3 of the Biggest Challenges for PT/OT/SLP + 5 Reasons Why You Should Still Enter the Field

Should I be an SLP? Should I be an OT? Should I be a  PT?

1. Increasingly corporate medical conglomerates are taking over everything

In order to understand how corporations are taking over medical care, we need only to look at the numbers of some of the most common employers of rehabilitation therapists. Take Genesis. Genesis Health Ventures was established in 1985 with the acquisition of nine healthcare centers. Between 1985 and 1998, Genesis Health Ventures grew from a $32 million to a $2.4 billion public company through the acquisition of nursing homes and services such as rehabilitation therapy, diagnostic testing, respiratory therapy, and pharmacy.

Trying to track the sale and acquisition of these companies requires an advanced degree. It’s like trying to follow the plot of Game of Thrones. The characters talk faster than Gilmore Girls and the plot shifts faster than a Quentin Tarantino film. I tried to provide some sort of plot guide to the sale and acquisition of rehabilitation facilities but was dizzy after only 15 minutes of research. Who is Sabra Health Care REIT (Nasdaq: SBRA)? Skilled Healthcare Group Inc? What’s a sale-leaseback? With assets in the millions (or billions), many of these companies are acquired by massive investment management firms that are controlled by either shareholders or boards or … who knows? Either way, the bottom line, every time, is making as much money as possible.

How does this affect clinicians?

  • Clinicians increasingly feel that patient care is not patient-centered, but profit-centered. Many clinicians live in ethical grey zones that challenge their morals and drain their energy. The pressure to provide services in a way that maximizes profits has reached unprecedented levels.

Why is this not a reason to avoid the field of rehabilitation?

  • All of this is a swirl. At the end of the day, it is always there and will never go away. What matters most is your connection with people on a daily basis. You get to be the real, live human who connects with people when they need it most. Healthcare and its costs will always be a challenge. No system is perfect. It’s possible that our current status has reached a fever-pitch, and if so, the worst has arrived and the only way forward is better solutions. Now more than ever, we need real people with real values who will have real conversations that spark healthcare grounded in ethics and people-centered values, all while keeping the budget balanced in a fair way.


Should I be an SLP? Should I be an OT? Should I be a  PT?

2. Collective burnout
There appears to be a collective burn out across rehabilitation clinicians. In the midst of Medicare reimbursement policy changes, many are losing their jobs, getting their hours cut, and feeling more and more pressure to bend to profit-driven policies (see point #1). Enter the field, and it’s likely you’ll meet a supervisor who has become jaded, their enthusiasm worn thin by the ever constant pressure from corporate HQ to perform super-human productivity feats. Maybe they’re not drinking water so they don’t have to go to the bathroom. Or skipping lunch so they can clock out and furiously finish their paperwork so that their on-clock productivity finally meets expectations. Maybe they are short with a patient, all the while glancing nervously at their watch, knowing that they’re either going over their minutes or are not achieving enough minutes. No matter what, if you’re going into this field, you’re bound to run into a perhaps higher level of collective burnout than 5 or 10 years ago.

How does this affect clinicians?

  • Join a large SLP, OT, or PT social media forum and you will see very quickly just how burned out everyone is. Multiple posts per week will appear. There is even an entire group (with concerningly large numbers) devoted entirely to helping active and licensed clinicians find a different career. If the world of rehabilitation therapy has a collective unconscious, it is deeply in mourning. It is desperately in need of new energy and fresh enthusiasm.

Why is this not a reason to avoid the field of rehabilitation?

  • Getting to work with people to overcome obstacles is so incredibly rewarding. If I was injured in an accident or facing a medical crisis, I definitely want a team of humans who knows how to step in and make me feel valued, understood, and challenged to reach new levels of understanding and ability. This is what it’s all about. Burnout is a problem, but it’s a problem with any job. Any city. Any family member. Any situation. Collectively, we have great power, and we as a field need to find that power and re-energize the world of rehabilitation. We need to value self care and healthy lifestyles. We need to help cultivate an environment where patient care and therapist value comes first. We are the only ones who can do that.


Should I be an SLP? Should I be an OT? Should I be a  PT?

3. Unreasonable expectations on time and productivity
This point is really just the culmination of points #1 and #2. Productivity expectations have slowly creeped up from 60% to 100% over the past decade. This is due to increasing demands on corporate investment returns and is exacerbated by major revisions in healthcare policy.

Why is this not a reason to avoid the field of rehabilitation?
Worldwide, productivity expectations have gone up. We live in a culture of faster, better, smarter, cheaper. There is no escape from this reality, no matter which career you choose. While this does not justify the poor ethical standards that have pushed productivity standards to inhuman levels, it does paint it in a broader context of larger cultural shifts over the last decade. No matter the job you choose, you will be expected to out-perform and out-produce, and do it in half the time. Until our culture starts to value quality over volume-based profits, this will not change. Not for rehab therapists, and not for anyone.

And to end on a good note, here are 5 reasons to go into rehabilitation therapy:

1. We are on the verge of major advancements in research, technology, and collaboration.
Just look at the advancements being made towards a learning health system.

2. One degree, many opportunities.

Want to work with kids? Adults? Acute? Post-acute? Geriatric? Hospital? School? Skilled nursing? Assisted living? Therapist? Manager? Content creator? The possibilities are so broad.

3. Never boring.

Every single day is so different and unique and challenging. You never know what’s going to happen.

4. Always learning.

There’s no way a grad school program can capture it all. Plus, our knowledge base is always expanding and evolving. Every day, there is a chance to learn something new!

5. Increasing demand for pharmacological-free treatments.

The hay-day of big pharma is coming to an end. More and more people are valuing the results they can get with drug-free treatments. The services that physical, occupational, and speech therapists provide are invaluable when it comes to improving health literacy and optimizing patient health as related to their own personal goals. Nothing beats that!

If you’re reading this and are considering a career as an SLP, OT, or PT, I hope you found some insight. Most of all, I wish you so much fun in your adventure ahead, wherever it takes you!

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