7 Biggest Issues Facing Physical Therapists in 2020 (And Tips on Tackling Them)

2020 is here and in a lot of ways, it's a new world. This blog post explores top issues for PT practices and ideas to tackle them.

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2020 is here and with it comes new challenges

The physical therapy landscape has changed dramatically in 2020. PT's are pulling together to tackle some of the hottest issues occurring in physical therapy practices across the United States right now. And while items like self-care are still on the list, practices have adjusted their protocol to provide modern solutions for their patients who need it most.Let's explore the seven biggest issues facing physical therapists in 2020 and how to solve them:

1. Cleanliness

Cleanliness has been a massive focus for physical therapists opening their doors. Keeping clean is the first step when maintaining patient and PT safety. And while most practices are already sparkling clean, the addition of PPE, CDC guidelines for physical therapists, and changes in standard operating procedures moving forward has made this issue quite complicated.

Meeting CDC guidelines

The CDC has released numerous precautions for physical therapists to return their practice to normal. As most have already adapted their strategies for inpatient therapy, what about outpatient therapy? According to the CDC, These five standard guidelines must be met for outpatient physical therapy to operate safely:

  1. Hand hygiene
  2. Use of personal protective equipment
  3. Safe injection practices
  4. Secure handling of potentially contaminated equipment or surfaces in the patient environment
  5. Respiratory hygiene/cough etiquette.

For maximum effectiveness, these measures should be paired with the proper educational training and administrative policies recommended by the CDC (both found here).


Physical therapists have changed their standard operating procedures (SOP) due to these unprecedented times. Every aspect of your practice must be analyzed, including facility demographics, infection control infrastructure, facility practices, and infection control guidelines. This comprehensive checklist released by the CDC will help you go over each one of these topics in-depth. Physical therapists should study these guidelines and adjust their SOP to reflect these changes. Minor changes in your practice's daily routine can cover the majority of these recommendations - keeping your staff and patients safe.


In combination with preventative strategies, wearing the proper personal protective equipment (PPE) is recommended by the CDC within 6 feet of co-workers and patients. Examples of appropriate PPE would be gloves, goggles, face shields, face masks, and respiratory protection. Proper use, care and guidelines for this equipment can be found in this OSHA document.

2. Telehealth Services

Telehealth has become a hot issue in the physical therapy community because of the demand by patients. Some practices are starting from scratch, and telehealth services are uncharted territory. While it can feel like a leap of faith, it's not. According to APTA, "Telehealth is a well‐defined and established method of health services delivery." The introduction of telehealth services has enhanced the therapy process reducing unnecessary in-person visits, retaining more patients while providing them additional therapy options, and keeping essential physical therapists on the payroll. Now with Medicare allowing telehealth for physical therapists, more patients can finally receive these services, and physical therapists can accurately measure the impact on their practice.

3. In-Home Therapy

Physical therapy clinics in some regions of the country are reducing staffing due to lack of patients, state laws, and difficulty meeting CDC guidelines. But others are opening back up and need all hands on deck. For this reason, in-home therapy can be an option for physical therapists. Likewise, if you're a practice owner and keeping your entire staff employed is difficult, in-home therapy could be a good option for qualified PTs until things get back to normal. Many don't know that Medicare does cover in-home physical therapy on an outpatient basis (e.g. under Medicare Part B). These types of visits can be offered and billed in the same fashion that an clinic visit can be offered. It's possible that some patients will be more comfortable not being seen in a clinic-setting as opposed to receiving care in their home. It may or may not work in your area but it's worth consideration.

4. Patient Retention

It's no secret that retaining your patients is good business, but why is this one of the most significant issues facing physical therapists in 2020? According to a 2019 survey amongst outpatient OT & PT clinicians, managers, directors & owners, the three leading causes (outside of insurance concerns) with patient retention are time, cost, and physical therapy expectations.

  • 53.3% of patients have time commitment and scheduling difficulties
  • 40% of patients believe PTs have unrealistic expectations for treatment
  • 73.3% of patients don't agree with the cost of treatment

All three stem from one major problem, value. Time commitments would no longer be a problem if patients understood why therapy is necessary. Expectations wouldn't seem difficult if the value were apparent. And the cost wouldn't concern patients who knew physical therapy treatment was essential to living their best lives. Treat every patient with sterling professionalism, continually underline the benefits of physical therapy, and praise people for their efforts along the way. You'll keep the patients you have and fuel future visits from their friends and family. Build a culture of value around your craft, and never let your enthusiasm waiver for impressive results.

5. Practice Management

Managing a physical therapy clinic is tough work, even for the most skilled entrepreneur. There are so many moving parts in the physical therapy industry. It's almost impossible to stay on top of everything simultaneously. However, with the proper delegation, marketing channels, and software systems, physical therapists can build and maintain an environment that's optimal for patients and their staff alike, promoting a culture beaming with productivity.


The vast world of marketing is always changing. Every year the digital space evolves, making older marketing techniques inefficient. In 2020, remarketing your practice to clients and communicating when and how you're opening back up is essential. Additionally, your marketing efforts should include detailed explanations of how your clinic is keeping safe and clean during these uncertain times. Building a solid customer base, engaging with prior patients, and retaining top PT talent revolves around marketing on the right platforms, at the right time, to the right audience. These methods include marketing your practice to physicians, along with prospective patients using tools such as:

  • Website Updates
  • Email Newsletter
  • Blog Articles
  • Social Media Posts
  • Word of Mouth
  • Google rankings and review-based services

Staying in the digital space has never been more relevant than now when launching a marketing campaign. Once you've polished and launched your campaign, study the results. Pinpointing the most successful features can save you loads of time and money in the future and could reveal eye-opening prospects.

Staying HIPAA compliant

HIPAA violations can be a severe offense for physical therapists, some resulting in fines up to $50,000 and imprisonment. The Office for Civil Rights has received over 233,581 complaints from April 2003- April 2020. The most significant compliance issues occurred in the following order:

  1. Impermissible uses and disclosures of protected health information
  2. Lack of safeguards of protected health information
  3. Lack of patient access to their protected health information
  4. Lack of administrative safeguards of electronically protected health information
  5. Use or disclosure of more than the minimum necessary protected health information

Among these complaints, private practices and physicians were among the most likely candidates to commit HIPAA violations. Therefore, practices that back up their encrypted data, create strong passwords, install antivirus software, and continuously educate their PTs about HIPAA are far better at staying compliant. This is doubly important with so many therapists working from home.

Managing Staff

Practice owners have more hurdles when managing their staff as of late. Ensuring your team is educated on new additions to your practice, such as telehealth services and following CDC guidelines is essential. But there are certain hardships in physical therapy that were already challenging, so what has changed with maintaining motivation, stellar recruiting, and productivity metrics?

Motivating Staff

Added stress and anxiety have altered career pathways, affected families, and made physical therapy difficult for all PTs. Now more than ever, one of the most impactful things practice owners can do is actively listen to their employees. You should also communicate all the information you have about the ongoing situation with your staff. Sharing this information helps employees feel connected and could also help provide solutions. By asking for their feedback and showing appreciation along the way, people will have a newfound sense of purpose and are motivated to find answers in the workplace.

Recruiting and Retaining Top Talent

Whether you're ramping back up for business or you've lost valuable employees in the first six months of 2020, recruiting and retaining top PTs is invaluable to any organization. The fact of the matter is, lots of professionals are out of work for one reason or another right now, and your practice could be where this talent lands. Recruiting is as simple as finding the best place to post job offerings, updating your website's career section, and providing proper job descriptions. Create a framework for your interview process where you can compare rockstars and decline unfit candidates immediately. Retaining talent is a bit more tricky and boils down to excellent communication, goal-setting, and workplace flexibility. Creating an environment where the lines of communication are wide open promotes growth, and when goals are in place, employees feel like their work is meaningful. When your staff is supercharged with purpose, and you respect their time by allowing flexible PTO policies and scheduling, you'll rarely lose employees.

Overcoming Productivity Metrics

Productivity metrics are important while measuring individual PT and the clinic's success. But understand they are valuable tools to understand your employees. Use these metrics to identify the strengths and weaknesses of your staff. Ask questions about why specific PTs have better metrics, such as net promoter scores to figure out how to build up the entire team.

6. Career Development and Growth

As a lot of facilities have been closed, where does that leave physical therapists in their career pathway?

Continuing Education

Continuing education (CEU) is almost mandatory in the world of physical therapy. But which courses should physical therapists pursue? Highlighting courses that align with professional goals can help develop the best clinical skills and industry knowledge - setting you apart for the competition. Look for classes that match your career pathway with their defined course goals, target audience, instructional level and faculty certifications. Currently, APTA is offering free courses on relevant subjects like telehealth services and additional member discounts.

Struggles of Starting a New Practice

Starting a new practice is hard by itself, add the complications of the times, and it seems daunting. The good news is that most states are opening their economies and getting back to business. Hopefully, you've weathered the storm and were able to take advantage of the CARES act to keep your business afloat. Focus your efforts on marketing and building relationships with local physicians to establish a sturdy patient foundation. If you're opening a new clinic, it's best to check current federal, state, and local guidelines before acting on your business plan.

7. PT Self Care

Self-care is always an issue facing physical therapists, as the industry can be demanding. New PTs out of school might be facing more stress because they're trying to learn new skills while adjusting to updated policies and procedures. Meanwhile, established PTs are attempting to find a positive work-life balance to avoid burnout.

Work/Life Balance

Burnout and finding a positive work/life balance is difficult for PTs working in a hospital or high-volume practice. Especially with fewer employees on the payroll, somebody has to pick up the slack. Managing burnout and creating this balance is typically due to a lack of communication. Practice owners and physical therapists alike need to be vocal when they've bitten off more than they can chew. Shifting the workload evenly amongst your PTs will eliminate potential burnout and create happier - healthier employees.


Managing the stress of work, life, and therapy outcomes can be a heavy burden. Patients who don't show up for treatment and wonder why they aren't getting better can overload the best PT. Even worse, some patients have suffered a traumatic injury or are dealing with a debilitating illness. Identify signs of stress by asking yourself some of the following questions:

  • Have you become cynical or critical at work?
  • Do you drag yourself to work and have trouble getting started?
  • Have you become irritable or impatient with patients?
  • Do you lack the energy to be consistently productive?
  • Do you find it hard to concentrate?
  • Do you lack satisfaction from your achievements?

If the answer is yes to any of these questions, it might be time to communicate your concerns with your leadership, take additional time to decompress, and speak with a doctor or mental health provider.

The Bottom Line

Being a physical therapist is a challenging and rewarding profession. When PTs can overcome these obstacles they find in their daily routine, it gives them purpose - making their job enjoyable and fun.  Helping patients can be one of the most rewarding feelings on the planet. Physical therapists are on the front lines every day, facing down the issues in this article and making recovery a possibility.

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