Why PT Productivity is the Wrong Measure—Part 1

Why most companies focus on it, and why MovementX does not

There’s nothing that ground my gears more in past physical therapy jobs than a manager commenting on my productivity.

• What’s your cancel no/show rate?
• How many patients did you see?
• How many units did you bill?

ARGH!

Sure, I had a few cancellations last week. My patients were sick! Do you want me to get sick, too? Then my productivity would go way down…

And why did I only bill 3 units? Because the patient had to leave early! Or maybe it was all they could tolerate in the moment, and it was simply the right thing to do.

I had these conversations over and over again with managers. My productivity was not bad by any means; on the contrary, it was well within the ranges the clinic was shooting for each month—yet they still questioned me on it!

But here’s why it bugged me so much:

Productivity is the wrong thing to measure.

That’s one of the many reasons why, when we started MovementX, we said we would never have productivity measures. Six years later, we are proud to say we still don’t have them.

And we never will—so long as I have anything to do with it.

 

Why Most Traditional PT Companies Measure Productivity

One caveat before we dive too deep—I understand why most physical therapy clinics measure productivity so closely. There’s a direct connection with traditional productivity metrics and how a company performs financially.

When you know how much money you get per patient, and you know how many patients you see per week, you have a quick and easy view into how much revenue you can expect. So, it’s no wonder why most business advisors suggest physical therapy companies measure productivity.

I do believe profit is fuel for our mission. That is equally true at MovementX as it is at any other organization. Your organization needs money to survive!

Productivity is certainly a helpful metric to know and keep your eyes on. But there are just so many problems with it…

 

What Gets Measured Gets Managed

Here’s where I think productivity went wrong: when productivity became a metric related to individual physical therapy job performance—rather than acknowledging all of the structural and circumstantial factors that influence it.

After all, as the famous saying by Peter Drucker goes,

“What gets measured gets managed.”

And traditionally, PT clinics have over managed productivity. In fact, they’ve abused it, beaten it to a pulp, and put the blame in the wrong place when it goes awry.

As businesses started to focus specifically on physical therapy job performance metrics that align so closely with finances, and managers became responsible for their collective clinics’ and providers’ individual output, they started paying even closer attention to productivity.

All of a sudden, productivity metrics became the #1 focus for managers, regardless of whether or not it’s actually right for the patient and the provider, or even a relevant indicator of quality care.

And when productivity falters? Most often, it became the individual clinician’s fault—and the guilt and blame followed.

 

3 Reasons Why Productivity is the Wrong Measure

There are so many problems with productivity as a measure, but I’ll share my top three.

1. It treats clinicians as a number. Too often, management views physical therapists as people who are only capable of pushing billable units. This perspective ignores the diverse set of talents and other types of value that talented clinicians can bring, de-humanizing healthcare. What you measure and emphasize communicates what you value!
2. It doesn’t acknowledge that poor productivity could be a structural problem. How was the patient’s interaction with the front desk? Did the patient get the appropriate reminders of their next appointment? Was the care delivered considered appropriate for the patient? Patient experience is a result of your entire team and systems, not just the effort of one person.
3. Most importantly, it puts focus in the WRONG place. As passionate physical therapists, we should be focused on delivering great quality care above how many billable units we have delivered. If everyone measured quality as closely as they measured productivity, maybe we wouldn’t even have a productivity problem…

If we show value and provide the best physical therapy experience, patients will come back and our productivity metrics will be just fine.

That’s swimming downstream—something I can get behind!

 

The Right Measure

On the note of swimming upstream, there’s a concept in business called leading indicators versus lagging indicators.

As the name implies, lagging indicators are a measure of past performance. Productivity is one of those measures—it looks backwards in time.

On the other hand, leading indicators predict future performance. They are powerful because they allow you to change quickly as needs arise without any gap in performance.

At MovementX, the biggest leading indicator we have found, and what we think gets closer to measuring performance, is accountability. If you develop the right skills, execute the right strategy, deliver great quality, and focus on learning from everything that you do, you will see success.

At MovementX, we don’t have productivity standards. We have accountability standards—for both providers and for the organization.

I’ll dive deeper into our accountability standards in part two.

Spoiler alert: we think it’s much more effective, more fun, and builds a stronger physical therapy organization than only looking at productivity.

 

Conclusion

Too often, productivity is conflated with greatness in physical therapy jobs and clinics. Are high billable units and tons of patients seen actually something we should be proud of as an industry? Has it led to success in the past?

I’d argue that it has led to overutilization and sped up the massive burnout problem we face as an industry.

We need a new set of metrics focused on why we are actually here in the first place—delivering great care to the patient, and ensuring we are doing so in a way that continuously fires up our providers.

And the more we can swim upstream on those metrics using leading indicators, the better.

At MovementX, we hope to usher in a new era of performance metrics in physical therapy as we raise the bar on what’s possible. Check out Part 2 for more details on how.

 

---

 

At MovementX, we are committed to building a community of 100 thriving physical therapists by the end of 2025. You can read our Vision of Greatness (aka, exactly what we hope to look like when we achieve that Vision) here: 100 Thrive in ‘25.