Student Loan Debt: APTA Member Sandra Norby Testifies Before House Committee
On Tuesday, June 12, 2019, Sandra Norby, PT, DPT, was one of several health care providers and students to speak in front of the US House of Representatives Committee on Small Business about the effect of student loan debt on the ability to sustain a small practice. Norby, who is chief executive officer of HomeTown Physical Therapy in Des Moines, Iowa, testified on behalf of the American Physical Therapy Association and the Private Practice Section.
Following is the full text of her spoken remarks. You also can download her more extensive written testimony (.pdf).
My name is Dr Sandra Norby, and I am a physical therapist and CEO of HomeTown Physical Therapy in Des Moines, Iowa. On behalf of the American Physical Therapy Association, and the Private Practice Section of APTA, I thank you for the opportunity to provide testimony on the impact that rising student loan debt has on small practices. Today I will share with you my perspective on how small medical practices, including physical therapy clinics, struggle to recruit and retain good talent—and the significant role that student loan debt plays in that challenge.
My small business consists of 5 clinics in rural Iowa with a total of 25 employees. When we opened our doors 13 years ago, we named our business "HomeTown Physical Therapy" because it represented our desire not only to be a part of the local economy and community, but also to hire individuals who had grown up in Iowa's small towns—hometown people who had gone away to school, earned their degrees and developed expertise, but who wanted to be able to come back to their hometown to practice.
One of my clinics is in Lake Mills, Iowa. A recent graduate from the Mayo Clinic College of Physical Therapy and Rehabilitation is engaged to marry a farmer who lives 15 minutes outside of Lake Mills. They plan to live and work on that farm, but she is struggling to find a job locally that will compensate her enough so that she can also pay her student loans. My clinic in that town is in high demand and we treat a variety of patient populations. The patients we treat run the gamut from student athletes recovering from concussions, to farmers with low back pain from long days on the combine, to seniors recovering from joint replacement. Forty-five percent of our patients are Medicare beneficiaries, and the need for services for our seniors is growing with the greying of rural America. While our patient load is high, it is not high enough to pay a second additional full-time physical therapist. We are currently in negotiations to determine whether or not I could bring her on board and pay her enough of a salary to cover her loans.
I knew the risks and opportunities of starting a small business, and the variables that come into play when running a small practice in a rural area. But one variable stands out that continues to have a growing impact on the ability to recruit and retain staff and keep my business open—the impact of student loan debt.
The challenges that small practices face in rural areas in recruiting and retaining providers has been highlighted by the current opioid crisis and the critical need for increased access to nonpharmacological options. However, recruiting therapists, especially those who have expertise in pain management, is a challenge, given the competition from higher-paying salaries offered in urban and suburban areas.
There is no easy fix or silver bullet to the complex problem of student debt. There are 2 immediate policy solutions highlighted in my written testimony that APTA and the Private Practice Section strongly support that would alleviate the burden of student debt on small practices' ability to recruit and retain recent grads.
One that I would light to highlight is enactment of H.R. 2802, the Physical Therapist Workforce and Patient Access Act of 2019. This bipartisan legislation, introduced by Reps Diana DeGette and John Shimkus, would allow physical therapists to participate in the National Health Service Corps Loan Repayment Program. I am grateful for the opportunity to thank Chairwoman Velazquez in person for her cosponsorship of this legislation.
Policy solutions that assist practices in recruiting and retaining graduates with student debt to Iowa, and to other rural and underserved communities, not only make sense for small business, they assist in improving public health.
I truly appreciate the committee's interest in addressing the student loan burden of providers who are willing and eager to be a part of the engine of the local economy—working in a small business—and practice in rural and underserved areas. I look forward to working with the committee, and I am happy to answer any questions you may have.
APTA greatly appreciates Norby's advocacy on behalf of future physical therapists and practice owners. Your voices are essential to informing policy makers about the very real issues affecting the profession, whether on the federal or state level. To learn how you can become an effective advocate, visit APTA's "Take Action" page.