Why Are More Clinicians Choosing Therapy in School Settings?

To (partially) quote Charles Dickens, now may be “the best of times and worst of times” to be in the therapy services field.

Smiling male physical therapist in school setting gives kindergarten girl “high five” after she completes a block puzzle.Why the best? Because in the next decade, demand for therapists should grow much faster than the average for other occupations.

Why the worst? Because this demand will come mostly from settings where recent insurance changes are leading to less job security and lower income for therapists.

However, practicing therapy in school settings can be a way out of this “tale of two fields.” 

At Pediatric Therapeutic Services (PTS), we’re seeing more therapists leave medical and home health care settings so they can work with students who receive special education and related services. And many new therapists are setting their sights on school-based practice at the start of their careers.

These therapists aren’t making the switch solely to avoid new insurance nightmares—though that’s no small motivation! They also want the unique fulfillment providing therapy in the school environment can bring.

Why Many Medical Settings Are Suddenly Slashing Therapy Services

The U.S. population is getting older, and America’s swelling ranks of seniors will need multiple therapy services.

Largely for this reason, the Bureau of Labor Statistics projects increasing job opportunities for Occupational Therapists (OT), Physical Therapists (PT), Speech Language Pathologists (SLP), and Psychologists, among others.

Senior citizens will receive these physical and mental health services at home, in hospitals, and in long-term care facilities—and insurance changes mean the therapist job outlook isn’t as sunny as statistics might suggest.

Medicare recently implemented new reimbursement models for skilled nursing facilities (SNFs) (a model with consequences for hospitals) and home health care agencies. Both are part of a move away from a volume-driven, fee-for-service approach to a value-based system. Since many private insurers follow Medicare’s lead, these models’ impact will be widespread.

Unfortunately, since implementation, these models have prompted several providers to reduce therapists’ hours, or cut their positions entirely:

  • The American Speech-Language-Hearing Association (ASHA) reports a “seismic wave of layoffs, pay cuts, and reductions in hours” for SLPs and other SNF therapists at industry giant Genesis HealthCare that may mark as high as a 6% workforce reduction.
  • The American Physical Therapy Association (APTA) started hearing from PTs and PTAs (Physical Therapy Assistants) about “layoffs or shifts to PRN [as-needed] roles with reduced hours and fewer or no benefits” within 48 hours of the new plans’ launch.

To be clear, Medicare’s new rules don’t mandate job cuts or reduced hours. They’re meant to incentivize highly customized patient care and stop providers from delivering more therapy services than patients need. 

Unfortunately, many skilled nursing and home health agencies are cutting therapists out of concern for the bottom line, and therapists say patients are paying the price. Far from getting too much therapy, now they’re getting too little.

Federal Law Requires School Settings Provide Related Services

Given this sea of change, is it any wonder more clinicians want to practice therapy in a school setting?

Young elementary school boy sits at table in physical therapy room and completes wooden jigsaw puzzle, toys on shelves in background. The Individuals with Disabilities Education Act (IDEA) requires schools receiving public funding to give qualifying students a free appropriate public education (FAPE) “without charge.”

The “free” in FAPE means free to the students and their families. While schools can and do bill third-party payers (including Medicaid as appropriate), to defray their expenses, they may not bill parents or guardians.

Since so many of the services school-based therapists provide or participate in are mandated by law and paid for by schools, you don’t have to deal with the same insurance pressures your colleagues in other therapy settings do.

Now, we don’t want to sugarcoat things: Money’s tight in the education environment. The federal government continues to underfund special education, and local school boards sometimes make budget crunches even tougher. 

But as long as the law requires special education, districts will need school-based PTs, OTs, SLPs, and other clinicians to deliver the related services spelled out in those students’ Individualized Education Programs (IEPs). 

While no profession can guarantee 100% job security, at PTS, we’ve found school-based therapy can come pretty close! Even on the rare occasion when we’ve stopped working with a client district, we’ve virtually always had other placements where we could send our therapists who wanted to keep working. 

When You Work with PTS, You Know You’re Making a Difference

Beyond the peace of mind you get when you’re providing a service mandated by law, therapy in a school setting rewards practitioners with a special sense of satisfaction therapists in other settings sometimes find elusive.

Consider, for instance, what one anonymous psychiatric specialist wrote about her experience: “As a therapist, I just want to help people. In a hospital setting, because it’s meant to be short-term, it’s difficult to feel that you’re making a difference.”

Would all therapists who practice in hospitals agree? Of course not. And we school-based therapists face our own special challenges: upset parents, inflexible classroom teachers, inadequate space, and more. 

Nevertheless, when consistently working with students one-on-one and in small groups, the difference you’re making is often abundantly clear.

The student who finally holds her pencil correctly. The student who starts articulating his “R” sound clearly. The student who walks herself up the school stairs with minimal assistance. In moments like these, you know you’ve made a positive impact.

We hope you’ll consider making that impact as a member of the PTS team! Click here to discover more about working with us as an independent contractor

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