By: Dr. Trey Martin PT, DPT
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I want to touch the surface of the student debt to income crisis that is obliterating the field of physical therapy. This blog will be a mix of my opinions, data points, and potential solutions. I hope this blog stirs discussion, growth, and potential solutions. By no means am I self-declaring expertise. Let's get started.
An APTA report surveying 3,073 physical therapists, found that 9 out of 10 PT graduates are in debt with the average debt being $152,882. The report further found that, due to this debt level, PT's had to put off life goals such as: owning a home, starting a family, and getting married.
A small study looked at early-career physical therapists (and APTA members) from the state of Florida. *Note that the study is survey based, one state, and small sample size, meaning the potential for selection bias is high. The study found an average 197% debt to income ratio, with average salaries being $69,328. Put simply, the respondents showed twice the amount of debt to income and were spending 22% of monthly income on student loans, These numbers are double the debt to income ratio we see with Family Medicine Physicians. First reaction: yikes.
As a new grad and ear to the ground type of DPT, I can confirm that starting salary is always between 55-80K. I went to one of the cheapest DPT state schools in the country and the price tag came out to 70K. That doesn't include cost of living for school, and paying for housing if you did internships in a different city. ETSU is one of the cheapest, Johnson City is super affordable, and the price tag easily eclipses 100K. Also, don't forget that a DPT takes 3 years to complete, aka 3 years of lost income potential. If you understand compounding interest and investments, you see that this can be quite costly.
Now, before you old PT's reading this get all bent out of shape on "accepting responsibility for your choices," put yourself in a young PT's shoes. Imagine, all you wanted is to help treat young kids who have neurological difficulties. You get into a school out of state that is the best for this. 3 years later you have a bill for $205,000 and your first job in neuro pays you $72,000. You are spending 25% of your take home pay on loans. Not an uncommon story. Look, I hear you. Being a physical therapist is not for the money or even the respect. Being a physical therapist is about helping someone regain the ability to walk, making sure a senior is less likely to fall, or guiding that young athlete back to the sport they love. But at what point is enough enough?
If you've made it this far, I appreciate you. I am an eternal optimist deep down and I paint the doom and gloom above to illustrate the urgency. I love this profession too much to just make dire statements without proposed fixes. Let's peel this onion.
Trey Martin's Guide on How to Revolutionize the DPT
1) Streamline the credit hours
CAPTE requires 90 hours, average DPT program is 117. My program was 127 credit hours. 37 hours x $601 per hour for an ETSU credit=an extra $22,237 on the bill. We have to force universities to get lean with their courses. (Please forgive me ETSU) The first 1.5 years of PT school contained great coursework, the last 1.5 years of PT school classes were not useful. Cuts can be made. You don't need an entire 2-3 hour course on how to use an E-stim or ultrasound machine. Also, ETSU is very affordable compared to most other schools, remember that.
2) Streamline the calendar itself
Lessen the time off from campus and embed classes within clinical rotations. South college uses this model and condenses the program into 2 years. This could be overwhelming for some students potentially, but it would save money. Cut the program from 3 years to 2, 12-15k is saved in cost of living. Earning potential for an extra year of work is approximately 70K for a new grad. Points 1 and 2 just changed the balance by approximately 100,000-110,000. Students saving $35,000 and earning $70,000.
3) Embrace the power of the internet
Zoom, skype, email, google docs, youtube, etc. The internet has massively useful tools that professors can utilize to educate. Pre-record lectures, get creative with Youtube demos, and open up the chance for more courses that can be taken with students out on clinical rotations. Automating more online courses will help make solution 1 and 2 possible.
For the university admins: This idea will placate the university bottom line, listen closely... Make really good educational content with your professors, use the internet, and now you can enroll more students. If Khan academy can help me pass college chemistry and physics, I think you guys can teach physical therapy on Youtube. More students+leaner program=bottom line still happy. That being said, schools are opening at alarming rates (because DPT programs are big money and can subsidize other programs). I do not endorse this dilution of the field by increasing student output, and the job demand won't be/isn't there. If you are considering PT school, this is your warning, the job market isn't what you think it is. I am aware, however, that universities are a business and I cannot ignore their need for funds in my solutions.
4) Scholarships
I truly don't know this answer. Why can I get a Bachelors in Exercise Science for almost free with scholarships at a state school, but to become a noble physical therapist it is 100K minimum? Where is the support for healthcare workers? You all think we make so much money, but 70K with 150K in debt to be a Doctor of Physical Therapy is not exactly "vacation home in Tahiti". We need scholarships for people pursuing higher level degrees. If you want the best healthcare system in your state, listen up. Recruit the best students to your state schools, offer them free education for their doctorate or masters degree, and make them stay in the state for 5 years after the fact. You would have all of the medical talent in two years.
5) More Graduate Assistant Jobs
In PT school, I had the blessing of a GA job for 1 year. The job required 20 hours per week of departmental work in exchange for about $15,000 in tuition fees waived+a stipend of $10,500 for the year. It was a SWEEETTTT gig. I don't know the practicality or feasibility of this as a solution, but if we could have more opportunities like this, what a game changer. For PT students, maybe it looks like them getting paid for treating patient in a University PT clinic.
6) State Funding
One shocking thing I learned while interviewing my Dean at ETSU is that state funding for schools has dropped in the past 20 years. He broke it down like this. If it costs 100 dollars to educate a student, in 1980 the state or federal gov would pay 80 dollars and the student 20 dollars. Now, the state or federal gov pays 20 dollars and loans the student 80 dollars. According to him, the relationship of school funding has changed drastically. This, coupled with a rampant increase in administrator jobs, is why schooling has become so much more expensive. I don't have a lot of faith in the federal government changing on this issue, but I wanted to highlight. Also, as most people know, once the federal government took over loans, universities started abusing this by charging more and more. The students are taking the brunt of it.
Okay, there ya have it! As I mentioned in the beginning, I am no expert on this and these are a mix of opinions and date points. I know everyone is always pissed off on the internet these days, so please, view this as one man's ideas. I welcome the conversation from this issue and I hope you have found this both interesting and eye opening. Hit that share button if this strikes a chord with you!
Until next time,
Dr. Trey
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