Improvise, Adapt, Overcome…

ImageThirty years ago, I was an athletic trainer and teacher in high school. An orthopedic surgeon named Steve Hunter was my team doc. I went to surgery and clinic with Dr. Hunter when I was not teaching class. He taught me the fine points of exam of sports injuries and to avoid the pitfalls of “you see what you look for and you find what you know”. Dr. Hunter introduced me to George McCluskey and Tab Blackburn, physical therapist who would become my mentors for life in the skills needed to succeed in the profession of physical therapy. George and Tab convinced me to attend physical therapy school at Georgia State University.

After graduation, I joined George and Tab in private practice. George McCluskey was a pioneer in the early days of private practice physical therapy. He was and continues to be an advocate of independent small business in the practice of physical therapy. I enjoyed 18 years in practice and learned so much about business and people, and what makes a successful healthcare business.

Fast forward to 2003. I opened my own outpatient physical therapy practice. At the time, many physicians were opening their own physical therapy practices. When I spoke to my orthopedic surgeon friends and referral sources, they told me that a good patient care was more important than the extra money that owning PT would bring them.

My team and I provide excellent care to patients in our area and enjoy a collegial relationship with the local physician community. We make their patients happy and consult often. We work hard to make sure our mutual patients have the best possible outcomes.

Fast forward again to 2013. Each morning I pass a three-story steel skeleton. It is the infrastructure of a new medical office building, which belongs to my friends, the orthopedic surgeon. It will house their new clinic and MRI and their new physical therapy office.

I have often been asked to join their new practice. I admit that I have thought about it a lot. These physicians are my friend and my colleagues. I knew them back when they were orthopedic fellows. We have learned together, played together, consulted and worked together side by side on an equal footing. I have asked them and myself: why I would want to be an employee instead of a fellow professional?

As a member of APTA for 30 years, I admit that I am fully indoctrinated in the governance of our profession. Our professional association debated for many years the effects physician self referral would have on our profession and is on record as opposing such business arrangements.

Physician ownership turns autonomous, decision-making professionals into technicians. If not in practice, in process. While reviewing PT documentation from a physician-owned practice, I have seen that the “supervising” physician co-signed the note, along with the physical therapist that provided the service. Doctors of physical therapy do not need to be “supervised” by physicians nor do we need to have our notes co-signed.

The Affordable Care Act is changing the health care system in ways we do not yet understand. Physical therapy is uniquely positioned to become the preferred provider for evaluation and treatment of neuromusculoskeletal conditions. PTs are graduating with the skills to do this.

When physical therapists are employed by physicians, they impede change in an already-broken healthcare system. If we become technicians, our profession and our future doctors of physical therapy will have no place to grow.

I am not the first to feel the impact of physician self-referral and I am sure I will not be the last. My physician friends tell me that they like the way my team and I treat our patients, but they are forced to refer for profit because of the changing healthcare economy.

Others have taken the hit and improvised, adapted to the change and overcome to prosper in this environment. Our profession will certainly do that as well.

Our patients will continue to seek out competent physical therapists. Unrestricted access to our services is essential to allow a level playing field for competition and best use of the dwindling health care dollar.

Let us choose to be leaders of healthcare change. And as doctors of physical therapy, let us choose not to be perceived as technicians in practice or process.

RM Barney Poole, PT, DPT, ATC

Thoughts or comments? Contact PTAG President Barney Poole at


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