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Physical Therapy in the Face of a Pandemic

Dr. Niles J. Bracy, PT, DPT reflects on how the COVID-19 pandemic has affected the practice of physical therapy.

The coronavirus pandemic which has swept the globe in the past few months has had an effect on all aspects of everyday life in the United States and as well as the globe – changing the way we celebrate birthdays with friends and family, our ability to enjoy a night at the movie theater or take a trip to see a baseball or basketball game, and even affecting the simple experience of grocery shopping. While our livelihoods have already been threatened by a contagious virus, for many people, this livelihood has also been threatened by unemployment and lack of job security. As a doctor of physical therapy, I’ve always felt comfortable knowing two things – that I had a career that would not be at risk of being lost to technology, and that I provided a service that would always be useful and necessary. However, I speak on behalf of physical therapists across the country when I say living through the coronavirus pandemic has been a very humbling experience.

I want to specify that there are a variety of settings physical therapists can work in including hospitals and skilled nursing facilities where PTs are hard at work, but I’m referring specifically to outpatient physical therapy clinics. Physical Therapy in itself, regardless of setting, is a job that relies heavily on close contact and physical touch during the various manual therapy techniques, cueing for proper form, or even when providing assistance during balance activities and other exercises. In the past two months many physical therapists, who in February of 2020 had very secure jobs, found themselves among the 30+ million Americans that have been unemployed in the United States.

Because of social distancing requirements and fear of contracting/spreading COVID-19, the number of clients being seen in person had decreased significantly across the country and most especially in New York City. Physical therapy business owners have responded by cutting staff, cutting in-person treatment hours, or by closing their doors completely. This has meant that many physical therapists, most of whom hold a Doctorate or Master’s Degree in their field, have also been at home in this confusion – uncertain of what their immediate future may hold. Sadly, this situation has also created debates amongst physical therapists about whether outpatient physical therapy – where we help people decrease pain and recover from injuries and surgeries – is an essential service. I won’t go too deep into this, but can explain that both sides of the argument are understandable – small business owners are fighting to keep their business alive by treating clients in person and others have felt that they could best help their clients by telling them to stay home to decrease their risk of exposure to COVID-19.

Similar to many businesses, some outpatient physical therapists have also found a way to work remotely in the face of the pandemic in order to continue providing our service. Zoom Video Conferencing has emerged as a HIPAA compliant conferencing platform that many PTs have used to continue assisting their clients in achieving their goals and living a pain-free life. While some physical therapists have been able to use Zoom, this still does not mean that all PTs are back to work as some businesses continue to struggle to maintain their original client base whether it be in person or via telehealth because of coronavirus fears or general disinterest in tele-therapy. Luckily, for physical therapists in New York, Governor Cuomo has allowed hospitals and outpatient clinics to return to performing elective surgeries in 49 out of 62 counties as of May 18th, including Westchester and Suffolk counties, the homes of many people who normally seek out physical therapy clinics conveniently located near their place of work in New York City.   

A common theme of the past few months has been uncertainty. A conversation I’ve had with many of my peers in the physical therapy community as well as those in other fields has centered on what will the outlook be for physical therapists in the coming months and years.  The biggest positive of this situation has been the confirmed success of telehealth as a viable option to provide care for clients. Personally, I’ve seen just as much success treating clients via telehealth as I have in person and it has also allowed me to think of creative new ways to do some exercises and target specific muscle groups as many of my clients have far from the amount of equipment at home as I am usually able to use with them in person. While some PTs have actually been providing telehealth for quite some time prior to the coronavirus pandemic, many others have accepted that it will definitely be an important part of the future of our careers and most especially for those businesses where telehealth was the only option keeping them afloat.

Sadly, the uncertainty of the pandemic has also brought up many other questions as well. Many insurance companies have chosen to cover telehealth rehab services, but reimbursement for physical therapy services has already been at an all-time low in recent years and companies like Medicare were already planning to make more cuts prior to the pandemic. Along with this, the typical outpatient physical therapy clinic often has multiple clients in a facility at a time and most times each physical therapist is treating multiple people simultaneously. With reimbursement rates already being low and PTs being unable to see as many clients in a day because of social distancing requirements or telehealth, it is likely that this style of outpatient physical therapy will be phased out for cash-based options. Cash-Based PT offices have already gained popularity in recent years as they allow therapists to treat less clients while often providing a higher quality of care in one-on-one settings, all while being paid the same salary because the client pays out of pocket rather than going through insurance.

When looking further into the question of what this pandemic holds for the future of physical therapy, there lies another sad reality of the COVID-19 pandemic. Physical Therapy programs across the country have pushed back internships for their graduating class which will effectively push back graduation, when new graduates will take their licensing exam, and when they will be able to enter the job force – an issue that has been the case for a variety of other professions as well. What will be the largest downside for this graduating class of professionals in a wide range of fields however, is that they will be entering a workforce that will likely have no immediate place for them as they compete for work with their more experienced peers after finally reaching what they may have originally seen as the light at the end of the tunnel.

This article represents the views of the author only and does not necessarily represent the views or professional advice of this publication or the author’s employer.

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