If your staff is feeling overworked and overwhelmed, then it’s high-time to make a change—and that change may very well entail adding to your headcount (and your payroll). But, a smart practice—and a smart leader—will want to maximize those dollars by making the right hire. Do you really need another full-time therapist? Maybe—but maybe not. Instead, perhaps you need a per diem therapist—or a PTA. Before you post that job description, take a look at what kind of hire would really best serve your practice and your budget. But first, here’s a quick refresher on the differences between a PT and a PTA.

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The Difference Between a PT and a PTA

As WebPT’s Courtney Lefferts explained in this article, “physical therapist assistants (PTAs) generally assist in the treatment of all patients and can work in a variety of settings—from hospitals to fitness facilities.” According to the APTA, “PTAs implement selected components of patient/client interventions (treatment), obtain data related to the interventions provided, and make modifications in selected interventions either to progress the patient/client as directed by the physical therapist or to ensure patient/client safety and comfort.” As such, there are some job responsibilities that PTs and PTAs share.

It’s important to note, however, that it’s the licensed physical therapist who must always perform the initial evaluation, outline the plan of care, supervise the PTA, and cosign the notes. While most payers will reimburse for services performed by a PTA—as long as they meet supervision and billing guidelines—the Medicare law that repealed the therapy cap also changed the reimbursement structure for assistant-provided services. As WebPT’s Kylie McKee wrote in this post, “Starting January 1, 2022, services furnished by PTAs and OTAs will be reimbursed at 85% of the usual rate”—as a means to “theoretically offset the extra expenditures associated with the cap repeal.”

Now, let’s get to some hypothetical scenarios—and who might be the best hire for each:

1. You can’t get new patients promptly scheduled for initial evaluations, because schedules are so jam-packed.

When a patient reaches out to you to schedule an appointment, chances are good that he or she is in pain—or at least not able to perform an important physical function. For those patients, waiting weeks to begin the healing process can feel excruciatingly long—and that may very well cause your prospective patients to seek out other providers. To be sure you can provide the very best care—when your patients need it—you may need to hire another full-time physical therapist. He or she can step in to take new patients immediately, thereby ensuring that you don’t lose patients before they ever set foot in your practice’s door. (To prevent losing patients during the course of their care, you’ll want to turn your focus to the patient experience and patient retention.)

2. Prospective patients are asking for appointments on days (or at times) that your current therapists aren’t available—or willing to work.

Today’s patients may expect their healthcare providers to adapt to their schedules—not the way around. Depending on your market (and your desire to be competitive with other practices in your area), you may need to expand your hours in order to offer appointment times before or after the workday—and on the weekends. If your current staff is spread too thin to accommodate this type of a scheduling shift, then bringing in a new full-time therapist with a very flexible schedule might be the way to go. That way, you can set expectations from the get-go regarding schedule availability.

3. Patients are waiting too long for instructions between exercises.

If you’re able to complete your patients’ initial evaluations without a hitch, but you’re finding that patients aren’t getting enough attention while they’re in the clinic for subsequent appointments—and when they’re performing their exercises—then you may want to bring in a PTA to assist. He or she can work with the PT to understand the plan of care, and then work with the patient to carry out that plan in the clinic. PTAs can also provide support in training patients to complete their home exercise programs (HEPs), thus ensuring that patients feel confident enough to perform their exercises at home—safely. Plus, if you’re using an HEP software that comes stocked with a secure messaging portal that patients can use to provide feedback about their HEPs—and ask questions—PTAs can be invaluable resources in terms of not only responding to patient questions, but also identifying patient challenges and bringing those to the PT’s attention. That way, the therapist can modify the existing plan without having to wait for the patient to return for his or her next appointment.

4. Your patient volume ebbs and flows, so your staff is overworked right now—but that changes with the seasons.

No one wants to hire a full-time employee for a short-term increase in patient volume—because when that patient volume falls (say, at the end of the season), you’ll either have to pay a salary for an employee you don’t need or let someone go. Instead, consider bringing in either a travel PTA or PT—or someone local you can pay by the day (i.e., a per diem therapist). That way, you get the help you need when you need it, and there are no expectations regarding long-term employment (or benefits). As an added bonus, you can often use per diem therapists to fill in when your regular staff members call in sick or go on vacation. Just be sure you know the ins and outs of credentialing and billing for travel and temp staff.


Regardless of what role you decide to hire for, you’ll want to ensure that you hire for culture first—even if we’re talking about a temporary team member. After all, your patients won’t know the difference between a full-time employee and a fill-in. And everyone who interacts with your patients represents your brand—and impacts your reputation.

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