1) Finding a good physical therapist who takes your insurance and has availability is near impossible.
Many of the clinics in LA have waitlists and inconvenient hours (i.e. close at 2pm!). It is on you to call around to all the PT clinics in your area and find one that takes your insurance. It takes patients on average 2-4 hours to book a physical therapist appointment! The opaqueness of the insurance process also leads to a lot of frustration and many people who need people give up and just live with daily pain.
2) The practice of physical therapy is very broad and is never a consistent experience across physical therapists or across clinics
Some physical therapists hate doing manual therapy (ie massage), some only want to do massage and no exercises. Your experience is going to drastically vary based on which clinic you go to and which PT you see. The variety is terrible for patients because you never know if you are having a good or bad experience as you have nothing to compare it to.
3) Reimbursement rates are low necessitating clinics to squeeze in as many patients per hour as possible
There is an extremely high rate of burnout amongst physical therapists because some clinics have PTs seeing 4 patients an hour, back to back. It’s incredibly difficult for PTs to do a good job and treat patients if they only have 15 mins with the patient after which the patient is passed to a physical therapy aide or assistant. As the patient you may not know this but physical therapy aides have no training in the body and movement. In an insurance based model, the PT just assesses patients and writes up treatment plans for the aides to walk patients through. From a physical therapist’s standpoint, seeing 3+ patients per hour barely allows me to think or even provide proper care to the patient.
4) No incentive to pay attention to patient experience or follow up
Clinics are so busy they don’t have time nor are they incentivized to give you direct access to the PT post visit or to check in with you after your visit to see how your visit went and how your exercise plan is going. In physical therapy, compliance with treatment plans is less than 35%! This is terrible! This means that people are not actually following the doctors’ orders and doing what needs to be done to decrease their pain!
5) Insurance does not cover preventative visits therefore insurance based practices are not able to look at your body in a holistic manner.
I suspect this will change over time, but for right now, insurance will only cover a certain number of visits and the visits must be directly related to your pain or injury. For example, if you have tennis elbow, your insurance will only cover PT sessions to relieve your elbow pain. Your PT can’t advise you or give you any exercises related to any other part of your body!
This is unfortunate because your body is the sum of a bunch of interconnected parts. If one part doesn’t function properly or is weak it affects the whole system! For example, you may have elbow pain from tennis elbow but the reason you developed tennis elbow is because your back and shoulders were weak and therefore your elbow was working harder than it should have to compensate for your weak back and shoulders. In a regular PT session, the PT would only be able to treat your elbow pain. But if you don’t strengthen your back and shoulders, you will likely develop elbow pain again as you go back to playing tennis.
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