without having a physician act as an initial gatekeeper.

On the other hand, all this education has come at a steep price, and salaries simply aren’t keeping up. If anything, they’re stagnating or even declining.

So, it’s no wonder that, while WebPT’s recent State of Rehab Therapy report revealed that approximately 60% of PTs are happy with their work (we all know patient care is immensely gratifying), many respondents indicated that they’re not so happy with the direction that rehab therapy—and health care in general—is heading.

We need to call a spade a spade, and admit that with each passing year, a career in physical therapy is becoming a worse financial investment. And with many PT leaders talking about burnout, but not doing much to improve it—productivity requirements are still increasing, and documentation demands are still mounting—PT isn’t the best investment for long-term health and happiness, either.

In the past, we could feel good knowing that even if we weren’t going into a profession for the money, at least we’d be happy. Now, the future career outlook for physical therapy is not looking so bright. Here are some of the reasons why physical therapy professionals aren’t feeling totally rosy about the profession:

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We love the player—but hate the game.

Patient care can be enjoyable and fulfilling—at least to some degree—but it can also be mentally and physically demanding. And when you couple that mental and physical burden with additional “red tape” demands like those listed below, the joy starts to drain:

I recently saw the results of a Facebook poll revealing that less than 33% of PTs want to own their own practice. And honestly, I wasn’t all that surprised. After all, if you love physical therapy, but hate feeling like it’s all about profit and bottom line, then why would you willingly go into private practice?

Some simply don’t enjoy patient care.

It used to be faux pas to say openly, but more and more PTs are admitting that they don’t enjoy patient care. Because PTs are considered such giving and caring professionals, hearing a clinician say that he or she doesn’t enjoy the most hands-on, people-centered part of the job can be a bit jarring.

But, I’m one of those people. I enjoyed aspects of patient care, but I also found it draining. No matter how caring we are—and no matter how good our jobs are—some of us simply find constantly interacting with people (or being on our feet) exhausting. As a result, we find ourselves dreaming about leaving patient care. And while it's possible to find non-clinical careers in physical therapy, we still have a long way to go to fully address the stigma around PTs who pursue nontraditional roles.

The ROI is too low.

As mentioned above, we’re dealing with a terrible debt-to-income ratio. The cost of school continues to skyrocket (average tuition costs tripled between 1999 and 2014), and we’re still fighting the same old battles to stop declining reimbursements. The previously cited State of Rehab Therapy report revealed that six in ten PT graduates will have more than $70,000 in debt upon graduation. With starting salaries averaging $60,000-$70,000 a year, those students are signing up for many years of paying back loans—while working in a field they may or may not enjoy.

One of the most frustrating things for me to read was that males are more heavily represented in the $70,001-plus salary segments, while women are more heavily represented in segments earning less than $70,000. This is not okay (especially in a female-dominated profession), and if you haven’t yet read WebPT co-founder Heidi Jannenga’s recent article on this topic, I strongly encourage you to do so.

Gender bias and low starting salaries aside, in many workplaces, raises are unheard of, and therapists have to be okay with the fact that salaries for new grads are the same as those for PTs with five-plus years of experience and continued education.

The profession could lose diversity.

One thing that concerns me is that the falling ROI of a career in PT will restrict it to only those who can afford the price of entry outright. It will become a luxury education and an ivory tower profession, meant only for students whose parents or benefactors can help pay the cost of tuition.

People from underserved areas—or those of a lower socioeconomic status—will not be able to justify the debt-to-income burden, and will instead pursue PA, PharmD, and NP degrees, all of which pay more (and have more non-clinical opportunities in case those graduates ever wish to switch out of patient care).

There’s still a glimmer of optimism.

Still, despite the tone of this article, it’s not all doom and gloom. There are reasons to feel optimistic about the future of physical therapy. As the saying goes, “Necessity is the mother of invention.” And PTs have been more inventive than ever in the past few years.

Increasing numbers of physical therapists are pursuing non-traditional physical therapy career paths. They’re opening cash-based practices (allowing themselves to be blissfully free from the stresses of insurance), becoming entrepreneurs, pursuing telehealth PT, and forming integrative practices in which income is generated on a holistic practice model, rather than one relying solely on paltry PT reimbursements.

Additionally, there are some organizations out there promoting travel physical therapy as a solution to the physical therapy debt crisis. It’s also a great way to make use of our increased baseline training as well as the new physical therapy compact.

The important thing for all of us is to address these findings head-on. We’ve been quietly murmuring about these issues for years, and it’s time to openly recognize that we’ve got a major problem on our hands. Our profession must take serious steps to deliver on the promise we make to our incoming students—one of a happy, stable, financially satisfying career—because it’s something that some of us newer grads have only heard about, but never gotten to experience firsthand.

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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