Outpatient physical therapy practices in the United States are facing severe staff shortages, with vacancy rates as high as 17%, according to a recent report by the American Physical Therapy Association (APTA). The report, based on a survey of 133 outpatient physical therapy practices, revealed that factors such as salary, relocation, and work-life balance issues were the main drivers of employee loss. While the COVID-19 pandemic may have accelerated the staffing shortage, only 1.7% of practice owners cited the pandemic as the primary reason for leaving.

Dr. Susan Taddonio, an assistant professor at Long Island University and a practicing pediatric physical therapist, highlighted the impact of the shortage on the pediatric population, particularly in New York. She stated, "There is certainly a shortage of physical therapists, especially here in New York, and the pediatric population is suffering." Taddonio also noted that physical therapists are retiring, changing careers, or selling their practices to corporate entities, further exacerbating the staffing shortage.

One of the contributing factors to the shortage is the significant student debt that physical therapy graduates face. Students typically spend four years earning a bachelor's degree before embarking on a three-year doctorate program in physical therapy. However, the median annual wage for physical therapists ranges from $88,000 to $101,500, which may not be enough to cover the high student debt. According to a 2020 report, at least 80% of recent physical therapy graduates have an average debt of $142,000.

Lower Medicare reimbursements are also impacting the ability of physical therapists to establish sustainable private practices. The Centers for Medicare & Medicaid Services (CMS) has planned a total reduction in reimbursement of 9% over four years, with an additional reduction scheduled for 2024. Medicare patients make up a significant portion of the patients treated by physical therapists, making it difficult for new graduates to establish private practices.

Regulatory changes have been implemented to provide more flexibility for physical therapists and occupational therapists in providing services to patients. One of these changes allows for general supervision of therapy assistants by physical therapists and occupational therapists in private practice for remote therapeutic monitoring services. This change eliminates the requirement for physical therapists to be physically present to supervise these services.

The shortage of physical therapists is particularly affecting the early intervention system, which helps address the developmental needs of infants and toddlers with disabilities. Dr. Taddonio highlighted that children in the early intervention system are experiencing long wait times to receive therapy. She noted that there has been a 33% drop in children being identified and serviced each year since the onset of the COVID-19 pandemic. Budget and Medicaid cuts have also resulted in stagnated pay rates for the preschool population.

The staff shortages in outpatient physical therapy practices have significant implications for patient care, particularly for children in need of early intervention services. The combination of factors such as student debt, lower reimbursements, and regulatory changes has created a challenging environment for physical therapists. The APTA was contacted for additional comment on the issue.