The Ethical Gap Every Physical Therapist has to Navigate

The expectations laid out for me when I was getting my doctorate were clear: study hard, pass your tests, excel in clinicals, become a superhero for people who need your help to heal.

Then, I entered the workforce where physical therapists and other medical professionals are regularly expected to sacrifice quality of care and patient outcomes in favor of billing insurance and maximizing productivity.

I was quickly faced with decisions that required me to choose between my patient’s healing and my employer’s pockets.

Hot Take: Patients NEVER benefit when facilities prioritize productivity over care.

I realize medical facilities are businesses and finances are important. However, we are talking about putting human bodies on the line. There is a massive difference between maximizing a session with a patient and billing that time fairly, and hooking a patient up to E-stim so you can bill them while you do documentation.

It is highly likely your employer will push you to rely on modalities that do not require your full attention, group patients together in group sessions, or cut important conversations short because those “can’t be billed.”

As a physical therapist, you are going to have to decide which is more important: pleasing your employer or progressing your patient.

This is no small thing! Standing up for your patients will put you in uncomfortable positions and in some cases, it’s the thing that costs PTs their job.

What are PTs supposed to do about it?

Be prepared. Students need to know that they are entering a workforce that is riddled with complications and unethical players. Juggling billable hours, productivity, and patient care will keep excellent physical therapists awake at night. Do not be blindsided.

Ask questions during interviews and orientation. Find out what the standard productivity requirement is for physical therapists at this facility. Ask about the most common outcome measures or special tests utilized at this facility. What is the PT to PTA ratio? What documentation system will you be using? And what types of modalities does this facility rely on? 

Gathering this information lets your employer know that you are already on the lookout for patient care. And, it gives you insight into how the clinic is run. If you don’t feel good about their answers, let them know you’re exploring other opportunities.

Learn the ins and outs of billable hours. If you are working with a patient toward an outcome, you can bill for that time. Many employers will discourage long “conversations” with the patient because that time does not count toward your productivity. But, that’s wrong. If you are actively talking about their outcome measures, making a plan, or explaining the process to the patient, that’s billable. The key is in documentation. Document that time spent under the CPT code that encompasses the activity that is being discussed. Document the details of the conversation and how they help achieve the patient’s goals or improve the plan of care.

Know your worth. You have a very expensive education and a very defined set of skills. There is no shortage of work for you and career opportunities for physical therapists are increasing! Your employer is making more money off of you than you think (or than they want you to think). Do not pigeon hole yourself with them! Spread your wings and find ways to connect with other physical therapists. Pick up PRN hours at different facilities, take continuing education classes or specialize in something, get a mentor, start exploring other income options like public speaking or opening your own practice. Keep dreaming about other possibilities so that you never feel stuck in your current job.

Physical therapists will be the ones who change the culture.

Ultimately, this is not a problem that can be solved on an individual basis. At PT Learning Lab, we’re trying to propel a larger conversation. We want PTs to be empowered to stand up for their patients and advocate for their best treatment without fear of losing their jobs. It has to start somewhere, and I believe this movement starts with us.


Keep being a superhero,

Dr. Rachel Bradrick, DPT

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