Physicians often order therapy 2-3x/week for 4 or more weeks.  They do this because they have been taught to order it that way and have been ordering PT like this for all my 40 years in practice.  This amount of therapy is often not necessary, but the “order” is often used to justify the frequency to enhance profit.  Charges for physical therapy in many healthcare systems are very high because they have a lot of overhead – a lot of managers/administration.  Private practice therapy facilities often charge similarly because they can.  The notion that charges are somehow based on costs is a myth.  Charges are based on what one can get paid, and in the case of private practice therapy facilities (non-hospital-based) they charge close to (but often slightly less, for marketing purposes) what the local hospital charges because that’s what they can get – not what it costs them to provide the service.  In her book “An American Sickness”, Dr. Elisabeth Rosenthal lists this as her number 10 rule of healthcare; “costs will rise to whatever the market will bear”.  In either the hospital or private practice, therapists are encouraged and often rewarded or incentivized via “profit-sharing” schemes to maximize visits to maximize profits.  Private practices often offer discounts, but the cost per episode of care is large simply because of the large number of procedures and visits.


Physicians are often pressured by their administration to “keep the business in the house” and refer to therapists employed by the healthcare system that employs them.  Sometimes it is inferred that this is in the patients best interest when it may be in the best interest of the healthcare system’s bottom line and not the patient’s well-being.  Not all PT is the same just as not all doctors are the same.  Some specialize or have more expertise in certain areas.  I have over 35 years of experience devoted to musculoskeletal/orthopedics and care that is evidence-based.  I don’t do much like I was trained to do in the 70s, whereas many therapists do!