It’s a common scenario…
- Busy physical therapist in an outpatient setting
- Multiple therapists at each location and between locations
- Patient arrives for their initial evaluation…sees “therapist A”
- On second visit, patient arrives and finds out they’re scheduled with “therapist B”
- On third visit, patient arrives and finds out they’re scheduled with “therapist C”
- Patient gets frustrated and stops attending physical therapy
In day to day practice, there are multiple times that we hear the question from patients “Are YOU going to be my physical therapist?” It’s a question borne from frustration, and unfortunately, common experience that many patients have when referred to physical therapy. While there are many potential arguments that could be made for why this is occurring, the bottom-line question that should be asked is…what is the impact on the patient?
Intuitively, as physical therapists, we know that the patient seeing the same therapist at each visit improves outcomes and patient satisfaction. It just makes more sense. A recent study (1) attempts to objectify what we’ve likely known all this time. The aim of the study was to examine the impact of continuity of the physical therapy provider on health care use and costs in patients with low back pain referred from primary care. What the authors found was that continuity of care in physical therapy improved outcomes, in this case, lowering costs and reducing the need for surgery in patients with low back pain.
Is provider continuity the end-all, be-all to improve outcomes and reduce the need for surgery in patients with LBP? Of course not. Timing of referral to physical therapy (2) and the therapeutic alliance (3) between patient and PT are factors that must be taken into consideration as well. However, from personal experience, continuity of care does matter. As a patient, I personally know that my experience was better when I saw the same PT at each visit. I developed a relationship with him and developed trust over time. How can you develop a relationship (and subsequently trust) if you see a different provider at each visit? As a therapist, I wanted to take ownership of my patients. It was important to me, as a physical therapist, to create the relationship with my patients so that they would trust me with their injury. I could feel the walls come down with my patients when they knew that I was going to be the only person in charge of their care. It was key to a patient-centered approach that was important to me as a PT. I got into this profession and have remained involved in this profession because of the difference we make in the lives of others, in large part because of the relationship we develop with patients over time.
We believe it’s an important conversation to have as physical therapy providers as we continue to advance as integral members of the healthcare team. Subtleties, such as a laser-focus on continuity of care, can not only make a difference for the patient in a positive way with regards to outcome, utilization and cost (1) but the patient experience as well, at least based upon the feedback from patients and NPS (net promoter score) feedback. And, in the end, consumers will make the ultimate choice based upon their expectations vs. their actual experience.
So, next time you attend physical therapy for an injury or following a surgery, have the conversation with your provider. Ask them…”are you going to be my physical therapist?” See what they say.
1 Magel et al. Associations between physical therapy continuity of care and health care utilization and costs in patients with low back pain: a retrospective study. Phys Ther. 2018;98:990-999.
2 Childs et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Heatlh Serv Res. 2015;15:150.
3 Ferreira et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93:470-478.
About the Author: Bruce Watson, MPT graduated from Washington University School of Physical Therapy in 1997. Over the past 22 years, he has been involved in outpatient physical therapy settings as a therapist, business development representative, executive and consultant. He has worked with his colleagues at Axes Physical Therapy to continually strive to improve the patient/client/employee experience.