It wouldn’t take much to close the physical therapy access gap

Let’s talk pain. It happens. A lot. In fact, 50 million Americans — that’s one out of every five adults — report suffering from some form of chronic pain. 70% of adults will experience lower back pain, one of the most prevalent types of musculoskeletal conditions, during their lifetime. And while physical therapy has clearly been shown to reduce pain and improve daily activities when used as the first form of treatment, less than 25% of the population has access to traditional physical therapy care.

Enter Physera. One of our driving missions at Physera is to dramatically increase access to physical therapy for all. How are we doing this? Remote-managed care. And it’s changing lives.

In this post, we take a look at the current availability of in-person physical therapy across the continental United States, and demonstrate the impact that widespread adoption of remote care will have on physical therapy access.

A modestly-sized network of remote physical therapists would enable most of the continental US to enjoy a level of access to musculoskeletal care currently only available to less than 25% of the population.

The state of physical therapy access today

Figure 1: Number of physical therapists per 1000 people (PTP1K). Physical therapy practice data obtained from the Centers for Medicare and Medicaid’s National Provider Identifier Registry and the Physician Compare database. Practice locations from these data were mapped to latitude and longitude using a geocoding service. Population densities, current population estimates, and county shape files obtained from the US Census Bureau.

It’s interesting, but not surprising, that we see the highest ratio of physical therapists to residents most often in rural counties. And it makes sense, right? Because there are fewer residents in these less-densely populated areas. But, as you’ll learn in a moment, the ratio of physical therapists to residents doesn’t tell the whole story of access.

As we look across the country, some other trends begin to emerge, especially when we look at physical therapy access compared to population density [Figure 2]. For example, we see that densely populated metropolitan areas on the East coast are in the top 20th percentile of access, but other large metropolitan areas such as Los Angeles County are in the middle 40–60th percentile of access, despite having more physical therapists (3759) than any other county in the U.S.

Figure 2: Physical therapy access levels (PTP1K) contrasted against population density (thousand people per square mile). Bright red indicates counties in the upper 33rd percentile of population density, but the lowest 33rd percentile of access to physical therapy.

In the San Francisco Bay area, for example, only Marin county ranks in the top 20th percentile of access, even though most of the nearby counties are in the top 20th percentile of actual numbers of physical therapists. Why is access to physical therapy challenging in some of the country’s more densely populated areas and not others?

Then, when we turn our attention to the south and much of the Midwest, we find these regions are generally under-saturated with physical therapists. Do people in this part of the country have different physical therapy needs than others?

So what’s going on?

Why do some parts of the country have a high number of physical therapists relative to their resident population while others do not? Why do some densely populated regions have lower rates of access even though they have a high number of physical therapists?

We can assume that musculoskeletal pain and related conditions don’t discriminate based on where you live. Given the high prevalence of musculoskeletal pain and related conditions across so many age and socioeconomic categories, it seems unlikely that regional needs for the therapeutic services offered by physical therapists would be different. The question becomes one of access.

How do we close the access gap?

Clearly, it stands to reason that if some counties are well served by a ratio of about one physical therapist per 1500 people (the lower end of the upper 20th percentile in Figure 1), then many more counties could benefit from a ratio closer to that number. But how? Put another way, how can we respond to the widespread latent demand for physical therapy across the country?*

Remote-managed care will undoubtedly play an important role in closing the current access gap. Suppose we were able to supplement the in-person physical therapy clinics in each state with an additional network of 10 remote physical therapists licensed to practice in the state. What would happen? As Figure 3 shows, even this small increase in availability would have a dramatic impact.

Figure 3: Number of physical therapists per 1000 people with 10 additional remote PTs per state, using current PTP1K percentiles. The effect of these 10 additional remote PTs per state is to move a large swath of the continental US into an access level currently associated with the upper 20th percentile at PT access, or greater than 1 PT per 1500 people.

But, what would happen if we increased this number to 100 remote physical therapists per state? As Figure 4 shows, we’d be looking at near total coverage for the entire country. Imagine that for a moment: Increasing the coverage from less than 25% to country-wide … simply by introducing the benefits of remote-managed physical therapy care.

Figure 4: Number of physical therapists per 1000 people with 100 additional remote PTs per state, using current PTP1K percentiles.

The future of physical therapy

Obviously, we’ve made a couple of assumptions here that are worth calling out. First, we are implicitly assuming that people will prefer to utilize physical therapy clinics close to their homes, and will be unwilling to travel “too far,” according to some definition of “too far.” Given modern health trends, this assumption is probably reasonable, but county boundaries will not always be a good definition of “too far.”

We’re also assuming that a ratio of one physical therapist for every 1,500 people is adequate. However, one of the great benefits of remote care is that people who currently are not able to avail themselves of in-person options might choose to seek out care for the first time. In this scenario, it stands to reason that even the one physical therapist for every 1,500 people ratio might be insufficient.

But, one thing is clear: Virtual physical therapy offers a convenient and effective care option for anybody in need of musculoskeletal care. Whether in a rural or urban area, high or low density, remote-managed care offers numerous benefits over traditional MSK care; which is often filled with unnecessary steps, less-than-effective care approaches, and excessive costs.

At Physera, we’re excited to see how increasing access to physical therapy through remote-based care can allow a modestly-sized network of remote physical therapists to make an enormous impact on the availability of physical therapy for people across the country — making our goal of access for all a reality.

Full details of this analysis, including a jupyter notebook for producing the choropleths, are available here.