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Fighting the Good Fight

	The boom is over.

 
Prospective payment systems and managed care—and, most importantly, the federal regulations that govern Medicare and implement elements of the balanced budget act—have brought an end to an era of unrestrained growth for the physical therapy profession. And just as some people pine for the "carefree" times of the early 1920s or the bustling can-do spirit of post-World War II America, we may pine for our boom time. But history makes it clear that eras come and go and can never be perfectly recapitulated.

We cannot expect payment for necessary services, and with that reality jobs have begun to disappear and potential physical therapists are looking elsewhere for career options. We can only hope that we have reached the nadir of policies that hurt both health care professionals and the patients they serve. We can also hope that although we may never return to a time of seemingly limitless growth, we might yet find a balance, a way to do what we need to do, a way to have adequate numbers of skilled practitioners to provide effective care that is undeniably in our patients' and our society's best interests.

Some would have us believe that the grim reaper for professions is about to descend upon us with scythe in hand, waiting for the right moment to mow us down. Physical therapists and patients both are facing a future that is dictated not by rational decisions and human needs but by political expediency. Many political leaders are more concerned with sound bites than they are with the well-being of their fellow citizens. The needs of those whose access to health care they have diminished are not as important to them as their ability to pander to public mood with claims that they have balanced the budget. But if our response to changes in reimbursement are primarily profession focused and we appear to care only about our jobs and our profession's status, we deserve no pity and perhaps should welcome the reaper to end our self-indulgence.

If we choose, then, to cry out against the inequities of new payment systems and caps on reimbursement, let us also look at what else our political leaders are doing in the name of the "public good," at how we have dismantled much of the safety net that once protected Americans who need government assistance or who at least deserve a fair deal. Only if we as a profession are willing to consider budget cuts that affect us in a more global context will we have credibility in questioning the path our nation has taken—a path that seems to ignore the needs of many and to sacrifice quality of life in the name of financial exigencies.

According to an often-repeated axiom, societies are judged not by how they treat their most powerful or influential members, but by how they treat their poorest and most needy. By that standard, our nation is in trouble and clearly needs a recalibration of its moral compass. Our stockmarket continues to boom and the economy continues to flourish, but we seem to have forgotten that there are values more important than skimming off monies for a tax cut or for new projects when citizens are being condemned to do without the rehabilitation they need.

Indeed, our society condemns itself when elderly people who have had strokes are forced to choose, by virtue of spending limitations, whether they will regain speech or the ability to walk. If allowed to continue, the financial limitations that Americans have permitted their politicians to place on rehabilitation services will lead to an era of broken promises—and broken lives.

Now as never before, physical therapists should understand the importance of political action and the need to support APTA's efforts in that political action. But if we become engaged in the political process only because we see the harm being done to us, we will miss an opportunity to begin a great new era in physical therapy. We will miss the opportunity to have a profession that grows not solely because there is a shortage of reimbursable professionals, but because we speak for those who cannot represent themselves, because we speak for our patients and the good that we can prove we do for them and with them.

Current policies and payment schedules will no doubt cause many therapists financial hardships and will reduce school applicant pools. But if we lose applicants whose commitment to physical therapy was shallow and driven purely by greed and self-interest, we will have benefited from the current chaos. If schools of physical therapy close because in this new market they are not competitive in terms of quality and relevance, we will have another reason to see the positive side of these draconian budget cuts.

Physical therapy grew from the seeds of altruism and flourished when that altruism was nurtured by generations of therapists who joined the profession not because they could do well for themselves but because they could do good for others. As long as we remember that history—and allow it to guide our actions as we fight for political change—we will be fighting from the moral high road and marching toward a better future instead of toward self-interest and political power. Many professions have had to fight for their survival, and many professionals have gone through tough financial times. Remembering them as we for the first time in decades find ourselves under siege will help us focus on what is unique about physical therapy and physical therapy practitioners.

As always, physical therapists are in an excellent position to see what happens to people when illness, injury, and pathology are compounded by the failure to provide adequate care in either acute settings or rehabilitation facilities. In the face of today's limitations we must act. We must crusade on behalf of our patients and the unmet needs of those who have little political power in the cynical world in which we live. To whatever extent we do that, we will have returned to our roots, and our profession will be the better for it.

Let's ensure that we don't look back on this time as the beginning of our demise, a time when our profession began an inexorable move toward extinction. Instead, let's make this our finest hour by remembering, even in the face of our own hardships, who and what we are—and by reminding the world that above all, it is the patient who matters.

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This Article Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rothstein, J. M Search for Related Content PubMed PubMed Citation Articles by Rothstein, J. M Related Collections All Editorials Jules Rothstein Health Care System Social Bookmarking                      What's this?