Revolutionizing Physical Therapy: Embracing Direct to Employer Services

Introduction

Direct to Employer (D2E) services are heralding a new era in physical therapy. With the growing interest towards D2E, physical therapists are moving closer to becoming first-contact providers for neuromusculoskeletal (NMSK) services for workers. Embracing the D2E model of physical therapy delivery could be the strategic career move you need to reignite your passion and truly practice physical therapy at the highest level of your expertise.

Change is Certain

Gone are the days when clients would flock to your clinic simply because you offered a needed service. In today's fast-paced world, convenience is king, and people expect immediate solutions to their concerns. Thus, it's time for physical therapists to think beyond the confines of traditional clinics and consider meeting clients where they are—at their workplaces. While concierge and mobile physical therapy services are a step in the right direction, there's an even more efficient and effective solution: bringing physical therapy directly to large groups of people at their places of work.

Consider this: in the United States alone, there are approximately 151 million employed individuals, with 13% categorized as "blue-collar" workers. That translates to 19.3 million individuals facing potential work-related injuries and manual labor challenges daily. Moreover, people spend a significant portion of their day at work. It's no surprise, then, that physical therapists working onsite at employer locations are gaining traction as a viable and rewarding practice model.

Reflecting on my journey, I recall how traditional physical therapy practice settings focused on specialties such as neurology, pediatrics, orthopedics, and geriatrics. Onsite, Occupational Health and D2E services were hardly part of the conversation. However, over the past decade, my commitment to educating both physical therapists and employers about the benefits of onsite physical therapy services has been growing. I wrote my book, The On-Site Physical Therapist, Direct to Employer Care,1 to serve as a beacon of awareness and education for physical therapists venturing into D2E services.

Employer Site Snapshot

As an onsite (D2E) services provider, I engage directly with employees, offering a spectrum of Occupational Health services tailored to their needs. My "client" refers to the employer, with whom I establish a contractual rate for a specific number of hours per week and the client pays me monthly. I have set my business up so there is no need for insurance billing or reimbursement processes. My clinic operates inside the employer's premises, strategically positioned near the employee entrance to optimize exposure. This designated space, measuring ~12x14 feet, is outfitted with the bare essential equipment such as a massage table, instant ice packs, tape, and resistance bands. From conducting comprehensive job analyses to ergonomic assessments, administering preemployment/return-to-work testing, and providing job coaching, my primary objective is to elevate workplace wellness and proactively prevent injuries. When treatment is needed, my method is characterized by its brevity and effectiveness, typically encompassing manual therapy targeting stressed soft tissues, one or two workplace-specific exercises, and personalized education for the employee about their condition. By integrating physical therapy treatment as per Colorado's Direct Access statute, I not only address musculoskeletal issues promptly but also contribute to significant cost savings for employers by minimizing the severity of injuries and reducing lost work time.

Let's consider the demographic I serve. Equity in healthcare is paramount, especially for workers in physically demanding roles. These essential workers often lack functional access to comprehensive health and wellness programs, either due to cost constraints, language barriers, or inadequate health literacy. As an onsite physical therapist, I serve as a first-contact provider, leveraging my expertise to address musculoskeletal (MSK) concerns and guide workers on seeking appropriate medical attention when needed.

Long Time Coming

While D2E services may seem like a novel concept, it is not. D2E services have their roots in longstanding practices, such as the military's use of physical therapists for orthopedic issues in the 1970’s and physical therapists embedded within combat units today. As 1st contact providers in the military for NMSK issues, there have been no adverse events recorded which speaks to the safety of having physical therapists in this role.2 Evidence shows that early physical therapy intervention reduces the severity of disability and lowers the overall cost of care as compared to usual care.3 The American Physical Therapy Association (APTA) has also played a pivotal role in advocating for physical therapists as primary care providers, with numerous milestones along this journey.

Physical Therapy Profession Must Accept the Challenge

The landscape of healthcare is evolving, with increasing recognition of the effectiveness and cost-efficiency of early physical therapy intervention for musculoskeletal issues. With primary care provider shortages and rising healthcare costs, the momentum for physical therapists to assume a primary NMSK provider role is undeniable. By delivering these services onsite, D2E, physical therapists can truly realize the autonomy and impact of their practice. The therapist has both personal and professional responsibilities in this D2E transition that we should address. First, you must practice physical therapy at the top of the educational and ethical continuum to allow excellent physical therapist and first contact provider care. Second, providing services at a place of work will most likely expose you to an assortment of languages, lifestyles, and ethnicities (or philosophies) that are new to you. You must, therefore, be open to diversity in all areas of the human experience Third, you must seek out education when needed, such as the D2E Business Certification4 or Occupational Health Practitioner Certificate.5 Both are offered by the APTA.

Summary

The rise of D2E services presents an unparalleled opportunity for physical therapists to redefine their role as primary NMSK providers and make a meaningful change in workplace wellness and productivity. Embrace the shift, step out of the clinic, and embark on a journey towards a more autonomous, lucrative, and impactful practice.

Key Words: future of physical therapy, on-site care, injury prevention

References

1. McCallum CA. The On-Site Physical Therapist: Direct-To-Employer Care. Gatekeeper Press 2023
2. Mabry LM, Notestine JP, Moore JH, Bleakley CM, Taylor JB. Safety events and privilege utilization rates in advanced practice physical therapy compared to traditional primary care: An observational study. Mil Med. 2020;185(1-2):e290-e297. doi:10.1093/milmed/usz176
3. Fritz JM, Brennan GP, Hunter SJ. Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: Associations with future health care utilization and charges. Health Serv Res. 2015;50(6):1927-1940.
4. APTA Private Practice. Direct-to-employer services designation program. Accessed April 15, 2024. https://learningcenter.apta.org/private-practice-D2E
5. Academy of Orthopaedic Physical Therapy. Occupational Health Practitioner Certificate. Accessed April 15, 2024. https://www.orthopt.org/content/special-interest-groups/occupational-health/occupational-health-practitioner-certificate-program

Conflict of Interest: Author of the book, The On-Site Physical Therapist: Direct-To-Employer Care

Author Bio:

Christine McCallum, PT, DPT received her Master of Physical Therapy at The University of Southern California, and her transitional DPT from Regis University in Denver. She owns and operates a small PT practice that specializes in Occupational Health and D2E services and consulting. Chris is a long-standing member of the American Physical Therapy Association, is also a member of the Private Practice Section, Academy of Orthopaedic Physical Therapy and the Occupational Health Special Interest Group. In 2023, she took on the role of PR Chairperson for the OHSIG and her book, The On-Site Physical Therapist: Direct-To-Employer Care (Gatekeeper Press, Tampa) was published on September 19, 2023.

Figure Legends

Figure 1. Dr. Chris administering a pre-employment test for a warehouse order selector position.

Figure 2. Dr. Chris and an employee discuss workflow and lifting issues with the warehouse slot racks.