PT Mills: Why Physical Therapy Doesn’t Work Anymore

What is wrong with the state of Physical Therapy (PT) as a practice?

Physical therapy (PT) as a discipline has been changing. In the past, a client could be evaluated and treated by a licensed PT with great confidence that everything that needed to be done to achieve pain free movement was going to happen. It was a proud profession with the noble goals of bringing clients out of the darkness of pain.

Nowadays, PT clinics, and PTs themselves, have made a violent shift in focus toward high volume. Clinics are over-stuffed with patients vying for the eyes, ears and hands of fewer PTs. The therapist becomes a glorified crossing guard; managing traffic, logistics and paperwork. The high level care that we are capable of is more often passed off to aides and technicians, most of which hold no license and have minimal training. Oh, but it’s ok, because the PT is somewhere in the same building, so it’s just like the PT is providing all of the care, right? NO!

What Went Wrong? Third Party Payers (aka Health Insurance)

Quality care, patient outcomes and overall customer service are falling away. The number one reason for this shift is the increased involvement of third-party-payers (health insurance) in the making of health care decisions. People have become accustomed to rely on their health insurance to pay for these services. Patients have been trained to place a lower value on PT. Physical therapy clinics have realized this and placed untrained staff into key positions to offset costs and assist with the added volume of patients needed to operate.

The Birth of the Dreaded “PT Mill”:
The Churn and Burn Widget Factory of Physical Medicine

The goals of the PT Mill are to:

1.      Get as many people as possible through the door
2.      Highly research potential patients’ insurance coverage and maximums
3.      Take extreme advantage until benefits are exhausted
     a)  Oh, and if the patient gets a little better along the way, that’s great!

Physical therapists by nature are passionate about helping people and very highly trained to do so. However, a therapist practicing in a PT Mill, is stretched very thin. It becomes logistically impossible for each patient to get the quality care they need to get all the way well.

The Solution: Get Back in the Driver’s Seat and Get All the Way Well

It starts with doing your homework! When you call to set up an evaluation or treatments, ask:

1.      How much time will I spend with the PT each time I have a session?

     a)  Is this a PT Mill/factory?
2.      What is the blend of manual treatments to self-guided exercise?
3.      What special skills do your physical therapists possess to ensure I can get back to my favorite activities without pain?
4.      What happens after I’m done with PT? Is there a system in place to make sure my pain/issue stays fixed?
5.      What about wellness and fitness programming?
Are you seeking a PT with specific skills? Manual/hands-on skills? Dry needling? Sports specific rehab? While we may not all be athletes it’s uncommon that ALL you will need to be able to do is ‘go up and down a set of stairs’ or ‘sit quietly at your desk’.

How Physical Therapists Can Make a Difference

If you are a physical therapist that wants to be an ‘all-the-way-well’ PT you can take action too! Your patients are smarter and better informed than all who have come before them. They are connected to message boards, activity groups and other exercise and health professionals. Ask them “Who do you read for advice about X?” or “Where did you learn about that manual technique?” Use and stay current with these resources to add tools to your toolkit.

The Therapeutic Alliance

More importantly, is to place the patients’ goals and education back on top of the list of priorities.  Teach them why you are doing certain techniques and not others. Explain evidence-based practice to them. Answer all questions thoroughly. Help them understand the process! By ensuring that each treatment addresses this premise you will improve the therapeutic alliance; this is the trust that comes from your patient when they truly feel that you are doing what is best for them.

Physical Therapy that Works: The SPARK Physiotherapy Difference

We have been doing our best to stem this tide. At our clinic, SPARK Physiotherapy in Alexandria, Virginia,  all of our treatment is 100%, one-on-one work with our patients. We work hard each day to ensure that the client experience is optimized. Their PT is not a chore, but a highlight of their day. They will leave each session with less pain, more strength, more control and more confidence that they have made the best choice in physical performance and health.

Our clients are not ok with ‘good-enough’ PT. Our clients have true movement and performance goals. We rely heavily on manual techniques, trigger point dry needling (an advanced skill in soft tissue manipulation), corrective exercise for maximum functional mobility and we TEACH. We educate our patients on every type of treatment, every exercise, and all aspects of their care.

As true MOVEMENT specialists, we have created a setting where we are passionate about doing more for our patients than manage traffic.

To listen to Dr. Berio discuss this topic and how SPARK Physiotherapy is taking a better approach to physical therapy, click on the player below to listen to this episode of

SPARK Physio Radio:

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Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. Carlos remains active in several sports and is an avid agility training, power lifting and adventure race runner.  He can be reached at cjberio@sparkphysio.com.