I am amazed at some of the pessimism and complaining that runs rampant in our profession. I think some of this general crankiness comes from a serious lack of perspective. Firstly, we now generate more relevant clinical research not only in our own journals, but in many well-respected journals of the medical profession. Secondly, despite relevant misgivings about the current state of our education and training, we are arguably kicking out more well-rounded and academically prepared therapists into the work force. Lastly, although I hear PT's complain about their pay entirely too much, salaries have never been higher. Basically there has never been a better time to be a physical therapist and we are doing some things very well.
At the same time, we do have our share of important issues to deal with. Reimbursement is declining across the board. Regulation of our practice (guided by the flagship CMS) is at an all time high. While innovation is being championed in the form of inspiring new clinical research, emerging and potentially useful practice patterns are too often fractured by suffocating reimbursement and regulatory guidelines. To whom should we cast the first stone?
- Ourselves in not policing our practice patterns when the money was good.
Thanks to our gluttonous billing patterns of yesteryear (Can you say "HUMing?), we are currently paying the price. Everyone was doing it though...so it's ok right? Right.
- Third party payors in realizing they could actually make more money by regulating us more tightly (say cheese ACN). Sometimes, its hard to explain how the corporate world could be even more irritating than the federal government. The blame shifts again back on us however, as we have gently rolled over for these jerks and it continues to pay off...for them.
- The federal government in wielding restrictive legislation with the precision of a sledgehammer. The result is an inexplicably complex federal health care system that is confusing to it's beneficiaries and frustrating for it's providers. Are we sure we want to turn the whole thing over to these hacks? If your answer is 'yes', you clearly have never picked up a copy of our federal tax code.
- Our patients in creating a culture of unaccountability from of our actions. The founders of our country would probably get nauseated at the sight of our behaviors.
Despite incontrovertible medical evidence, public awareness, corporate and federal funding, our nation continues to resist adopting healthy behaviors. Trips to the local gym aren't nearly as frequent as those to the troughs of the local all-you-can-eat buffet. Pictures like the well-nourished gentleman above would be hilarious if they weren't so sad.
One might say we aren't handling these challenges very well. We whine at legislative defeats, but refuse to contribute to our PAC. We bemoan the pitiful reimbursement from third-party payors, but continue to feed off these scraps. We get upset at fringe providers who continue to practice voodoo like craniosacral and myofascial therapy, but don't have the guts to force our own professional organization to marginalize them. Lastly, we complain our patients are fat and smoke too much, yet don't take enough time to counsel them in an appropriate manner. Basically, we aren't contributing much to a solution.
Working Toward a Solution
We are free to blame the federal government, third party payors, and even patients for our problems. In the end, it's wasted energy without salient action. Those actually doing the heavy lifting for our profession are too busy to complain. They are busy actively researching, teaching, and advocating for a profession that largely doesn't act like it wants to play in the big leagues. The next time you complain about reimbursement, POPTS, payors, or patients, you may want to take an inventory to decide just which side of this funny little equation you are on.
Sorry, but treating patients isn't enough. We get paid to do that remember? Conscious effort beyond the call of duty is required to shift this equilibrium toward a favorable outcome. Contribute to our profession beyond the time-clock. Teach. Perform clinical research. Write your congressman. Give time to your local school district, community, or church. Doing something will always trump complaining about everything.
Lastly. I would be remiss if I didn't state the obvious: It is an election year with serious implications for the future of our health care system. Please vote! Remember. Our vision for 2020 is worthless without action in 2008.