We sit at a critical juncture in the US healthcare system when it comes to embracing diversity, equity, and justice. Are we willing to push for meaningful change? Or will we let these noble values simply languish as buzzwords? As healthcare providers, physical therapists have an obligation to effectively treat an array of patients while ensuring accessibility, inclusivity, and human dignity for everyone. But to do so, we must think critically about improving the patient experience as well as the attraction of top talent to our field and the effects systemic racism on our ability to accomplish these goals.
The Roots of Racial Inequity in Physical Therapy
An overwhelming majority—90 percent of patients—of those who could benefit from physical therapy are not receiving it. In part, this is tied to how the general public perceives physical therapy as ancillary to primary care rather than as a first line of treatment. However, we’d be remiss if we didn’t look below the surface of this gap in accessibility and recognize the contribution of racial inequity.
Of the 8% of Americans with self-reported arthritis who attend at least one in-office PT visit each year, Black Americans are less likely to attend—even after variables like insurance, income, and education level are corrected. As an industry, we must ask ourselves why. In short, are we creating safe and accessible spaces for all patients?
BIPOC patients are subject to the lingering effects of systemic racism perpetrated by healthcare institutions and providers. Importantly, unconscious bias and false stereotypes about pain levels and drug use have resulted in a deep mistrust of the healthcare system. Therefore, BIPOC patients are often hesitant to seek the care that they need. But the issue goes even deeper than mistrust. Racial minorities face obstacles like limited access to care, lower-quality insurance coverage, and less economic and social flexibility than their white counterparts. Taken together, these factors severely limit BIPOC patients from accessing the benefits of physical therapy.
A 2008 study focused on in-patient rehabilitation following hip fracture found “significant differences” between the non-Latinx white and minority groups’ hospital lengths of stay and functional scores on the Functional Independence Measure. The authors also noted lower follow-up FIM ratings. A 2019 study in the American Journal of Surgery looked at who utilized rehabilitation services after hospital discharge following a trauma event. Compared to their white counterparts, Black Americans were significantly less likely to access rehab services, like outpatient PT. Of course, this lack of care may lead to poorer functional outcomes.
Another part of the issue is the woeful lack of racial diversity within the physical therapy provider workforce. Only 6.5 percent of the U.S. physical therapy workforce identifies as Black or Latinx, while both groups account for more than a quarter of the entire nation. The results of this disparity have been demonstrated in studies, such as the recent rehab therapy industry report that found that more than three-quarters of rehab therapy professionals identify as white, while the 2020 US Census reports just under 60 percent of the population is white. Research shows that this diversity gap prevents many BIPOC patients from finding providers who they perceive can identify with them—and this can lead to differences in treatment outcomes.
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A Movement to Influence a More Diverse Industry
Behavioral change starts from within and requires a commitment of time, effort, and emotion. A good start is to educate both ourselves and our clinic staff on unconscious bias, the benefits of diversity, and—perhaps most importantly—the damage being done by a lack of awareness and action to combat systemic racism. We can learn from webinars, articles, books, research papers, conferences, and more. Additionally, organizations such as the American Physical Therapy Association (APTA) and the National Association of Black Physical Therapists (NABPT) regularly host educational courses to share relevant information on topics ranging from DEI initiatives to cultural competency. We can also connect with and learn from BIPOC rehab therapists and support their efforts.
Any meaningful solution must also include employing people of diverse backgrounds at all levels within the industry—from practice leaders and clinical staff to administration. Modeling a more equitable and inclusive environment creates an environment of empathy, understanding, and justice for our patients. To this end, many corporate healthcare organizations, including physical therapy companies, have pledged to act in support of more inclusive workplaces.
Investing in a Better Future
One of the best paths to lasting change within the industry involves recruiting more racially diverse students to the physical therapy profession. Most high school students—and especially BIPOC students—are not introduced to the profession unless they or a family member have received treatment. By exposing BIPOC students to the physical therapy profession through guidance counselors, internship opportunities, and current therapists sharing their stories, they are more likely to consider physical therapy as an attractive career. And the more students see other physical therapists who look like them and are successful at what they do, the more students will consider this as a career path for themselves.
By investing in students, we’re investing in the future of the physical therapy profession. It has been shown that ethnically diverse students transform both the universities they attend and the health industries that they join post-college. To that end and in pursuit of positively impacting the profession that has given so much to me, I created the Rizing Tide Foundation to help nurture a more diverse and inclusive physical therapy workforce. The program’s goal is to support potential physical therapists in overcoming the most common barrier to entry: tuition or the burden of student debt, as well as creating an empowering community that will allow these future therapists to see themselves as an integral part of this thriving industry.
It’s easy to feel overwhelmed by the magnitude of racial inequity within healthcare. After all, of the approximately 10 million Americans attending outpatient physical therapy or occupational therapy visits per year, the majority are white, insured, educated, and middle- or high-income. But we cannot let that paralyze us and allow the status quo to continue unchecked. As we strive to reach our goals in health justice—higher-quality, lower-cost, patient-centered care that is accessible to all—inclusivity is imperative. Let’s work together today for a better tomorrow where everyone has a fair and just opportunity to be healthier.
