You are hurting and you’ve heard that physical therapy can help. A doctor, chiropractor, friend, or co-worker may have recommended that you see one. Okay, now it’s time to choose. So who should you see? How do you find the one most qualified and best suited for your particular needs?
Let’s face it, there are literally thousands of physical therapists out there offering their services. However, only a small percentage of them specialize in an area of practice, such as pelvic health, men's health, vestibular rehab, and TMJ disorders. And, out of those, only a fraction are lucky enough to work in a quality, personalized setting where you aren’t treated like a number. That probably leaves just a handful of actual physical therapy "specialists" in your local community.
To know if you're selecting the right PT for you, and making the right choice when it comes to your health, you will have to answer a few questions.
IN-NETWORK VERSUS OUT-OF-NETWORK
Should you go within or outside your insurance network? These two treatment models are very different in terms of the amount of undivided time and attention you will receive from the physical therapist. The in-network model revolves around the insurance company, where the PT has to juggle multiple patients at the same time while delegating tasks to an assistant or aide. The out-of-network model revolves all around you, where the PT focuses on just one person at a time. Typically, having more undivided time and attention from your physical therapist will yield more significant and faster results.
But what about the price difference? The out-of-pocket cost per visit for in-network versus out-of-network can vary greatly, as can the quality of service you’ll receive. We’re not saying that the most expensive is always the best. However, insurance restrictions and time limitations have made it very difficult for even the best PT to provide good quality care in an in-network environment.
In a previous blog post, entitled How Much Do You Value Physical Therapy, we discussed the cost-benefit analysis between these two models. You might be surprised by the results, once you factor in the cost of having to attend more visits on the in-network side.
Also keep in mind that certain out-of-network providers, like Activcore, will submit claims on your behalf, so that you can still get reimbursed by your insurance company. Collecting some reimbursement can help offset the investment you are making in your health, should you choose to go out-of-network.
A SPECIALIST OR NOT
Do you need to see a specialist? Since price is THE number one barrier for people seeking the help they need from a specialist, knowing what you will actually get for your money (i.e., the value) is vital when answering this question.
A specialization requires much further study, training and practice following graduation from physical therapy school. There are a few methods for physical therapists to achieve credentials of specialization. So let’s break them down to help you better understand their value.
1. Board Certification
Board certification is earned through the American Physical Therapy Association (APTA) and governed by the Americal Board of Physical Therapy Specialists (ABPTS). They define a board certified specialist as having “... a greater depth of knowledge and skills related to a particular area of practice... exceeding that of the physical therapist at entry to the profession and unique to the specialized area of practice.”
Let’s use Orthopedics as an example. As of 2019, out of around 248,000 PT’s nationwide, only 15,896 or about 6% have their OCS (Orthopaedic Clinical Specialist) certification. This is a special designation that provides formal recognition for physical therapists with advanced clinical knowledge and experience in orthopedic care.
For Pelvic Health, the numbers are even fewer. As of 2019, only 489 or less than 1% of all physical therapists have their WCS (Women’s Health Clinical Specialist Certification). Another designation of Pelvic Health specialization is the PRPC (Pelvic Rehab Practitioner Certification) which is overseen by Herman and Wallace, an entity outside of the APTA. It is inclusive of all genders and more specifically geared toward pelvic conditions, versus all of women’s health like the WCS certification. Less than 200 physical therapists nationwide have earned this PRPC title.
2. Skills and Techniques
A board certification is helpful in knowing your provider is well-versed in an area of study. However, board certification isn’t everything — let us explain why. The credentials are earned through examination of broad knowledge base and demonstration of critical thinking skills, typically through case study. Manual skills and clinical techniques are generally not assessed though. Clinical skills (including hands-on, neuromotor training, exercise prescription, etc.) are very different from having book knowledge.
For example, imagine trying to do yoga, learn a new dance, or play baseball by only reading instructions. The information is important, but actually doing the movements sure helps in developing those skills. The same applies to physical therapy. Also, the same technique doesn’t work with everyone. If a therapist is highly skilled in one technique, that’s great. It will really help that specific set of people who need exactly that one thing. However, a truly skilled therapist has training in a variety of skills to meet each person where they are.
Some of the various skills and techniques we employ at Activcore include manual therapy, pelvic floor muscle retraining, postural restoration, Redcord neuromuscular activation, trigger point dry needling, Pilates exercises, resistance strength training, biofeedback, and blood flow restriction therapy.
3. Experience Level
Has your therapist treated people with your particular issues before, and if so, how often? Does your therapist feel comfortable in helping you define not only what is going on, but also the options for moving forward? Typically, a specialist has more experience with more complex conditions. Both skills and knowledge develop over time and with exposure to many clients, situations, and conditions. Having experience with a complicated issue may allow for more efficient treatment to get you where you need to be faster.
Keep in mind that years of practice do not always make someone a specialist. It really depends on what they did to better themselves professionally during that time. Some therapists do the exact same thing year after year, without furthering their knowledge base. Meanwhile, others use this time to pursue an area of practice, like breast cancer rehabilitation, golf swing analysis, and running analysis. They make an investment in their education, along with the latest tools and methods to get the best clinical outcomes possible for their clients.
Conversely, just because someone has minimal years of experience, doesn’t mean they aren’t capable of treating like a specialist. Some of these physical therapists are top notch early on in their careers. Just a year or two out of physical therapy school, they would totally blow you away with their knowledge base, insight, innovation, and scope of practice. With the right guidance from a clinical mentor, they are on an accelerated track to become a specialist.
DEFINITION OF AN EXPERT
So how do we really define an ‘expert’? This question was addressed in a well-known published article titled, Expert Practice in Physical Therapy:
They defined four components you should see in an expert therapist:
- Multidimensional knowledge base – extensive and defined in terms of each individual client; incorporating various realms of information including experience, research, medical, and interpersonal
- Clinical reasoning – contextual collaboration with the client; specific medical diagnosis not as central in management as how current condition is affecting that client; innovation in approaches to treatment
- Movement analysis – hands on and listening skills for evaluation and treatment; more automatic programming for skills application and analysis of movement patterns
- Virtues – high standards for themselves and staying current on evidence; client-centric
Another important factor they identified as common among all of the experts is that the clients are not judged. The expert clinician (as we’d argue all clinicians should) assumes responsibility for trying to solve complex clinical cases, versus labeling clients as “non-compliant or malingering” and subsequently dismissing them.
MAKING THE DECISION
The truth is, all physical therapists go through rigorous training in graduate school and some level of ongoing post-graduate education. They are all very smart and dedicated healthcare professionals. So given that, really, how do you know who you should see?
The lists below can help guide you to make an informed decision.
Why would I NOT need to see a specialist:
- If your symptoms are from a known, more recent injury
- If your symptoms seem more ‘straight-forward’
- If you don’t require much undivided attention from a physical therapist
- If your physician didn’t tell you to see a specialist
What are some signs I SHOULD see a specialist:
- If you have seen multiple providers (chiropractors, PT’s, MD’s, etc.) without needed improvement
- If you have a few (or several) issues involved, not just one symptom
- If you have had a previous complicated intervention, like surgery
- If you have other medical conditions that need to be managed along with your PT-related issue
- If you require more undivided time and attention from your physical therapist to get better
- If your physician told you to see a specialist
Either way, please know that physical therapy can be a game-changer for you. This should be considered a front-line treatment approach for musculoskeletal pain and so many other conditions. Research shows that physical therapy can save you time, money and frustration in terms of testing, medications, doctors visits, and time away from the things you love to do.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.