Many physical therapists are physically active individuals. A lot of us also have a passion for sports - both as athletes and as fans. While we get much personal enjoyment out of team sports, we can also learn valuable lessons from the way these teams operate. In particular, we should take note of the structure of an American football team. Pay attention to how the quarterback directs his team and you will realize that his actions parallel the physical therapy profession. Physical therapists are now the musculoskeletal healthcare quarterbacks.
PTs as healthcare quarterbacks
Under direct access physical therapy, physical therapists have new responsibilities. Patients often come to us first with their healthcare concerns. This puts us in the position of the quarterback of musculoskeletal healthcare.
Patients may be confused by the letters after our name or they may not know how we differ from massage therapists and athletic trainers. We should be able to confidently differentiate ourselves from others by making executive decisions for our patients, just like a quarterback does for his team.
A quarterback distinguishes himself from other positions like wide receivers, running backs, or the offensive line by determining the course of action for the team. He then chooses a play and delegates tasks in order to score. Since we are now in a quarterback position, the same applies to us.
We differ from PTAs, athletic trainers, and massage therapists. We are now in a position to choose the plan of care (play), delegate responsibilities, and lead everyone to an end destination of crossing the patient (football) over the goal line.
The right direction
There is a large movement within the physical therapy profession to deliver value to patients. The best way to achieve this is by knowing what the patients value the most.
"In healthcare, patients are conditioned from a young age to run to doctors to make decisions for them. As time goes on, this becomes ingrained in their behavior and becomes what patients value the most." - Paul Gough
If you really think about it, Super Bowl winning quarterbacks are more valued for their knowledge and decision-making skills on the field than they are for athletic ability. In the healthcare field, the same can be said for physicians. Even surgeons are more valued for their knowledge, as opposed to what they actually do with the patient.
As physical therapists, we are healthcare quarterbacks and doctoral experts. Our greatest value lies in in our ability to make decisions. Whether the patients tell you that or not, this is what they value the most.
So my skills don't matter?
Your skills are important and necessary. In order to survive and be successful in the NFL, a quarterback must have a strong and accurate arm, athleticism, and the ability to take a hit. The same is true for our profession. We must have sound fundamental training, strength and endurance regardless of setting, accurate and calculated technique, wise modality choices, and the ability to manage the stress of a high patient load or a difficult case. However, as much as we value our clinical skills, we should remember that the patient may not have the same appreciation for them as we do.
The interesting thing about quarterbacks is that, if they run the play correctly, little physical activity is needed - most of what they do is cerebral. They evaluate the defense, call a timeout, talk with the coaching staff, and change the play if necessary. They then throw or hand the ball off to their teammates.
"People are looking for answers to their musculoskeletal pain and are paying you as a physical therapist to provide them with and decide for them the next course of action. If you are able to provide this service, patients will have a new respect for you and will instantly understand the difference between you and other professionals." - Greg Todd
Physical therapists can mirror a quarterback's course of action. As doctors of physical therapy, we can evaluate a patient’s impairment, establish a plan of care, refer when necessary, delegate tasks to our teammates (physical therapy assistants, techs, nurses, physicians, massage therapists, trainers, the patient, and family members), change the play as necessary, and then run the play. This process will help the patient cross the goal line.
So what plays can we run?
Quarterbacks use iPads for playbooks, review film of the opposing team, and have keywords for certain plays, blocking positions, and routes. Just like quarterbacks, we should use stories, analogies, models, and technology to educate patients on pain, explain impairments, and set up the proper plan of care.
Play #1: marketing
Direct access - we fought for it and we now brag about it. However, it means nothing if we don't directly market to the consumer. Many physical therapists struggle with marketing, but it's a great way to separate yourself from the crowd. It also helps you get in touch with what your customers really want. By marketing yourself as a clinician who provides direction and answers, you will build a long-term brand of trust and respect with your patients.
Honestly, the public doesn't really know what we do. At times, it is even hard for us to agree on what we do. Marketing is a way to inform the public of how we can serve them. There are people walking past us every day with pain who can benefit from our services. It is our responsibility to help them.
While marketing, it is crucial that you remember to talk to your patients, not your physical therapy peers. Speak the language of your consumer - they are the ones who matter. Your peers are most likely not the people paying your bills.
Marketing is especially important if you're interested in opening a cash-based clinic. If you decide to operate under this model, patients will not be funneled into your clinic like they are to other clinics where insurance is accepted.
For those of you who think business and marketing is unethical and money-hungry, think about this: more people will live a more active, healthy, and pain-free life because of the information you've provided to them through marketing.
Play #2: telehealth
You may or may not like it, but telehealth is here to stay. As the primary clinicians of musculoskeletal care, we should take advantage of all that telehealth has to offer.
Of course, not everything can be accomplished through telehealth. However, it is a tool we can use throughout the plan of care. So much can be done with the help of telehealth - evaluations (limited), answered questions, explanation of impairments, scheduling, home exercise programs, "bad weather" appointments, and post-discharge communication. New patient consults can also occur on telehealth platforms.
But wait! Are there legal issues with telehealth? Will medicare pay for it? Medicare codes are on the way and it is already legal in California. Stop making excuses. An easy loophole is to refrain from calling the telehealth service a PT evaluation.
Play #3: networking
Connect with other healthcare providers. People are complex and patient care should be provided in a holistic format. All healthcare providers should work together for the benefit of the patient. Physical therapists should aim to establish symbiotic relationships with other professionals as opposed to parasitic relationships.
Until recently, most physical therapists relied on physician referrals as a source of patients and ultimately as a source of revenue. Even today, some states are not completely unrestricted and some insurance payers require a physician script. However, there are ways to establish symbiotic relationships with physicians. You can directly market to patients and use the current law restrictions to your advantage by referring patients to physicians. Create a relationship with the physician by referring your own patients to them, instead of renting the physician's patient.
When you make an initial referral to a new physician, you have an opportunity to open the door for new business. In return, you will most likely receive new patients from that provider. Therefore, you're now getting double the patients from a single marketing source. All you had to do was directly market to the patients.
While we are leaders in the musculoskeletal space, we may not always be healthcare quarterbacks in every situation. When working with other professionals, know when to lead and when to follow. Be a team player.
We can learn a lot from other health professions. Instead of bashing and discrediting the work of another health professional, see what they can teach you. We can acquire new knowledge from them and also offer our support in areas where they are lacking.
This approach is key to establishing good relationships with other health professionals who market better than we do. Many of these professionals are more popular in the general community. Having positive relationships with them will only help us improve our own standing in the community.
Play #4: teamwork
Any member of a sports team knows that it takes teamwork to make the dream work. The same principle applies to physical therapy. At the end of the day, we are all in the same profession with many problems to solve.
Fortunately, there has been great collaboration and teamwork within our profession at all levels. From veterans to new grads, all the way down to PT students, I have witnessed alliances within the profession that continue to move us forward.
Another positive attribute I have noticed are the partnerships in business, clinical, and legal aspects of the profession. This is a great sign for the future. Like any team, there is bound to be disagreement, but I would urge us to keep the positive energy going. I'd rather have you on my team than my ego or opinions.
Play #5: clinical expertise
Our profession is doing a fantastic job of implementing evidence-based practice and delivering the best possible care to our patients. There is also a positive shift towards a patient-centered approach, combined with customer service. When we take the time to intently listen to our patients, they feel as though they are truly being cared for. It is important that each patient feels like a person, not just another CPT code.
"No one cares what you know until they know you care."
Only after a patient feels cared for will they care about their diagnosis, prognosis, and treatment. Once trust is established, adherence, respect, and outcomes will significantly improve.
Our reach is far and wide in the healthcare field and our clinical expertise is needed beyond the clinic and hospital. Environments such as schools, moving and shipping companies, corporate America, video game communities, construction, trucking, low-income communities, third-world countries, and countless more can benefit from our clinical expertise. We must show that we are innovating and evolving in order to provide the best value possible.
Play #6: customer service
Physical therapy can learn a lot from companies like Disney, Amazon, Ritz Carlton, and Starbucks. These companies don't simply provide a service. They provide an experience. The experience begins before the customer even steps foot into any of these companies.
Through marketing, reviews, word of mouth, and much more, these companies build a relationship with the customer and establish a standard of excellence. When the customer finally arrives, they are prepared to continue experiencing great moments with that company.
Due to the current state of insurance deductibles and copays, patients are healthcare consumers. They are shopping for healthcare the same way they shop for vacations and food. We must respect this shift in the healthcare economy and adapt.
If done correctly, physical therapy practically sells itself. Conservative care allows patients to avoid medications and surgery. It also allows them to build relationships with their healthcare providers.
Be a physical therapist instead of an insurance therapist. Over time, physical therapists can start to see patients through their insurance, almost forming prejudices against them and altering their care accordingly. Like most of you, I went into physical therapy to walk with patients through their transformations. In order to do this, you cannot rely solely on your clinical skills. We think patients will value us for our GPA or for our clinical skills. However, this is not the case.
The patient experience is more important than your clinical experience. Nurture your patients and treat them like you would treat your mom or dad. Aside from nurses, we arguably spend the most time with our patients and we get to know them the best. Intently listening, understanding, and building trust with your patients will result in a positive healthcare experience and will give you purpose in your profession.
We have a new responsibility. Under direct access, patients come to us first with their healthcare concerns. This puts us in the position of musculoskeletal healthcare quarterbacks. With this newfound role, we must display executive decision making and leadership.
Just as quarterbacks call for different plays in certain situations, physical therapists should redirect care when needed. Just how quarterbacks rely on their team to win games, physical therapists should establish positive relationships with our team of physical therapy assistants, techs, nurses, physicians, massage therapists, trainers, the patient, and family members.
Lastly, we must be strategic and calculated about the plays we run. The winning plays consist of marketing, telehealth, networking, teamwork, clinical expertise, and customer service. By taking a play out of football's playbook, we can learn many lessons on how to be the healthcare quarterbacks of the musculoskeletal world.