Chasing the dream

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“Don’t chase the paper, chase the dream” –Sean P. Diddy Combs

It is not an accident that we provide care in a particular style, for an amount of time and for a certain price.  The fundamental beliefs behind the decisions made at our clinic are to provide the best level of care in the most cost efficient manner for the patient. In the physical therapy world a therapist is often judged by how productive they are. A CEO or regional manager or clinic manager sets a “standard” for how many patients each therapist should see. Many levels of management place subtle or often not so subtle stress on the therapist to treat a high volume of patients. Often the therapist is told that this is what they need to do in order to gain the proper amount experience and that if they did not treat this many patients that the company would fail and that they would not get to help anyone. In order to “see” all of these patients one on one care with the therapist is kept to a minimum, often 15-30 min per patient and then “handed off” to an aide for the rest of their care. This type of therapy is cost effective (for the company) and productive (for the company). For the patient it can lead to increased number of visits, lack of progress and increased time and money spent at the physical therapy clinic. For the therapist it can lead to the frustration of not truly knowing what is being done with their patients, increased paperwork and paradigm shift from the focus on patient care to focus on statistics.
As a doctored profession we have a right to uphold the ideals that we learn in PT school. We have the right to treat our patients to the best of our ability. To teach and learn from our patients, to build relationships, to keep the cost down and quality high. Having worked for large companies in the past I am finally at a point in my career where I can control the duration and frequency of patient visits without corporate pressure. I can see a patient for a whole hour at time, I do not go home wondering what exercises/how they may or may not have been taught to my patients. I can spend less time worrying and more time helping, listening and refining my skills. Less time with paperwork and more time teaching patients how manage their own symptoms so that they do not need to spend time and money in the clinic. And, the dirty secret that no one wants to tell you is that it doesn’t cost you any more money. In fact our rates are on the low end of the national average. When you go to a clinic where the PT sees 2,3 or even 4 patients an hour they are billing as much or more for each patient as we do. But we are only seeing one per hour. Our focus is not to make the maximal amount of money but to make the maximal amount of change. To me, seeing four patients an hour versus one is like the difference between wonder bread and an artisanal bakery. The only weakness of this model is that we can not treat everyone in need of physical therapy. Once the dough is done that’s it, no more baking for today! Smaller batches of patients with higher quality care. Quantity or quality the choice is yours (and ours).
 Andrew S. Eisen DPT
Andrew is a cooperative partner at Union Physical Therapy