• Feature

    Recruiting Tomorrow's PTs & PTAs

    Physical therapists, physical therapist assistants, students, and educators work to bring in newcomers.

    Recruitment

    When Deb Gulbrandson, PT, DPT, engages in outreach to middle and high school students, she puts a contemporary spin on a profession with deep historical roots. Some of the younger students don't know what a physical therapist (PT) or physical therapist assistant (PTA) does, or the difference between a PT and a personal trainer.

    "I tell students we're the CSI [crime scene investigation] of the health care world. We try to figure out problems. For example: What causes injuries?" At the middle school level, that approach can plant seeds of interest, says Gulbrandson, owner of Cary Physical Therapy in Cary, Illinois. "There is a real opportunity for us to be that role model."

    Avenues for Success

    In her experiences talking to students, Gulbrandson has discovered that many of them don't have a well-defined image of the profession. Meanwhile, some students want to go into "sports medicine," while struggling to define what that means.

    She believes she and her fellow PTs have an obligation to get the word out—making the profession visible and attractive to young people who might someday become outstanding therapists. "I'm so thankful to the PT who mentored me," she says. Gulbrandson injured her arm in high school, but it didn't straighten properly as it healed. She mentioned the mishap to a friend, who asked, "Isn't that what physical therapy is for?" Gulbrandson reached out to a local hospital and got in touch with a PT, who invited her to come and watch. She still recalls her reaction: "This is the coolest profession."

    She stresses the importance of making students aware of all the options within physical therapy. "I feel like I've had a dozen careers," she says of her 40-plus years in the profession. She worked in private practice for 26 years before recently merging her outpatient orthopedic practice into a health system. "As a private practice owner, I periodically received requests to speak to high schools about the business of physical therapy." She says her response always was yes.

    Gulbrandson shares that enthusiasm with others. Besides speaking at career nights at high schools in the greater Chicago area, she fields phone calls from students who are interested in the profession. Some of them go on to volunteer at her clinic. A few of her current colleagues once were those high school volunteers.

    Recruiting Amid Changing Demographics

    The physical therapy profession increasingly is addressing the issue of changing demographics both in the general population and among PTs and PTAs.1–6 Perhaps not as fully addressed is the issue of how tomorrow's health care providers will become attracted to—or even become aware of—physical therapy as a career option.

    That's important, because multiple studies suggest that a shortage of PTs may lie in the future. In 2016, APTA projected the supply of and demand for PTs through the year 2025. Under 2 of 3 scenarios—including the one deemed most likely—shortages were predicted.7 "We need to make sure there is an adequate supply of PTs to meet society's demands," says Ryan Bannister, director of centralized application services and student recruitment at APTA.

    Meanwhile, the US Department of Labor's Bureau of Labor Statistics projects a PT employment increase of 28% from 2016 through 2026—"much faster than the average of all occupations," says BLS. It explains, "Demand for physical therapy will come in part from the large number of aging baby boomers…. In addition, a number of chronic conditions, such as diabetes and obesity, have become more prevalent in recent years. More physical therapists will be needed to help these patients maintain their mobility and manage the effects of chronic conditions." And advances in medical technology, including the use of surgery, will mean that "Physical therapists will continue to play an important role in helping these patients recover more quickly."8

    Reaching the Next Generation

    APTA targets different groups through its student-focused events. Bannister and his colleagues start the recruitment process early, talking to young students about the options available to them. "When you talk to elementary and middle school students, it's very general. Also, we know we're not necessarily talking to the kid, but to the influencers, such as parents and teachers." Later, when speaking with high schoolers, the advice grows more specific—as in what classes to take to prepare for college if a student wants to become a PT.

    Heidi Jannenga, PT, DPT, ATC, says, "We must increase our visibility in communities and in care settings where we are not currently well-represented—and form partnerships and relationships with other health and wellness stakeholders outside of physical therapy to further expand our reach."

    APTA, for example, partners with HOSA: Future Health Professionals, an organization that promotes careers in health care. HOSA began in 1971 as the Health Occupations Education Division of the American Vocational Association and became a separate organization in 1976. Today, HOSA counts more than 245,000 students from middle school through college as members.9 According to Bannister, approximately half are members of underrepresented populations in health care.

    HOSA conducts competitions in various health care disciplines, including physical therapy. Its physical therapy event consists of 2 rounds of competition: a written, multiple choice test followed by a skills test which includes a problem-solving scenario.

    APTA sponsors events at HOSA's International Leadership Conference. For 2019, HOSA selected physical therapy as the profession to highlight in an educational poster campaign. Bannister notes, "We therefore have access to a captive audience—students who already are interested in health professions."

    Student Journeys

    Today's PT and PTA students discovered physical therapy in myriad ways. Jessica Nguyen, PT, DPT, graduated earlier this year from the University of Southern California in Los Angeles. She always was interested in the medical field, she says, and she originally wanted to become a physician. However, while volunteering at a hospital in college, she spent time in the institution's rehab department. "I liked physical therapy because of the time you spend with patients," she says.

    Madison Kirkpatrick, a second-year student at the University of St Augustine for Health Sciences-Austin in Texas says, "I've also been fascinated by the human body and medicine, and I've always wanted to help people." Her first experience with physical therapy came at age 15 due to an injury. She realized, she says, that the profession was what she was looking for.

    Derwin Hall, a third-year student at the same school as Kirkpatrick, also was introduced to physical therapy after experiencing an injury as a teenager.

    The path to PT school isn't always direct. Hall worked as a physical therapy tech for 3 years after college. "A physical therapist made an investment in me," he says. Her attention encouraged him to pursue physical therapy as a career. "If other therapists see and fan that spark in someone, it can provide a catalyst," he observes.

    Kirkpatrick recalls the application process for PT school as being both rigorous and opaque. She applied 3 times—earning a masters' degree in the interim—before gaining acceptance. "I did a bunch of things to differentiate myself," she notes, acknowledging, however, that not everyone has the means to do so.

    Diversity Matters

    APTA is doing its part to entice talented young people of all backgrounds to consider entering the physical therapy profession, Bannister says, explaining, "We look at diversity as being inclusive, and we are trying to bring everyone into the fold." From race to sexual identity and ethnicity, from socioeconomic status to geographic location, there are many dimensions to diversity.

    Kirkpatrick, Hall, and Nguyen all come from segments of the population that are underrepresented in the profession. Nguyen, who is Vietnamese American, remembers having a PT present at a career day for the Vietnamese youth group at her church. "It was nice to see people who look like me. I could see myself in their place," she says.

    Hall and Kirkpatrick echo the importance of representation.

    Hall remembers thinking that admission to PT school would be impossible because of the lack of African Americans in the profession. For that reason, he says it's important to show physical therapy's potential to underserved populations. "You're molded to be what people around you are doing."

    Kirkpatrick says, "As an LGBTQ+ woman, I don't see a lot of people like me. Other minority groups are severely underrepresented as well. There's not a lot of representation in the profession." She says that diversity in the classroom should mirror the diversity in the patient population. Kirkpatrick also is a first-generation college student who grew up in a rural, underserved community where the nearest major medical center was 3 hours away.

    Nguyen, Hall, and Kirkpatrick decidedly do not reflect the typical demographics of today's PT. As a white woman, Kirkpatrick is in the majority; 62% of enrolled DPT students are women, and 74.6% are Caucasian. Neither the Commission on Accreditation in Physical Therapy Education (CAPTE) nor APTA keeps data on sexual or gender identity, but, anecdotally, the numbers appear low.

    Nguyen is part of the 8.91% of PT students who are Asian. Only 3.39% are African American and, as a male, Hall is part of 2 minority segments within the student pool.1

    Physical therapy students also can play a role in promoting the profession to underrepresented groups. For example, Nguyen served as president of USC's Physical Therapy Multicultural Leadership Alliance, a community outreach program.

    Once a month, the program's students visit local schools to talk about careers in physical therapy. The younger students gain perspective from those who have recently gone through the process of applying to physical therapy programs. "In the local community, some minority youth don't feel comfortable pursuing higher education. Bringing out someone who looks like them makes them more likely to pursue it," Nguyen says.

    In fact, many of her USC classmates didn't know much about physical therapy until college, she reports—speculating that exposing people earlier could make attracting them to the profession easier. "It would be great if other schools developed these types of programs so we can continue to diversify," she says.

    Kirkpatrick and Hall agree that current students can play an important role in educating future PTs and PTAs. "We're the next generation," Kirkpatrick says. "We're shaping who's coming to the profession." She serves as community outreach coordinator for her school's Student Physical Therapy Association. Among other activities, the group hosts fun fitness nights at elementary schools, exposing those children to physical therapy.

    Jose Martinez, PT, DPT, and Victor Garcia, SPT—respectively, a graduate of Florida International University (FIU) and a current student—founded Leading PT, a mentorship group that now numbers more than 1,000 students nationwide. The goal is for PT students to help high school and undergraduate students conquer their fears and to answer their questions about the profession. Martinez and Garcia also run a Facebook mentorship group. Their website notes, "As pre-physical therapy students, it's easy to feel overwhelmed, discouraged, and disoriented." Leading PT offers a variety of tools and programs to counter those emotions.

    Hall notes, "It's important to come into students' lives to show them you can have longevity in this career." It's all about capitalizing on opportunities. He cites social media as an important vehicle to explain the process of getting into PT and PTA education programs. Current students and recent graduates can spread the message of perseverance. "If you get denied, don't give up."

    Other PTs agree on the value of social media as a marketing tool. "We need to meet people where they are," says TaVona Boggs, PT, a life coach and burnout specialist who works with PTs in Atlanta. She mentors for the National Association of Black Physical Therapists (NABPT). Boggs owns a contracting company, primarily focusing on acute care, and runs the Wellness PT Society, teaching other PTs how to start wellness businesses. "The passion for what we do is infectious," she says. Current PTs, she adds, should take it upon themselves to convey that passion to others.

    Practicing PTs should communicate through the channels that young people prefer. Business owners, for example, can use Snapchat and Instagram to promote physical therapy. "We don't market our services enough," Boggs says.

    PTAs Help Light the Way

    If employment of PTs is expected to grow "much faster" than average, projections for PTA employment are even stronger. The Bureau of Labor Statistics expects overall employment of PTAs to grow 30% from 2016 to 2026.11  

    PTA students are being actively recruited by schools across the country. One of those is Bryant & Stratton College in Wauwatosa, Wisconsin. Becky Thomas, PT, MSEd, the school's PTA program director, says, "I team up with our high school admissions representatives to speak to high school students—specifically to those in the health care classes. I bring several tools that PTs and PTAs use in the field, such as a goniometer, a pinch grip, a hand dynamometer, and exercise bands."

    The college does its share of outreach to educate potential students. Thomas travels with Bryant & Stratton's high school admission representatives to engage students in activities related to the field of physical therapy. She explains, "I engage the students in 'minute-to-win-it' games where they have to wrap an amputation simulator, put on a dress shirt with just 1 arm and a simulator arm hanging at their side to simulate a patient poststroke, and walk with a standard walker. The students always are intrigued."

    The school also raises awareness by attending college fairs, a state fair, and expos attended by high school students and the general public. Thomas makes the point that education regarding the function of, and opportunities for, PTAs is appropriate both within and outside the profession. "It's valuable for all people within physical therapy to know what PTAs do, and to raise awareness of the value they can bring to a practice," she says. "As professionals, our job is to raise awareness that although the challenges a PT or PTA may meet each day can be daunting, the end outcome of helping a patient makes the job worth it."

    While reaching out to more high school students has been a focus this past year, Bryant & Stratton already has a successful niche catering to nontraditional students—those not enrolling directly after high school. Such students bring a depth of valuable work and life experiences, Thomas says. The cohort for this fall consists of 2 traditional and 11 nontraditional students.

    Inclusivity Creates Better Experiences and Outcomes

    Once students are recruited to physical therapy educational programs, the job isn't over. The next step is providing the support they need to encourage them to stay and flourish.

    Karla A. Bell, PT, DPT, assistant professor and co-director of clinical education in the Department of Physical Therapy at Jefferson College of Rehabilitation Sciences in Philadelphia, says, "In our profession, we help lead people to their best health and wellness." To do that, the profession itself needs to be more inclusive, she argues. Bell is a board-certified clinical specialist in orthopaedic physical therapy and in geriatric physical therapy.

    Bell says programs need more resources to support LGBTQ+ students and other underrepresented groups. "Underrepresented students need resources on campus. It's not enough to just recruit them; they need additional supports for retention and success." Minority students need advisement and connection with local resources, she notes, because many of them struggle with added emotional, physical, and financial barriers. At her university and others, affinity groups exist to help students with specific challenges related to their lived experiences. Bell believes faculty should always ask themselves, "How can we be more supportive?" and "Am I doing enough in that realm for all students?"

    Bell and Melissa Hoffman, PT, MSPT, PhD, of Regis University serve as co-chairs of PT Proud, a committee within HPA the Catalyst—APTA's Health Policy and Administration Section. The group's goal is to bring about change in the profession through advocacy, policy, and cultural humility education. It aims to positively affect the health care experiences of sexual and gender minority patients, students, and clinicians.

    "Students do best when they feel like they belong and can bring their whole selves to the classroom and clinical world; research supports this," Bell says. That starts with students finding the school that supports their whole self. The Campus Pride Index is one resource to gauge campus support for LGBTQ+ students; it ranks colleges and universities based on their LGBTQ-friendliness in a number of domains. Once students are on campus, PT Proud is looking for more ways to support current DPT students, such as matching them with mentors and advocating for faculty development in sexual and gender minority content to assist in best practices for advising and teaching.

    PT Proud is asking APTA to collect demographic information on students' sexual and gender identity. It believes sexual and gender minority students should be included in the association's definition of underrepresented minorities. Bell notes, "We're trying to bring the conversation to the table. Everyone has a race, a sex, a gender, and a sexual identity. We can't ignore any of those."

    Inclusivity and diversity also are key to better patient experiences. "Research shows that patients do better working with people who look like and identify with them," Bell says. When therapists feel comfortable being their authentic selves in the workplace, it can lead to innovative solutions.

    Hall remarks, "It takes a collaborative group of people to reach others who are different." Diversity promotes change and forward-thinking. Adds Nguyen, "As the patient population gets more diverse, it's important to have more PTs who are culturally aware." PTs, she says, must learn early on to incorporate different viewpoints into patient care.

    Kirkpatrick agrees. "The more we're exposed to diversity in the classroom, the better clinicians we will be in the future." She suggests that PT clinics depict diversity in their marketing materials—pointing out that a simple gesture such as a sign reading "All people are welcome here" can carry large significance and make patients feel at ease.

    Boggs helps NABPT members navigate the potholes of careers. Mentors are important to all PTs but especially to those from underrepresented groups, she says, explaining that mentors share insights and resources, and help students and young practitioners build connections. "If people don't see someone who looks like them in a certain role, they won't have an idea they can do it," she says.

    Financial Education and Debt

    Besides lack of awareness among potential students, another roadblock is cost. From the application fee to tuition, earning a degree is expensive. According to CAPTE, the median total cost of a DPT education program in 2018-2019 was $62,196 in-state and $111,275 out-of-state.12 The median total cost to earn a PTA degree at a public school in-district was $12,448 in 2018-2019. The cost out- of-district was $21,246. The median cost at a private school was $38,922.

    A survey conducted by WebPT found that 60% of PT students will have more than $70,000 in debt when they graduate. For 25%, the debt will be more than $100,000. Yet, the median expected starting salary is between $60,000 and $80,000. It's apparent to many, Heidi Jannenga says, why PTs rank benefits/salary and income stability as reasons number 1 and 2 for accepting a job.13

    "So, how can we create a more welcoming environment for student PTs of all backgrounds?" Jannenga asks. "It starts with making this career path accessible and desirable to a wider segment of would-be PT students, which means taking a hard look at the seemingly inflated cost associated with DPT programs—and coming up with ways to reduce that cost. We should look at the curriculum and see where we have fluff." She points to some PT education programs that have pared their duration to 2 1/2 years or have started residency programs in which students are paid.

    After graduation, one way out of debt is increased income. Empowering PTs and PTAs financially should start early, says Boggs, who believes that the financial side of physical therapy does not get enough attention in physical therapy education programs. Students aren't properly educated on debt-to-income ratios, repayment terms, and other matters that will affect their lives for years after graduation, she observes.

    Boggs sees the strain of debt on the faces of the younger PTs with whom she works. Those young practitioners need to have scalable ways to augment their salaries and leverage those hard-earned degrees. "We need to teach students how to create more value for their organizations," she says, adding, "If they are more marketable, they will command a higher salary."

    "APTA is aware of the issues around student loan debt and is doing things to combat it," Bannister says. He notes that the association has launched Enrich (enrich.apta.org), a financial literacy website with materials targeting different audiences—those considering physical therapist or physical therapist assistant programs, current students, and new grads. It also has partnered with Laurel Road, which offers discounts on loan repayment rates to eligible APTA members.

    In addition, APTA is lobbying for legislative changes to address student loan debt relief. Legislation currently in both the US Senate and House of Representatives would permit PTs to be part of the National Health Service Corps (NHSC) Loan Repayment Program. Participants in NHSC can have up to $50,000 of their qualified student loan debt forgiven in exchange for working for 2 years in a designated Health Professional Shortage Area.

    The bill, which has bipartisan support, was referred to the Senate's Committee on Health, Education, Labor, and Pensions in April and referred to the House's Committee on Energy and Commerce in May.14, 15 A companion bill, HR 2802, has been introduced in the House and has been referred to referred to the House Committee on Energy and Commerce.16, 17

    Looking Ahead

    Earlier this year, APTA released its 2019-2021 Strategic Plan. One goal is to "foster long-term sustainability of the physical therapy profession."

    Specifically, the plan states: "For nearly 100 years, APTA has provided a community for the physical therapy profession. Now there are more ways than ever for members to connect with each other and the association, which paves the way for even greater diversity that will only strengthen the profession. APTA recognizes this opportunity and will nurture and support the growth of a more inclusive and diverse physical therapy community. Unfortunately, students today are graduating with significant student debt while pay for entry-level PTs and PTAs remains stagnant. APTA will continue to invest in efforts that amplify the voice of those beginning their careers and create new solutions for the profession. APTA also will work to ensure that professional and economic opportunities remain for future generations of PTs and PTAs through improved payment, greater participation in integrated models of care, and new practice settings to advance the physical therapy profession."

    Danielle Bullen Love is a freelance writer.

    References

    1. Wojciechowski M. Who are tomorrow's PTs and PTAs? PT in Motion. 2018; 10(5):30-41.
    2. Hayhurst C. Career Transitioning advice for aging PTs. PT in Motion. 2018;10(2):26-30.
    3. Ries E. Thriving in your late(r) career. PT in Motion. 2012; 2012; 4(8):
    4. Hayhurst C. Generation Stem. PT in Motion. 2012; 4(5):
    5. Wojciechowski M. Cultural competence and the changing patient/client population. PT in Motion. 2011; 3(10): 18-23
    6. Ries E. Coloring the Future: Racial and ethnic diversity in physical therapy. PT Magazine. 2006; 14(11): 36-43.
    7. American Physical Therapy Association. A Model to Project the Supply and Demand of Physical Therapists 2010-2025. April 2017. http://www.apta.org/WorkforceData/ModelDescriptionFigures/. Accessed May 19, 2019.
    8. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook, Physical Therapists. https://www.bls.gov/ooh/healthcare/physical-therapists.htm. Accessed May 19, 2019.
    9. HOSA Future Health Professionals. http://www.hosa.org/about. Accessed May 19, 2019.
    10. Aggregate Program Data. 2018-2019 Fact Sheets: Physical Therapist Education Programs. Commission on Accreditation in Physical Therapy Education. http://www.capteonline.org/uploadedfiles/capteorg/about_capte/resources/aggregate_program_data/aggregateprogramdata_ptprograms.pdf. Accessed May 19, 2019.
    11. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook, Physical Therapists and Aides. https://www.bls.gov/ooh/healthcare/physical-therapist-assistants-and-aides.htm. Accessed May 20, 2019.
    12. Aggregate Program Data. 2018-2019 Fact Sheets: Physical Therapist Assistant Education Programs. Commission on Accreditation in Physical Therapy Education. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Aggregate_Program_Data/Archived_Aggregate_Program_Data/CAPTE_2018PTAggregateData.pdf. Accessed May 30, 2019.
    13. WebPT. The State of Rehab Therapy in 2018. https://www.webpt.com/resources/download/the-state-of-rehab-therapy-in-2018. Accessed May 19, 2019.
    14. Physical Therapist Workforce and Patient Access Act of 2019. S.970, 116th Congress (2019). https://www.congress.gov/bill/116th-congress/senate-bill/970/text.
    15. American Physical Therapy Association. Student Loan Repayment Program to Include PTs? Health Services Corps Bill Reintroduced in US Senate. http://www.apta.org/PTinMotion/News/2019/4/5/HealthServicesBillIntroduced/ April 5, 2019. Accessed May 19, 2019.
    16. Physical Therapist Workforce and Patient Access Act of 2019. HR 2802, 116th Congress (2019).
    17. American Physical Therapy Association. Legislation to Include PTs in Student Loan Relief Program Now in House and Senate. http://www.apta.org/PTinMotion/News/2019/05/17/NHSCHouseBill2019/#. Accessed May 28, 2019.

    RESOURCES

    APTA

    2019-2021 Strategic Plan

    https://www.apta.org/StrategicPlan/Plan/

    About PT/PTA Careers

    http://www.apta.org/AboutCareers/

    Enrich: Personal Finance Website

    https://enrich.apta.org/

    Financial Solutions Center

    http://www.apta.org/FinancialSolutions/

    Information for Prospective Students

    http://www.apta.org/ProspectiveStudents/

    PT Proud

    HPA The Catalyst

    https://www.ptproud.org/

    You Can Be Me: A Career in Physical Therapy [Video]

    https://youtu.be/r35FQT3u0J4

    Other Organizations

    Bureau of Labor Statistics

    Occupational Outlook Handbook

    https://www.bls.gov/ooh/

    HOSA: Future Health Professionals

    www.hosa.org

    Leading PT

    https://leadingpt.podia.com/

    National Association of Black Physical Therapists

    https://nabpt.org/

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