Rate this article:
Average rating:
Total votes: 0
If you think the working world of physicians and nurses is in turmoil, take a look at the changes affecting present and future therapy-services professionals.
Physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs) and audiologists are all swept up in a tide of rapidly rising demand for their services, shifting government reimbursement policies and higher educational requirements.
Demand for therapy services is growing mainly because 76 million aging Baby Boomers -- those born between 1946 and 1964 -- have high expectations for the quality of their later life. "People are healthier at the earlier stages of aging, and they want to continue to be able to live at home and drive and so on," says Christina Metzler, public affairs officer at the American Occupational Therapy Association (AOTA).
Yet this increase in demand comes just as many Boomer-age therapy professionals are themselves nearing retirement. Those expected replacement needs plus current vacancy rates -- some in double-digit percentages -- signal strong hiring needs in the coming years. Indeed, the government projects the US will need an additional 62,000 PTs, 40,000 OTs and 49,000 SLPs between 2002 and 2012.
Student Enrollments May Have Bottomed Out
So it should come as a relief to overworked therapy professionals and their patients that based on recent enrollment trends, more students are poised to enter the field.
That's a welcome turnaround from the late 1990s, when enrollment in many therapy programs declined steeply in the wake of the Balanced Budget Act (BBA) of 1997. Under the BBA, Medicare reimbursements for therapy services were subject to annual caps per outpatient, which reduced demand. Congress suspended these caps with a series of moratoriums; the current two-year stay was set to expire on December 31, 2005.
But with demand for services rising, enrollment declines in education programs appear to be leveling off. For example, enrollment in OT programs, which declined by 2,125 students from 2002 to 2003, registered a shallower loss of 818 students from 2003 to 2004, to 10,123 students, according to AOTA data. Enrollment in OT assistant programs, on the other hand, was up to 3,601, or 251 students, between 2002 and 2004, the AOTA reports.
Raising the Bar on Education
It will take longer, though, for many of those students to enter the workforce. That's because the minimum education level required to enter some of the professions is being elevated to meet the increasing complexity that providing effective therapy requires.
The knowledge that a master's degree will become the entry-level credential for OTs graduating in 2007 or later has translated into some potential OTs being scared away by the greater cost and time commitment. "But that's settling out now, and people are realizing that this will still be a good career path," Metzler says.
Similarly, the doctorate is becoming the entry-level degree audiologists will need to get certified, while the American Physical Therapy Association (APTA) is recommending that all PTs hold a doctorate by 2020.
Public Policy Driven by Politics, Healthcare Needs
To ensure enrollments continue to recover, therapy professionals are hoping Congress repeals the therapy caps permanently.
"A full repeal is always a challenge based not on health policy but on fiscal arguments," Metzler says. Congress must show how it would fund a Medicare cost increase going forward 10 years, "which is why we've gone with one- or two-year moratoria," she adds. But getting the votes to pass an increase in Medicare costs will be tough sledding, given the projected federal deficit of more than $300 billion.
The APTA sees reason for hope in the long term. "There could be a Medicare bill that eliminates the therapy cap over time," says Dave Mason, the APTA's director of government affairs. "This would begin to meet budget objectives and allocate spending according to clinical need."
Several pending bills in 2005 would increase demand for therapy services by allowing Medicare recipients to see a therapy specialist without a prior physician referral. But as with a permanent repeal of the therapy caps, many believe these direct-access provisions have only a slight chance of passing in the current budget environment.
"Direct access will make it easier for SLPs in private practice to bill Medicare directly," says Reed Franklin, a spokesman for the American Speech-Language-Hearing Association. "I don't know which year this will happen, but it will happen."
Additional Articles in This Feature:
