Tuesday, August 16, 2011

Cost of PT Education


Does anyone think the cost of a PT degree is getting out of control?  I'll admit, the cost of all college education is getting ridiculous, but let's take a look at the cost of PT education.  With the average private graduate program pushing $50K per year and the public schools not far behind, when is the bubble going to be reached where the truly smart individuals start to say, "why would I pay that much to make $65K per year?"   It is a significant problem.  The schools continue to pump out DPT's with the ideals that they are the next greatest thing to the field, and are demanding higher starting salaries as a result.  Clinic owners are short of staff and scared not to meet their demands, offering higher starting salaries, while only modestly increasing their most senior therapists' salaries.  (Which by they way, are the real casualties in this argument.  The new grads are now making close to the experienced therapists.  Is that fair?)
What seems odd is that when I turn away a new grad after stating "this is the best I can offer you," there tends to be another clinic owner out there ready to meet their outrageous demands the following day.  The perfect example was a person I interviewed last year for a vestibular position.  She wanted in excess of $85k per year based on her experience.  But given that she could only see one patient per hour, my math showed she would be making 55% of the gross on her maximum that she could bill (if she were 100% booked), guaranteed regardless of her patient volume.  That didn't seem right and I told her this, stating that a bonus structure could be arranged once her program generated new business outside her own 40 hour a week caseload.  She of course balked, and went to work for a local hospital system.  My question is, what are the bean counters at the hospital doing to create an hourly wage for these people?  At some point, do you not have to figure out how much a person generates vs. what their salary requirements are to make a logical decision?  I sometimes feel I am in the minority when it comes to these business decisions in the PT profession.  And if the majority of clinics are not doing this type of calculus, how are they staying in business?
I fear our profession is in jeopardy of two things.  First, pricing itself out of the market regarding fiscally responsible job offers.  Second, eventually limiting the number of quality applicants in the work field by offering a poor return on investment regarding the cost of their education.  Sure, right now while the overall job market is bleak, there are plenty of people applying to PT programs, but what happens when things turn around?  You don't have to be a genius to figure out a $150-200K loan for  a $65K/ year job is a bad deal.  Will we have bright people coming into the profession down the road if they are smart enough to figure this financing nightmare out?  Can the PT schools figure out how to get the job done of educating our students in a more cost effective manner?  The question needs to be examined.  We certainly can't just keep cranking up the costs year after year and expect things to continue to work out (see the US debt scenario as an example).
Given that reimbursement is only going to continue to decrease in the coming years, the leeway clinics are going to have to hire new grads at these higher rates is only going to shrink.  Would you want to be a new PT in the current market?  How about five years from now?  When are salaries going to have to drop to match the reimbursement of the day?
Unfortunately, I doubt schools are going to get cheaper, much less do I think insurance companies are going to pay us more for our services in the coming years.  It's a pretty picture isn't it!?   But this is a discussion that needs to be addressed.  Why it rarely seems to come up is puzzling to me.  Nothing would make me happier than to have someone convince me things are going in a different direction and that I have it all wrong.  I'll be listening.

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