Socialized Medicine Impact On My PT Practice

For 20 years I practiced in Socialized Medicine as a Physical Therapist in the Army.  What is the thought process of a Socialized Medicine Clinician?

….I get paid the same whether I see you for 30 visits or 3 visits…so it behooves me to heal you in as few visits as possible, so I can see the next patient and the next patient as quickly as possible.  So, every skill as a clinician is aimed to heal my patients in as few visits as possible.

  1. In 20 years of becoming as skilled as possible at healing my patients in the fewest visits, which skills attributed to that outcome?

    Manual Therapy.  I average 3-4 visits from evaluation to resolution of symptoms and that’s because I put my hands on my patients.  My hands tell me what systems need to be treated, my hands do the treatment and the patient’s body is able to complete the healing with typically one exercise or activity modification.

  2. As a socialized medicine clinician, you eliminate those aspects of your practice that don’t lend to your patients’ healing or at least don’t give you optimal bang (results) for your buck (time).  What did 20 years of practice in that setting teach me was fairly useless for the time invested by myself, my staff and my patient?
    1. Modalities… Time and time again, studies have shown that things like ice, heat, ultrasound, electrical stimulation and use of a LASER are of very limited value to the patients’ healing.  Guess what… Bare Necessities doesn’t own a single modality.
    2. Exercise… A lot of physical therapy practices provide a lot of supervised exercise time as it’s reimbursed well by insurance carriers and doesn’t require a lot of “work” on the part of the clinician.  However, in my experience the more exercises involved in a rehab program, the less likely a patient will be inclined to do any of them once discharged, especially if they involve equipment like a stationary bike or weight machines.  Once again, Bare Necessities owns no exercise equipment.  Typically, I’ll prescribe at most one exercise and that exercise typically involves no equipment that a patient wouldn’t already have access to in his or her home.
  3. Three visits/week… When I first left the Army, I worked for a civilian clinic and it always bothered my boss that I wouldn’t schedule my patients 3 visits/week x 4 weeks.  That’s how a lot of insurance based clinics operate: get the patient to commit to as many visits as possible.  Part of the reason they need so many visits is that these Physical Therapy practices offer very little manual therapy and fill the time with a lot of fluff such as modalities and supervised exercise.  I typically see my patients at MOST 1 visit/week and the course of care is usually complete sometime around the 3-4 visit range around the 6-8th

I’m not blaming civilian physical therapists for their practice philosophy. they are practicing as they were trained and to some extent doing what they need to do to survive with a very poor insurance industry reimbursement rate.

Lastly, in a medical setting with the foundation of healing the patient in as few visits as possible.  I was blessed to receive the Surgeon General’s award for clinical expertise as best of the best, an award that was given to the top 4-5% of military clinicians.  Come to Bare Necessities…it’s physical therapy like you have never experienced before.  There is hope for healing!!


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