SPOKANE -- One of Brian Cronin's physical therapy clients is in her 80s and is still skiing. Another is middle-aged, recovering from a water skiing injury. Another is a middle-school-age girl with Olympic gymnast dreams.
Cronin is the co-owner of U-District Physical Therapy, which started eight years ago, focused on sports-related therapy for high school and college athletes. With an aging, yet increasingly active population, Cronin has seen his business and the physical therapy industry expand.
"It seems like what people are doing now in their 70s is what people used to do in their 50s," Cronin said.
As baby boomers age, health care is changing to accommodate. And with millions of uninsured Americans poised to gain coverage through federal health reforms in the coming months, professionals in health care fields like physical therapy are facing the challenge of meeting the needs of more and more patients.
There were 360 licensed physical therapists last year in Spokane County, said Doug Tweedy, a regional labor economist for the state's employment security department. That's 40 more than four years ago.
Projections show another 50 therapists will be needed within a decade.
It adds up to what the U.S. Bureau of Labor and Statistics reports: Physical therapist assistants, physical therapist aides and physical therapists all rank in the 20 fastest-growing occupations from 2010 to 2020. The number of physical therapist assistants, for example, ranks eighth with expectations to grow 45 percent by 2020.
With demand for physical therapy jobs rising, there is worry that not enough people will be trained and licensed to keep up, especially as health reform awards insurance coverage to patients.
The American Physical Therapy Association reports there could be a shortage of 41,000 physical therapists by 2020.
The news is good for physical therapists running a clinic and those just entering the field.
"If you graduate on Friday, by Monday you'll have a really interesting, well-paying job," said Marc Goldstein, senior adviser for clinical practice and research for the APTA.
The bad news: The increased demand could hurt patient care in the long run and lengthen wait times.
"It certainly could have an impact on access," Goldstein said. "The time from onset of condition to the time that you can actually see a physical therapist will certainly increase. And that's not good for anybody."
While federal health care reform does not specify how physical therapy would be included in health insurance, it does list rehabilitation as a priority. And that has colleges worried about graduating enough students.
Byron Russell, associate dean of health sciences at Eastern Washington University, said the physical therapy doctoral program only accepts 8 percent to 10 percent of its applicants. It is one of three such doctoral programs in the state.
Recruiting professors is difficult, he said, as professionals have to accept lower pay to teach. The university also is limited by its state funding and accreditation standards.
Spokane Falls Community College faces similar challenges, accepting only 16 out of roughly 90 applicants for its two-year physical therapist assistant program, Director Marie Cole said.
Physical therapist assistant programs are popping up all over the country. In 2012, there were 280 accredited assistant programs in the nation, with 68 more in development, according to the Commission on Accreditation in Physical Therapy Education.
Cole said the demand for assistants is high because median annual income for the job is just $25,000 less than that of full therapists.
The position often attracts people embarking on a second career, looking for stable, well-paying work. Although the job only requires an associate degree, physical therapist assistants do a lot of the same work as full physical therapists.
Physical therapists, who earn bachelor's degrees and complete three-year doctoral programs, are responsible for creating the plan of care for each patient. Assistants can carry out a therapist's plan but are not part of the decision-making process with the patient.
A physical therapist must oversee all physical therapist assistants and aides. Aides do not require a degree. The maximum allowed ratio of aides and assistants to full therapists is 2:1.
Cronin, co-owner of U-District Physical Therapy, said his business has seven full therapists and about 30 total employees at four locations. They see about 1,000 patients a month.
"Spokane is a very active community that has four distinct seasons that generate a lot of different sports, activities and hobbies for people, but with that comes injury," he said.
Patients average 6.8 visits, less than a decade ago, due to insurance restrictions, Cronin said. As a result, physical therapists are forced to cram more therapy into fewer sessions and teach patients to do the work at home.
Justin Kane, owner of North Idaho Physical Therapy, said his business's three facilities are often opened to patients to do their exercises free of charge, but without the supervision of a therapist.
The cost of therapy after a common injury like a tear to the anterior cruciate ligament can range from $1,000 to $3,000. Co-pays can be up to $30 per visit.
"The challenge will be that the insurance industry is rapidly declining in terms of reimbursement so the patient has a greater and greater responsibility in terms of the cost," Kane said.
Higher costs become a deterrent, he said, and patients may not get the treatment they need.
Nancy Webster, director of therapy for St. Luke's Rehabilitation Institute, said a growing trend is to start physical therapy as early as possible after injuries or medical conditions such as strokes.
By starting early, "we're definitely seeing more positive outcomes in patients," Webster said.
St. Luke's provides therapy in the Providence Health Care hospital system.
While the trend is to put hospital patients into therapy earlier, another trend for outpatient care is to skip the medical doctor altogether. Washington, Idaho and 45 other states do not require a patient to get a referral from a medical doctor before seeing a therapist.
Russell, at EWU, said physical therapists are qualified to assess patients and determine whether they can be treated with rehabilitation alone.
"For the patient, it's usually more expedient care and less expensive," Russell said.
Medicare, however, does not cover physical therapy without a referral from a doctor first. Bills in Congress have sought to change that.
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