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One chapter ends, another begins.

Our Chief Executive officer reminds us that we should be proud of how we've emerged from the pandemic. The end of the public health emergency did in fact feel like the end of a chapter.

That's one way to think about history – as a series of chapters. And not just history in general, but the history of our profession. And maybe even our own personal histories. One thing, then another, then another, with the idea that we learn from our successes and mistakes so that we can take on the next chapter, and the next.

Take our profession. We like to say that we emerged from World War I and the Influenza epidemic. After that came the roaring 20s and reconstruction aides.

Over that decade, we created this association, launched a scientific journal, and began establishing education standards, and even hosting annual meetings. Then came the next decade, the next milestone societal event, and here we are—the product of one thing, then another, and another.

But there's something else at work.

In the moment, things don't always feel orderly like a book book. Chapters run together. They aren't always in order, but eventually a story emerges – a story of people taking action to shape their future.

So let's begin a new chapter.

We, this House of Delegates, have the opportunity and responsibility to begin to shape the future to our fullest potential.

But where to begin? In many steps, we've already started.

As you may know, over the past year APTA engaged in the work of foresight. Actually it's more than work—it's a practice. And it's a way of thinking.

We looked at data, trends, and information capable of disrupting the future – as a society, in health, and within physical therapy. Over time, a theme emerged. We quickly realized that it wasn't "the roaring twenties" we were facing. We are now in fact what we call "the turbulent twenties."

Our foresight work involves identifying long-held beliefs and assumptions about the profession and association, which we call "orthodoxies." Then we work to anticipate how we will thrive in that potential future.

This work is captured in a report that is available to you on APTA's website by searching the word "foresight." But it's not just something for you to read. It's there for you to challenge. It's a springboard for a deeper dive, and it's a place to begin to take action.

The opportunity with foresight's work lies far beyond the report, beyond the here and now. This report begins to answer the question of how we enrich the profession for the next generation.

So who is this next generation? It is the high school senior who graduated this spring with the hope of becoming a physical therapist or physical therapist assistant. That person begins their path this fall as an undergraduate, and many will become a newly licensed physical therapist in the summer of 2030.

The next generation is who we must keep in focus. They will inherit what we've built for them.

We've also focused on 2030 as a horizon because it allows us to develop an implementation framework in a reasonable timeframe to horizon. This horizon also aligns with the World Health Organization's Rehabilitation 2030 initiative, which seeks to dramatically increase access to and use of rehabilitation to improve the health of society around the world.

Another reason we targeted 2030 is because it allows time for all perspectives to shape our hopes and dreams for this next generation — and to join together in the work that will be required to get there. Our efforts to increase diversity, equity, and inclusion are both central and essential to this goal.

In the next year we will engage with you, our leaders and components, to begin to shape the strategic plan that will bridge the gap between our current efforts and the plan to reach that horizon of 2030. 

In order to do that, we must make the turbulent twenties our time.

That is our call — to create a profession ready for its next generation.

So what does that mean? Among other things, it means we need do three things.  

First: We must acknowledge that we are in a labor crisis—and do something about it.

This is not simply a matter of turning out more PTs and PTAs. Program growth will not matter if the current work environment is driving people to leave the profession. We must address the actual workforce challenges.

Second: In an era of innovation, we must embrace it.

We're all well-aware of how the pandemic sped up the adoption of new technologies and innovation. But we've seen another shift—fueled in part by technology, consumers are beginning to embrace a partnership model with their health professionals to seek consultation and education to manage their health.

Technology is a disruptive force. But it's a force that can be leveraged to reduce administrative burden, improve patient engagement, and enhance both accessibility and affordability of care. We cannot back away from this reality.

Third: When it comes to payment, we are playing defense when we should be playing offense.

We are undervalued and underpaid.

We must seek new payment models beyond the fee schedule and insurance-based models that have dominated our practice and created a dependence that is unsustainable for our next generation. Breaking that dependence will not happen through tiny changes at the edges of policy—we must move to a proactive approach.

At the same time, we must address administrative burden. APTA recently showed that prior authorization alone adds 8-10 minutes per patient encounter—for many in practice, that is equal to one billable code. It's also 8-10 minutes spent not providing care, but justifying the care you need to provide.   

We must work to ensure that technology does not add costs and reduce time with our patients. Instead, it should be helping to remove unnecessary administrative tasks.

So what can we do to answer the call? This is our charge—to ensure we are fit for the future.

Here are a few examples of how we're doing that.

This fall, APTA will launch its Value of PT report. We know that our profession has delivered high value care for decades, but this landmark report will help us make the case through evidence, and by consolidating our value perspective into one resource.

This resource will be dynamic and will evolve over time. But at its heart, this report tells our compelling story to engage policymakers and payers and to begin to reshape how those outside the profession view and incorporate physical therapy. This report is a tool for you to put to use by sharing it and shaping it for its full potential.

At the same time, we're empowering PTs to fully embrace the career they've chosen. One of the most important things we can do is address workforce challenges is by reducing costs for members on essentials for their career.

That's why APTA has begun to develop a series of member benefits and programs that are aimed at providing individuals with the flexibility and freedom to build diverse careers. Barriers such as liability or health insurance can be reduced, opening doors for individuals to start practices, engage in the gig economy, and not feel captive to employment solely for benefits.

We are changing our approach to identifying new member benefits – to embrace the license, the professional, the person in their pursuit of practicing as they choose.

We're also pressing for payment reform through collaborative efforts.

APTA is helping to develop legislation that could result in significant reforms to a series of limitations under Medicare that currently add cost or reduce payment.

This legislation is a new rallying point for our 400 advocates going the Hill on Tuesday. Perhaps more important, this effort marks a shift—away from a defensive posture of defeating or diminishing fee schedule cuts to a proactive effort to ensure the viability of our practice.  

Beyond this legislative package, we are continuing to investigate efforts on alternative payment models, pilots, and initiatives with the Center for Medicare and Medicaid Innovation to better leverage our expertise and create new avenues of payment.

Those are just three examples of what your association is already doing to answer our call. There is much more to come, and this body – our House of Delegates – can play a crucial role in charting our course to 2030.

In conclusion, let me share something that has resonated with me recently.

In June, Emmanuel John delivered the 2023 Lynda D. Woodruff Lecture on Diversity, Equity, and Inclusion. I hope you were able to watch it.

One of the things Dr. John said is extremely relevant to how we approach our future.

He was talking about addressing DEI specifically, and this is what he said:

"We're physical therapists. We were trained to deal with patients with complex conditions … and we don't deal with just one system at a time when they walk through our clinic doors. We deal with everything. We should not compartmentalize. We can multitask."

Dr. John is right. We can do this.

Choose your metaphor: It's in our blood. It's in our bones. It's part of our DNA. It's our bread and butter.

Whatever your metaphor, it boils down to is this: We're not afraid to approach challenges from a holistic perspective. We aren't strangers to complexity. And we never, ever give up on our future.

We have much work to do to reach our 2030 horizon. And when we get there, we will have a story to tell.

But know this: That new chapter—it won't be handed to us by history. We will be writing it ourselves, as we go.

We're physical therapists and physical therapist assistants. We are APTA. I say let's get to work.

Thank you.

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