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  • Keeping PTs in the Workforce May Be Key to Reducing Anticipated Shortage

    No matter how you slice the data, there will likely be a growing shortage of physical therapists (PTs) in the coming years. And while there are several moving parts that could affect just how big the shortage will be, authors of a new study believe that keeping PTs from leaving the workforce could have a major impact on reducing those supply gaps.

    For the study, e-published ahead of print in APTA's journal Physical Therapy (PTJ), researchers compared methodologies they used in calculating workforce projections in 2010/2011, 2012, and 2013. Authors describe how changes to elements such as a rise in PT graduates, a decline in the number of PTs failing the National Physical Therapist Exam (NPTE) for licensure, and the increase in the number of insured Americans under the Affordable Care Act (ACA) have an effect on just how significant the shortage of PTs will be through 2020.

    But it turns out that the biggest variable may be 1 of the hardest to pin down—exactly how many PTs will be lost to attrition over the next 5 years.

    Because no definitive research has been conducted on PT attrition, researchers looked at similar work in other professions to get an idea of the range of anticipated rates. What they found was that these rates varied fairly widely; so, instead of agreeing on a single attrition rate for physical therapy, authors of the current study analyzed data using 3 models of annual attrition: 1.5%, 2.5%, and 3.5%.

    Plugging in those rates, the 2013 model anticipated that there will be a shortage of 27,822 PTs by 2020 if attrition occurs at a 3.5% rate. That shortage drops to 13,368 should the attrition rate occur at 2.5%, and further declines to 1,530 at the 1.5% rate.

    Estimates developed in 2014—available at the APTA website but not included in this report—adjust that gap slightly, to 26,969, 14,167, and 606 at the 3.5%, 2.5%, and 1.5% attrition rates, respectively.

    "The proposed model for projecting [PT] workforce indicates that the US supply of PTs appears to be headed toward a shortfall, and this shortfall is projected to persist with or without increased demand related to the ACA," authors write, elsewhere stating that "the models assume attrition is a significant factor.” Based on the results, the authors believe that striking a balance between future supply and demand is linked to managing and reducing attrition rates.

    As in earlier models, the 2013 approach establishes a "supply side" by using data that include a 4% growth rate in PT graduates, a 2% NPTE failure rate, an annual addition of 535 internationally trained PTs entering the workforce, and a constant rate of 85% of PTs being employed full time, with the remaining 15% being employed part time at an average of 24 hours a week.

    On the demand side, researchers factored in general population projections from the US Census Bureau and projected increases in the insured population, mostly due to the ACA, that the Congressional Budget Office estimates will add between 14 million and 25 million Americans to the insurance rolls between now and 2020.

    The ACA is no small player in the anticipated workforce shortfall, according to the authors, who estimate, that if all other factors hold constant and the insurance predictions hold true, "the gap between supply and demand for PTs will almost double" by 2020.

    Given these predictions, researchers identified attrition rates as a variable that could be controlled in order to decrease the magnitude of the coming shortage. Authors also identify an increase in the number and size of PT education programs as something that might help but is largely beyond the control of society or the profession itself. Similarly, they note that upping the number of internationally educated PTs may help but add that licensure requirements may have an effect on just how significantly this number might rise.

    Which leaves attrition as the potentially controllable factor that could, as authors write, "'bend the curve' in terms of human resources."

    "Implementation of new policies within the physical therapy profession that affect workforce retention are equally as important as strategies that increase the number of providers," authors write. "In the aggregate, it is far less costly to retain a provider than it is to produce or educate a replacement provider."

    The researchers also call for more extensive data collection, so that future projections can focus on geographic regions, population density, or areas of need.

    "It would … be helpful into the future to be able to apply the model to particular types of practice, as previous work has shown that surpluses or shortages may vary by practice type," authors write. "Moreover, future models will be required to grasp the eventual outcomes related to the existing and potentially expanding role of physical therapist assistants (PTAs) in delivering care."

    Authors of the study include Michel Landry, BScPT, PhD, Laurita Hack, PT, DPT, MBA, PhD, FAPTA, Elizabeth Coulson, PT, MBA, Janet Freburger, PT, PhD, Michael Johnson, PT, PhD, OCS, Richard Katz, PT, DPT, MA, Joanne Kerwin, PT, PhD, MMHS, Henry "Bud" Wessman, PT, JD, LNHA, Diana Venskus, PT, PhD, and Patricia Sinnott, PT, PhD, MPH. APTA staff Megan Smith and former staff Marc Goldstein also are contributing authors.

    PT supply and demand projections are among several resources available at APTA's Physical Therapy Workforce webpage. Also available: median salary information, demographic data, and turnover rates in various settings.

    Comments

    • I couldn't agree more. When I left full time employmer it was ONLY because the did not offer part time or PRN options that would have better suited my needs in that season with aging parents and my family's needs. However, the longer I put off finding another part time employer, the more we realized we could manage without a second income altogether. And I don't know if I'll ever return to the work force now that I enjoy being a stay home mom and volunteering more in my community.

      Posted by Theresa N. on 10/20/2015 7:46 PM

    • I cna't find a part time job in manhattan, NY that isn't schools or homecare. there isn't a shortage of fulltime PTs in Manhattan!!!

      Posted by helene on 10/20/2015 8:03 PM

    • Attrition will continue to grow in our field. I'm betting it'll be closer to 5% over the next ten years. Many people are only continuing as PTs because they have such a major expense in their student loans and feel they need to pay that off before finding the "next thing". Unfortunately, our salaries typically do not justify the amount, or expense, of the education we have. People are not told this harsh reality before entering the field, and learn it long after they become a PT. These people have a hard time living comfortably while paying off their student loan, so they have to choose one or the other. Attrition will increase as we face declining reimbursement, increases in regulation, increases in caseload demand, increases in documentation requirements, encroachment by other professions, and our own inability to educate people of our true value rather than being considered an ancillary service for physicians to control.

      Posted by Scott on 10/22/2015 9:33 AM

    • A similar situation for me,Theresa, the facility that I practiced at, for 15 years, did not have or offer any options. But, I believe Attrition of PT's can be controlled positively with updated retention policies. And, I believe "Value", is a key word for retention. I can see that we are not valued by some. I recall, one of the many reasons I choose and dedicated myself to become a PT was to have an impact on the health disparity in the rural areas of America, this was in the 1989. There was a shortage then and still is.

      Posted by HP on 10/22/2015 5:14 PM

    • This is a very interesting article. One of the factors that it seems to leave out is the current movement to change the reimbursement model for therapy in the post-acute setting. If/when payment is reduced, and access reduced (either through minimizing reimbursement or reducing the current treatment intensity levels), this may have a very real effect on the need for additional physical therapists. The comments about expanding the role of assistants may also have a negative impact on the need for PTs (and this doesn't address the concerns of the level of quality that this shift may have). Job security is great...but the economic forces (of reimbursement) may be acting in a way that isn't accounted for in this research.

      Posted by Mark on 10/22/2015 6:18 PM

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