Motivational factors for PTs & PTAs: do you look forward to Monday morning? Is professional fulfillment an impossible dream, or an attainable goal? What factors--external and internal--can serve as motivators for PTs today?

"True motivation comes from within," observes Sue Schafer, PT, PhD, associate director of the School of Physical Therapy at Texas Woman's University (TWU) in Dallas. However, Schafer says, that internal drive must be nourished by a person's surroundings and interaction with others. In an academic environment, she states, "Instructors and clinical administrators strive to create environments that allow individuals to realize their true passion--to feel a part of things, to feel motivated. There are a host of creative actions managers can take to help individuals understand what makes them come to work and to stay excited about what they do."

Like Schafer, Diane Davis, PT, director of therapy services at The University of Chicago Hospitals (UCH), says that motivation comes from the inside. "Most PTs are self-motivated. The administrator works to find incentives to keep motivation at a high level," she explains.

Motivators vary widely and are influenced by factors including individual talents and goals, organizational standards and team goals, and an individual's role in a given environment. While personality types, ambitions, perspectives, and personal initiatives may vary throughout the profession, a few key motivators tend to inspire students and PTs at all levels.

1. Professional Growth

"PTs want to be seen as independent thinkers in the clinic," Schafer says, "as individuals who know what they are doing." At UCH "we develop expert therapists," Davis reports. "We create the desire to gain additional expertise, and we provide opportunities for professional development."

This drive to excellence holds true in academia as well. "Students want to be excellent clinicians," says Joyce MacKinnon, PT, EdD, professor and associate dean of the School of Health and Rehabilitation Services at Indiana University. "The job of faculty is to help them find their area of specialization. Part of my job is asking, 'where is your niche?' The ultimate goal is to become a unique contributor--within and outside the clinical environment."

Variety and creativity. Expanded opportunities in the work environment motivate many PTs. "A rotational aspect to the environment, where clinicians are able to work in different areas, is very motivating," Schafer says. New challenges, options for increasing their responsibilities, and opportunities for developing specialized skills keep PTs interested.

"Take advantage of those who want to think out of the box," Schafer suggests. For example, some staff members may have ideas on how to expand the clinic's offerings. Others may have administrative suggestions. "It's motivating to be involved in the developmental process of the department," she says.

Teaching others. George Wolff, PT, MBA, founder and co-owner of Wolff Fitness Center in Elgin, Illinois, notes that many PTs have an instinct for teaching. "So much of physical therapy is teaching--be it for patients, family members, or assistants. When given the opportunity, many PTs may find they are motivated and renewed by teaching--whether in the clinic or in an academic setting." Wolff, who for years has taught a course on professional issues at Northern Illinois University, reports, "It is very exciting to be among students. So many personalities, so excited about the profession. It is a real charge to take some of that back to the workplace."

Research. Others PTs are inspired by the chance to conduct research. "We currently are working to create a research coordinator position within the physical therapy department, because our staff has deemed it a priority," Davis reports. "While UCH is a research-based institution, our department lacks a principal investigator or a faculty sponsor for research. As a result, our PTs assist in orthopedic research, biomechanics research, and the like, but we currently don't conduct physical therapy research. Our goal is to change that within the next 2 years."

MacKinnon recalls how a researcher emerged from the academic setting. "One of our faculty members literally became physically ill every time she had to address a class. I spoke with her privately and helped her see she didn't have to make such a sacrifice. I asked, 'Where is your passion?' She admitted that she wanted to be a researcher. She now is thriving in a research scientist position. It all goes back to recognizing an attribute or skill, instead of focusing on a weakness."

2. Continuing Education 

Because opportunities for professional growth can serve as incentives for PTs, many facilities strive to offer ongoing options for continuing education. "Time off for continuing education is a highly valued perk," Davis reports. "PTs value any flexibility in scheduling that will accommodate self improvement." She describes the "step ladder" for advancement within the UCH physical therapy department: "There are four steps before reaching supervisor; the last two steps are Board-certified specialist and the advanced degree beyond entry-level. I strongly encourage our PTs to become Board certified. If they pass the ABPTS, we pay for it. They are promoted, and they receive more money. They also are eligible for tuition assistance if they seek the DPT."

Opportunities for continuing education are motivators within the private practice setting as well. Stephen W Clark, PT, OCS, MHS, MBA, owns Athletic Physical Therapy (Athletic PT) facilities in California. "We have six fulltime PTs on staff," he reports, "and five are going back for their DPTs. Three out of the six are Board certified. Our support of continuing education is an ongoing motivator for staff."

3. Recognition

Recognition of an effort or an accomplishment ranks high on the scale of key motivators. MacKinnon cites the importance of recognition in the academic setting: "We nominate students for a Leadership Award. It is extremely important to them to be individually recognized for a special attribute or skill." She notes that recognition can serve as a catalyst for career choice as well. "We recently conducted a study to determine factors linked to those PT students who chose a career in academia," she reports. "We found that the primary factor was that someone, somewhere along the line, simply told them they could do it and do it well."

She stresses the importance of individual encouragement. "Acknowledge expertise," she advises, "and be specific. Say, 'you're good at this, and this is how you demonstrated it.' Instructors and supervisors don't realize the effect their words can have. Don't hesitate to tell your students or staff, 'I have my eye on you. I think you can do this.' "

Clark encourages and acknowledges individual achievements among his staff. When staff members write articles for publication, "we frame the articles and display them in their offices," he notes. The practice sometimes attracts high-profile clients. "One of our PTs recently treated [the pop singer] Usher," Clark reports. "Usher wanted her to appear with him on TV, and we supported it. Needless to say, that was a real motivator for her," he says.

Recognition also can be as simple as acknowledging a job well done. Wolff, now in private practice, served as director of rehabilitation at Provena Saint Joseph Hospital in Elgin. "I saw firsthand how much this team was doing for people before they left the hospital. I made a point to tell them, 'Never underestimate the contribution you make. I see on a day-to-day basis what you do for these patients.' That kind of positive feedback is so important."

Davis notes that recognition by physicians can be a motivator for PTs on her staff. "They enjoy positive feedback from peers and supervisors, but they particularly appreciate physician recognition. Enabling this type of communication is a no-cost way of providing individual reinforcement."

4. The Work Itself

The patients they see and the interventions they perform are strong motivators for all PTs. "While they may not be conscious of it, a process of questioning is happening within each PT as they come to work," Schafer notes. "They're asking, 'Why do 1 want to work here?' All the things that tend to pull them back each day are motivators--specific patients, other PTs, staff, and increasing responsibilities."

Wolff notes how the many opportunities within the field can be eye-openers for PTs entering practice--and an exciting motivator. When he served as director of rehabilitation at Provena Saint Joseph, "most new PTs arrived thinking they wanted to focus on outpatient orthopedics," he recalls. "Bur an acute care general hospital offers such a variety of opportunities for specialization and for creative thinking. It was a joy to see them explore avenues they didn't know existed, to discover their true potential." He describes one PT who was exposed to neonatal rehabilitation, and defined an entire new life path. "She worked with a speech pathologist to develop a new program for early assessment of developmental delays in children," he reports. She now serves as the head of the neonatal rehabilitation program at Provena Saint Joseph.

5. Identifying With a Facility or a Specialty

Both students and practicing PTs draw strength from, and are proud to be associated with, specific facilities or institutions. "All of our students are very identified with our school," Schafer reports. "Many students come to us because they have met other TWU clinicians, and they liked what they saw."

Clark says that the special characteristics of the Athletic PT facilities attracts athletically oriented PTs. "Our clinics are located within fitness facilities, and we emphasize the link between physical therapy and fitness. Our PTs take pride in the tact that they have a unique combination of talents to offer our clients. While treating an injury, they talk one-to-one to the patient about sports, or about sports-related injuries. Chances are, regardless of what type of injury we're treating, one of our PTs has recovered from it as well."

Similarly, Davis ranks identity with UCH as an important motivator for her staff. "The reputation of the hospital is very important to our people," she states. "They are proud to say they work here."

6. Compensation

While compensation may not be the first motivator mentioned when PTs or supervisors speak of incentives, equitable pay is important. "It is a de-motivator to not be adequately paid," Davis says. Like extra time off, "if a staff member can get a little more money for an extra effort, it serves as a solid motivator. We offer a bonus for exceeding productivity expectations."

Clark notes that in private practice "those who are willing to share the risk should be able to share the reward." A clinician who contributes to business operations, for example, may become an office director, or the head of a branch office--with the consequent rise in both responsibility and income.

Knowing what incentives are of most value to individuals is helpful, but not enough in itself to keep an entire clinic or classroom motivated. Supervisors need to balance the motivation of individuals with the maintenance of team dynamics on a daily basis.

Open communication about staff members' personal goals and their reinforcement by the entire team call strengthen team dynamics. While individual goals can range from seeking an advanced degree to conducting research to teaching, some may be more attainable than others in specific environments.

"Conflict can arise if the team goals don't match personal goals. That's where the manager comes in," Schafer says. "The manager needs to give the team and its individual members a sense of direction--to develop clear objectives and goals for the ream, and for individuals within the team, so that everyone knows where they stand within the workplace."

Wolff stresses the importance of clear team goals for keeping individuals motivated. "Keep your management goals tacked up on a board for the entire team to see," he says. "That way, you don't have to 'issue orders,' to tell someone what to do. The goals are clear and set, and the team is working toward those goals."

Davis agrees. "First we set department goals. Then the team sets its goals related to the department goals. Then each individual has to set goals related to the team and department goals. If an individual's goal is program development, for instance, he or she must relate that plan to the department goals in order to go forward with the logistics--such as conducting necessary research. If the personal goal doesn't fit with tram or department goals, it simply may not be feasible at this time."

Team building activities can be motivators as well. UCH scheduled a full day of wall-climbing and other challenges at a local health dub for its therapist teams. "It was costly, since this meant time away from treating patients, and we had to split the department into two groups so it could remain open," Davis notes, "but the resulting insights into team dynamics were fascinating." As in the clinic, individual goals proved to be the strongest motivators. "Each participant was extremely motivated to see how high he or she could reach on the wall." Still, the teams worked well together when met with the challenge of competing against others.

Clark says that although Athletic PT doesn't offer formal retreats for staff, it does conduct informal team activities for each facility. "Our offices are 30 miles apart in Los Angeles. That makes it difficult to coordinate a retreat for all staff," he says. "So each facility schedules meals and informal get-togethers on occasion." He might also surprise an individual staff member with rickets to a basketball game for a job well done. "We just bought a paint ball kit," he notes. "We'll put something together to try that out as well."

Challenges

A number of outside factors can challenge both individual and team motivation--and put a supervisors creativity to the test. Among them are managed care, personal dissatisfaction, and change.

Managed Care. A major motivational challenge in the physical therapy clinic has been the transition to managed health care. "For a while, the changes wrought by managed care pushed individual gods to the back burner," Wolff recalls of his experience at Provena Saint Joseph. Administrative pressures to increase productivity, to practice with an eye constantly on the financial bottom line, appeared to conflict with the clinician's desire to put treatment first. Supervisors soon determined that "the only way to render quality treatment in the new environment was to work smarter, not harder," Wolff explains.

Davis agrees: "It's the outcome that determines quality of care, not necessarily the amount of one-to-one time with the patient."

"A good manager has to be a good communicator in both directions," Schafer says. "The administration needs to know the value of the department, that there are good people in place," she says. "And if a manager is doing a good job with staff, only a very small fraction will ever feel they are not a part of a productive team. There is a huge motivational role here for the manager."

Personal Dissatisfaction. Spotting dissatisfaction can be a challenge for supervisors as well. "Managers need to be vigilant, to scan staff for behaviors that aren't what you would expect. Dissatisfaction can be internalized and hard to spot," Schafer notes. "Once you sense a problem, initiate an interaction." Causes of dissatisfaction can range from family or personal problems to a student or PT realizing he or she simply is simply not happy in the current environment. Regardless of the cause, a key aspect of the solution is the willingness of the supervisor to listen.

Wolff recalls how one PT entered his office, shut the door, proceeded to complain about the challenges of the managed care environment, then rose to leave. "I asked, 'What can I do to help?' The PT said, 'Nothing. You just did it.' All the PT needed was to be heard." Wolff worked a standing "complaint time" into department meetings, during which team members were allowed a few minutes to complain, and "then that was that," he says. "From then on, we focused on the positive."

MacKinnon notes how some students realize they are on the wrong track. "When I spot an intelligent student who is floundering, 1 make a point to speak with him or her. Sometimes it emerges that the student didn't pick this major, the parents did. Sometimes the best we can do is to say, 'This career is not suited for you.' But don't leave them there. Help them to ascertain their strengths and their attributes. I've seen students who are [best suited to be] occupational therapists, and just didn't know it. Often, they don't stray too far from physical therapy."

Change in Itself. Since change is both universal and inevitable, providing tools for adapting to it is a strong motivator. "I have tried to stress that change is going to happen," Wolff says. "It's how you deal with the transition that affects you. I witnessed some PTs having a really tough time with the transition to managed care, while others coped and moved on. Drawing this distinction between the change and how you react to it is key."

MacKinnon emphasizes focusing on the positive to help with transitions. "One needs to be sensitive to the fact that people are motivated by different factors. Strive to mold their tendencies, their interests into a skill set that helps them perform. Encourage them to believe that what they do matters--that they can indeed have an impact."

Motivation as Reward

Achievements by staff members or students have an unexpected additional benefit: they serve as motivators for supervisors. "There is a great deal of self-satisfaction to be gained from seeing someone achieve his or her potential," MacKinnon notes. "Seeing a student surpass you--soar beyond you, become renowned--is quite exciting, and can be a true motivator."

Wolff agrees. He observes that "PTs are a stimulus in and of themselves." Witnessing their growth--and likewise that of the profession--is a source of pride for colleagues and supervisors alike.

The Workplace as Motivator: Defining the Delivery of Physical Therapy Services

Reporting for work is the key motivator for PTs practicing at the George E Wahlen Department of Veterans Affairs Medical Center (VASLC) in Salt Lake City, says Brian Murphy, PT, MPT, clinical manager of rehabilitation and acting associate director of the VASLC. The PTs at this acute care hospital function as a part of its primary care team--assessing and treating patients in the emergency room, through triage, at the patient's point of entry to the health care system--whenever and wherever their input is required.

Murphy says this area of practice offers exciting opportunities for PTs to be "a vital component part of the primary care team." The result is a vibrant atmosphere at the VASLC.

The PTs are required to meet basic standards for a range of competencies, including EKG assessment, and to understand national guidelines for management of diseases such as diabetes; hypertension, and heart disease. They also are educated in both the evaluation for and fabrication of biomechanical orthotics. "Each new staff member rotates through training as a student, regardless of his or her level of education and expertise," Murphy says. The result is a uniquely qualified practitioner. "Most are grateful for the training," he notes.

The physical therapy staff works as an integral part of the primary care team--alongside physicians and other specialists, in the VA setting, direct access is not an issue. As Murphy explains, "No one has direct access here, not even an orthopedic surgeon. All patients enter the system through a primary provider. We then provide patient care as a team."

When a PT is hesitant about taking charge of an intervention, "we assess their skill level and put them with an experienced therapist to increase what may be lacking. Physicians are grateful for our input as a part of the team," Murphy reports. "We are educating them daily about how we're trained and about what we do."

Murphy and Kristen Nelson-Veltkamp, PT, MPT, who at the time was the supervisor for physical therapy and occupational therapy, developed the primary care model for physical therapy at the VASLC in response to a budget crisis. While the VA setting isn't subject to Medicare restrictions, its budget is at the mercy of the US Congress. "We looked at how we could maximize what we were doing to provide the most efficient patient care for the least amount of money. And we asked: 'Why not take physical therapy delivery to the point of entry, to treat an acute condition before it becomes chronic?'" Murphy reports.

They focused on the positive to present the concept to other departments within the hospital. "We presented the idea by asking physicians, 'How can we make your life easier?' We'd visit the Emergency Department during a crunch time, and ask, 'How can we help?' Within a few minutes, we'd be co-evaluating patients and providing interventions. Soon, we were being called down to the ED as we were needed."

The result? Increased efficiency in delivery of physical therapy services. "In the traditional health care model, a patient may be scheduled for rehabilitation 6 weeks after being diagnosed with, for example, a rotator cuff tear," Murphy explains. "But if I can see him today, when he enters the system, and provide intervention, possibly a home program, he is better off--and the system saves money."

As a supervisor, Murphy faces the challenge of molding individual goals to the goals of the facility. In this case, he must convince PTs to adapt to the different paradigm. "Generally speaking, I have been able to match clinicians' inner drives with the goals of our program," he comments. "The key is finding what they are passionate about, and matching it to something I need."

"For instance, if someone is focused on manual therapy but hesitant about becoming a part of this model, I ask, "what is more challenging, seeing someone 10 times in the physical therapy department, or seeing her once in primary care, and providing an effective intervention, so she can get on with her life?'"

Motivation, according to Murphy, "comes down to inspiring people to be a part of what you are doing."

Having reported on VASLC's cutting-edge program at both the APTA Annual Conference and Combined Sections Meeting, Murphy also is a contributing author of a book on the delivery of primary care physical therapy services to be published this fall. He also has taught courses on primary care physical therapy at both the University of Montana and University of Colorado School of Health Sciences as part of its new DPT curricula.

Editor's note: Brian Murphy's comments are his own and do not necessarily represent those of the Department of Veterans Affairs.

Claire Coyne is a freelance writer.