Evolution Or Revolution?

The physical therapy profession is at a crossroads in the United States.

Over the past couple of decades, I’ve watched our profession go into a disconcerting holding pattern. The struggles of 2016 are strangely reminiscent of those in 1996.

We are now faced with what appear to be some difficult questions at this juncture in the history of our profession, and one is very simple. Are we going to accept evolution, or is it time for revolution?

In case you just tuned in, there are a lot of issues at stake in the world of physical therapy. There is a huge demand for physical therapists, but payments per visit are decreasing. Patient access continues to hover at 18 states, having been 15 states two decades - and two educational transitions - ago. In the vast majority of states, a patient still doesn’t have the right to see a physical therapist freely and of their own volition without some permission slip required at some time during their episode of care.

Yes, there is a huge incongruity there - but it gets worse.

Our profession continues to throw more money and evidence at the legislative process in the hope of gaining a voice of reason, but it’s simply not providing a return on investment. Why? First of all, the legislative arena is about money and votes and rarely about evidence. And when it comes to dollars and cents, the reality is that we don’t throw as much of it into legislators’ pockets as those who want to control us.

Our profession took a bold move in updating our vision statement … to one that, quite frankly, confuses most clinicians, let alone patients. Besides the confusion, it is laughable that “transforming society” requires a permission slip to do so.

We’ve become the victim of evolution.

We’ve become our own worst enemy by perpetuating incremental strategies and being satisfied with our little “victories”. We’re doing the same thing over and over again and expecting different results. Some call that insanity. Oh sure, we’re feisty in our words and evidence, but we remain subservient and passive in our actions. And you know what? It’s killing our profession - slowly.

We can choose evolution - or we can choose revolution.

Evolution is a slow, gradual process. Revolution is not.

Evolution is for those seeking to maintain the status quo. Revolution is not.

Martin Luther King, Jr. noted that “our lives begin to end the day we become silent about things that matter”. Therein lies one of the major problems. We’ve been silent about the things that matter to our patients and to our profession - civil liberties, freedoms, competition, and utilizing evidence and innovation to improve the health care system as a whole - for far too long.

Are we going to own our profession - and have behaviors reflective of this - or are we going to be forever defined by those outside of the profession?

I, for one, refuse to perpetuate the insanity. It’s time for a change. To quote the Wizard of Oz, “Dorothy, we’re not in Kansas anymore”. 

Revolution sounds like epiphany and acts like disruption when you choose to own your profession and to stand up for it while no longer allowing others to decide your fate.

Revolution is saying no to Big Medicine’s stranglehold on our profession and the illegal monopoly that is pursued (and maintained) on a daily basis.

Revolution is in being an equal in the market place to promote competition and to have the capacity to create new business models that can optimize care while cutting costs.

Revolution is demanding accountability from our legislators, especially when their backroom actions subvert their constituents.

Revolution is no longer accepting non-evidence-based standards of care and making our peers know we simply won’t accept it anymore.

We live in a country in which our civil liberties should never be over-run by the monopoly of the few. I demand the capacity to make choices related to my health. I demand the right to compete on a level playing field that is patient-centered and devoid of illegal monopolies disguised as “gatekeepers”.

If you’d like to stay within the status quo, then just keep doing what you’re doing. It is a self-fulfilling prophecy driven by passivity. As they used to say on television, “this is only a test of the emergency broadcast system. Return to your regularly scheduled programming already in progress”.

The revolution, however, will not be televised.

If you’d like to change the health care world, and you - as I - truly believe that the profession of physical therapy can be the agent of change to do so - then it’s time for something different.

But are you ready?

Photo credits: abesselink

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