Are we in the midst of historic times for our physical therapy profession? Will physical therapists become primary care specialists?

Physical therapy as primary care specialists for musculoskeletal conditions and ailments appears to be rapidly gaining momentum.

Even though the American Medical Association might not think it’s a good idea, consumer opinion and research appears to be proving otherwise (see “Resources” below). The strongest push seems to be coming from CMS, Medicare and government as the push for better and more affordable health care is becoming more and more an important agenda.

What can physical therapists do to prepare for primary care status?

There are a variety of steps you can take now to better prepare yourself for what’s coming in the future.

1. Improve differential diagnosing skills.

   It’s going to be paramount that physical therapists improve their triage skills. Knowing which patients to treat now versus which ones to refer on to other medical professionals, and which ones to send home with a care plan, will become an important part of our professional skill sets. Even though physical therapists already do this now, we will need to become better (and faster) than ever before.

2. Clarify referral guidelines and the decision-making process.

   The increased exposure and access to the public direct will require the physical therapist to be a better decision-maker. A clear set of standards on how a patient is directed to the most appropriate care must be improved. The decision-making process must be clear and a set of structured guidelines will be necessary.

3. Get patients better faster.

   The increased volume of patients that a physical therapist must manage will require more efficiency and effectiveness. If making the decision to keep and treat a patient, faster improvement will be required. The physical therapist must remove all “fluff” and cost prohibitive factors. Patient and payer satisfaction will be critical to success.

4. Increase promotion directly to consumers.

   Increasing public awareness of the new role of physical therapists as primary care specialists will be our responsibility. In order to help lower health care costs in this country, physical therapists must be effective in educating patients on when it’s appropriate to seek a physical therapist first (versus a physician).

5. Learn better communication and activation skills to gain more new patients absent referrals.

   In order to be successful in this new model of health care delivery, the physical therapy clinic must improve their conversation skills with new prospective patients. The reliance on the orders of a physician will no longer be available. The consumer will make judgements based on the professionalism of your front desk/reception personnel. Not only will they need to be more effective communicators but more knowledgeable as well.

6. Increase training of personnel.

   Questions such as “Who’s your doctor?” or “What’s your insurance?” should no longer lead the conversation. Instead “What is wrong? When did it start? How did it start?, etc. will be the new language.

7. Get familiar with your malpractice insurance.

   Primary care status comes with it a higher level of standards and responsibilities. The public will demand more, and so will consumer affairs. Your reliance on your malpractice insurance will become a higher priority. Learn what your limits are, not only for litigation but also for legal representation. Currently, most insurers only provide for $25k in legal representation in case of audit or scrutiny. You will want to increase that amount. It’s better to be safe than sorry.

Not all physical therapists are wanting to become (or wants us to become) primary care specialists but the tides of social, political and economic change appears to be demanding it. We as physical therapists can help push it forward by doing our part, by taking the above steps now. Being well prepared is essential for us to make the most of this historic time.

Resources

Effectiveness of physical therapists serving as primary care musculoskeletal providers as compared to family practice providers in a deployed combat location: a retrospective medical chart review.

MRI instead of physical therapy for low back pain leads to $4,793 higher price

What do you think about physical therapists playing the role of primary care? Share below.