By Dr. Hays Estes, DPT
Imagine you’ve been diagnosed with a partial rotator cuff tear in your shoulder or osteoarthritis of your knee (symptomatic partial rotator cuff tears account for 1/3 of all rotator cuff tears and around 87 million people worldwide each year experience symptomatic knee osteoarthritis).
You are referred to physical therapy. You’ve done your own research and have found that these conditions respond best to conservative management using exercise and progressive strengthening to reduce your pain, improve your mobility and strength, and re-learn with supervision how to safely perform the activities or sports you love to do.
So you arrive at your initial evaluation ready to find a way to get moving again and are excited to work with a healthcare practitioner who’s up to date on the evidence and ready to provide you the best quality of care. But once you get started, you realize that the majority of your time is spent on some sort of bicycle, haphazardly moving your arms on a pulley system, and then having a hot pack and some electrodes that make your muscles jump up and down placed on you. You endure this week after week and see several other patients (with the same appointment time as you) go through the same motions. You’ve only seen the Doctor of Physical Therapy once, and that was at your very first visit. Whenever you ask about “exercise,” you’re either met with a “this is the plan from the Doctor” statement or maybe you’re given a small elastic band and told to pull it apart a few times as your “therapist” leaves you to tend to one of their other 3-4 patients who looks equally confused. After “trying physical therapy” for 4-6 weeks, not seeing any improvement in your pain or mobility, and “failing” (according to your surgeon), you have no other choice but to schedule a surgery…or do you?
Yes, you do have a choice. But if we (YOU) continue to allow the public trading of healthcare, the patients are no longer the ones who the corporate physical therapy companies are looking to please; no, the companies are now trying to please shareholders. So that means the bottom line has become significantly more important and individualized care that is evidence-based (and therefore takes more time and attention to deliver) takes a back seat in favor of the “bill (your insurance company) and chill” model.
Case in point: ATI. For background information purposes, ATI is a massive physical therapy corporation based in the Midwest and expanding like wildfire. Rumors of employee dissatisfaction and poor patient outcomes were abundant, but these were only found on internet or social media forums. ATI kept growing. They became so massive that they became a publicly traded company. And then they stopped caring about patient outcomes and started caring about the bottom line, forcing physical therapists to see more and more patients, utilizing unskilled aides and techs, and enacting unreachable productivity standards. And then the therapists started to leave. ATI blamed the attrition on “intensifying competition…in the labor market,” “elevated costs for therapists,” and “an unfavorable revenue mix.” In other words, their therapists wised up and found other companies that wouldn’t make them feel like herders of cattle and/or who would pay them a living wage based off of their education and experience. Oh, and ATI blamed the insurance companies for low reimbursement rates, forcing them to further use unskilled technicians and see more patients per day. ATI’s stock price fell 59% in one year with a 2.5% decrease in revenue.
This isn’t meant to be a hit piece on ATI. There are several large, corporate physical therapy chains all over the country who also provide subpar care in the name of profits. ATI just decided to go public, and the public spoke (for now).
I’ve written before that healthcare is a business and the owners and operators of healthcare businesses deserve to bring home a living wage and enjoy the profits of running a business efficiently. But the patient has to come first. And for the CEO of a publicly traded physical therapy company to claim to be a “leader in the large and growing physical therapy industry” while losing employees left and right and losing revenue simply shows someone who is out of touch with the direction in which the profession is actually moving: individualized care that is based on evidence designed to avoid addictive narcotics and unnecessary (or, at least, premature) surgery while empowering patients to take control of their (unbelievably resilient) bodies and lives.
Patients aren’t widgets. If you want to “bet” on a company whose mission is to use the latest evidence to decrease someone’s pain and improve their daily function, I can introduce you to the private practice owners all across this country trying to make a difference in their patients’ lives and support their families who would love an investor. Your ROI will be much more than just a fund just to pay for your private jet.
Or there’s always crypto.