08/12/2026
Over the past year and one half, the chapter presidents and component leadership have met and discussed the key challenges and issues facing physical therapy today. We discussed these 8 challenges identified from membership surveys. From that, and our group discussions, the APTA has generated four priorities that are now the direct focus on the APTA and should be ours as well. . . .the following is a summary of those meetings and my notes. . .
Physical therapy continues to demonstrate strong clinical value and growing demand, yet the profession is increasingly challenged by the economic and regulatory environment in which care is delivered. An aging population, rising rates of chronic disease, musculoskeletal conditions, mobility limitations, fall risk, and the need to reduce unnecessary health care utilization all point toward a growing need for physical therapist services. At the same time, workforce projections continue to identify shortages of physical therapists in many areas. The primary concern is therefore not whether physical therapy is valuable or needed, but whether the current reimbursement, workforce, administrative, and delivery systems will allow the profession to meet that demand in a sustainable manner.
Payment remains the most immediate concern. Medicare reimbursement continues to be affected by budget neutrality, conversion-factor changes, MPPR, and other payment policies that do not consistently keep pace with inflation or recognize the labor-intensive nature of physical therapy. While proposed changes to Medicare practice-expense methodology may provide modest improvements for some PT services, those gains do not correct years of increasing labor costs, rent, technology expenses, compliance requirements, and administrative overhead. Commercial insurers often follow similar reimbursement trends, making the sustainability of independent and community-based practices an increasingly important concern. Private insurers and third-party administrators frequently use Medicare reimbursement methodologies, coding policies, fee schedules, and utilization rules as benchmarks when developing their own payment structures. As a result, reductions or restrictive payment policies adopted by Medicare can influence reimbursement across the broader insurance market, extending their financial impact well beyond Medicare beneficiaries.
Administrative burden compounds these financial pressures. Prior authorization, utilization review, credentialing, documentation requirements, payer-specific rules, claim appeals, and repeated requests for medical necessity consume significant amounts of staff and clinician time without generating additional reimbursement. These requirements can delay treatment, interrupt established plans of care, contribute to professional burnout, and create barriers for patients attempting to access medically necessary rehabilitation. At the same time, the increasing cost of obtaining a DPT degree, student debt, workforce shortages, and clinician burnout raise legitimate concerns regarding recruitment and retention within the profession.
Physical therapy has also made significant progress toward direct access and greater professional autonomy, but statutory direct access does not always translate into meaningful first-contact practice. Insurance policies, Medicare requirements, referral patterns, network restrictions, and organizational structures can still position physical therapists downstream in the health care system. As health care continues to shift toward accountable care organizations, alternative payment models, bundled payments, shared savings, and population health, physical therapy must ensure that our profession is not simply incorporated into these systems as another ancillary service. We must establish a stronger role as autonomous providers who can evaluate appropriate patients first, direct care when necessary, and receive recognition for the clinical and economic value we provide.
Eight interconnected challenges facing the profession:
Reimbursement and payment sustainability: ensures payment reflects inflation, clinical labor, practice costs, and the true resources required to provide care.
Prior authorization and administrative burden: reducing unnecessary processes that delay care, consume clinical resources, and increase practice expenses.
Workforce shortages, recruitment, and burnout: maintaining enough qualified clinicians to meet growing patient demand while retaining experienced professionals.
Educational cost and student debt: addressing the growing mismatch between the cost of becoming a physical therapist and the economic opportunities available after graduation.
Incomplete realization of direct access and professional autonomy: moving beyond legal direct access toward true first-contact recognition and practical patient access.
Limited participation in value-based payment models: creating opportunities for PTs to participate meaningfully in ACOs, alternative payment models, shared savings, and outcomes-based contracting.
Pressure on independent physical therapy practice: preserving competition, patient choice, local access, and practice ownership in an increasingly consolidated health care environment.
Demonstrating and capturing the economic value of physical therapy: moving beyond proving that PT improves function to demonstrating how PT can reduce surgeries, imaging, falls, hospitalization, disability, and overall health care spending.
From these challenges, I (chapter presidents/component leaders) believe four strategic priorities emerge for our profession: Payment, Autonomy, Workforce, and Administrative Reform.
Payment reform must go beyond occasional increases to individual CPT codes and address MPPR, inflation, practice expense, and the ability of physical therapists to participate in the savings they generate.
Autonomy should focus on establishing PTs as meaningful first-contact providers rather than simply maintaining statutory direct access.
Workforce policy must address educational costs, recruitment, retention, burnout, rural access, and career sustainability.
Administrative reform must reduce unnecessary prior authorization and payer requirements that consume resources without improving outcomes.
Together, these priorities provide a framework for moving physical therapy from a predominantly downstream, visit-based rehabilitation service toward recognition as an autonomous, prevention-oriented, cost-effective component of the health care system. Achieving that goal will require a coordinated effort among APTA, state chapters, individual members and non-members, and the broader physical therapy community through strong membership participation, grassroots advocacy, meaningful relationships with legislators and regulators, and public support for political action.
Lasting change will depend on the profession speaking with a unified voice and on therapists at every level actively participating in the work needed to advance payment reform, professional autonomy, workforce sustainability, and administrative reform.
