Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, September 24, 1995 TAG: 9509220126
SECTION: BUSINESS PAGE: F1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
Despite nearly every government agency and business - including health care - looking for ways to downside, she can go anywhere and find work.
And at good pay.
A physical therapist fresh out of school can expect to make from $36,000 to $45,000 a year in Western Virginia, Lucas said. The profession is one of the fastest growing in health care with an 88 percent increase in jobs expected over the next 10 years.
The Richmond native is certain she made the right choice when she gave up a full scholarship to the University of Richmond after her sophomore year because she had been accepted into the physical therapy program at the Medical College of Virginia across town.
Where Lucas might not have been so wise, she jokes, was in setting up her own physical therapy business three and a half years ago.
After a talk she made before a Roanoke Valley school class, a student asked if owning her own business was a way to make more money.
Her reply was: "Not if you look at the per-hour rate. It was better when I worked for someone." That's considering that Lucas begins work at 7:30 in the morning and doesn't get home until about 7 in the evening. From then until 9:30, she prepares dinner and spends time with her husband, Mark Lucas, and daughter, Colubrine, 16 months.
From 9:30 to 11:30 p.m., she does office paperwork. Until this past April, she also had work to do as an officer of the Virginia Physical Therapists Association. She's taking a break from the association.
Mark Lucas does the company bookkeeping and is co-owner of Lucas Physical Therapy Inc., but he also has a sales job with Thorax Corp. Wendy Lucas manages the day-to-day operations and supervises the company's 11 employees scattered at three locations.
That staff includes four physical therapists, an occupational therapist, a physical therapy assistant, two exercise physiologists and an athletic trainer plus office staff. For a local facility that specializes in outpatient treatment, it is fairly large, Lucas said. But, it's small compared to corporations that have operations over an entire state or region.
She opened the company with just one employee. Within three months, the business had doubled. And in six months, she has opened a second office.
Lucas Therapy's main location is in the Fralin & Waldron Office Park off Virginia 419 near Tanglewood Mall. The company moved there from Brambleton Avenue in February and was in temporary quarters until its space was completed last month. The office has 2,800 square feet that includes a treatment gym and nine private treatment rooms.
A second location, inside the Roanoke Orthopedic Clinic on Postal Drive in Southwest Roanoke County, is about the same size with similar facilities. A Vinton office, in space rented from an oral surgeon, is about a third as large as the others and specializes in treatment of head and neck pain.
Lucas Physical Therapy is one of five similar businesses in the Roanoke Valley. Multiple offices are fairly common because they make it easier for patients who might have difficulty traveling, Lucas said. Some of the staff, including her, work out of all three offices.
\ In addition to trying to provide locations that accommodate patients, physical therapy practices are finding that their staffs have to have a broader range of knowledge than in the past, Lucas said.
In Virginia, physical therapists must work under doctors' orders, meaning they cannot see patients unless they are referred by a physician. Once the patient comes in, however, the physical therapist has to decide on the method of treatment or evaluation.
Studies in anatomy, biology, chemistry, mathematics and physics are part of a physical therapy curriculm.
The business draws a wide variety of patients, but they generally fit three categories:
Patients recovering from an incident, such as a broken arm or ankle, some of which are sports injuries
Those with debilitating diseases, such as multiple sclerosis and muscular dystrophy
People with work-related injuries who need therapy to recover or be evaluated to determine if they are ready to return to work.
Lucas sees an example of each type of patient most every day.
On a recent Thursday for example, she had back-to-back appointments with Katherine Mitchell, who had an acute problem, and Kay Martin, who suffers from a chronic disease.
Six weeks before, Mitchell woke up with her right arm and hand severely swollen. Twenty-eight years ago, she had a mastectomy that required the removal of lymph nodes in that arm and made the arm more susceptible to fluid accumulation. Her doctor didn't find any medical reason for the swelling so he referred her to Lucas to get rid of it.
It was Mitchell's fifth visit. In addition to hands-on treatment from Lucas, Mitchell has been massaging her hand and arm at home.
"You can watch TV, and mash or push," she said.
Connective tissue such as that in the arm and hand seals in fluid like a honeycomb and massaging makes the tissue give up the fluid, Lucas explained.
Part of the job of a physical therapist is to teach a patient how to participate in the treatment.
Mitchell's therapy also requires that she wear a constricting "sleeve" on her hand and arm to prevent their swelling while she sleeps.
When Mitchell's arm is back to normal, she be through with therapy. But, Kay Martin, Lucas' next patient that day likely will be a continuing visitor.
Martin, a rehabilitation nurse, suffers from neurofibromatosis, which is commonly referred to as Elephant Man's Disease. The disease, which is progressive, causes tumors to develop throughout the body. Martin has tumors on her lower spine and in her neck and head. She had endured a headache for six weeks, and Lucas used massage and manipulation of the neck to help relieve the pain.
While most people barely know of the occipital bone at the base of the skull, Lucas has to know that too much pressure on it feels like a nail being driven into the head yet too little pressure won't bring Martin relief.
Martin has had several operations because of her disease and has been treated by physical therapists since 1988. Massage and ultrasound treatments help hold back the discomfort caused by some of the tumors.
As with all patients, Lucas will provide feedback on the progress of Mitchell and Martin to their doctors. Getting good results and making them known is the way a physical therapist gets more business.
A therapist can't ask a doctor to refer patients to her, but must depend upon reputation, and membership in health care networks, for new business. Mitchell's doctor originally referred her to a therapist in West Virginia. She told him she couldn't drive that far and asked if she could see Lucas instead. Mitchell had heard about Lucas through a relative.
Now, if Mitchell is pleased with the treatment, Lucas can expect further referrals from that doctor.
"It's very difficult to build a business. You try to get a physician to send a patient and hope everything works out well so he'll send another," Lucas said.
\ While not negating the value of physical therapy, insurance executive Lawrence Colley said a lot of the growth in the demand for it can be traced back about a decade when the government mandated that the therapists be eligible for insurance reimbursement.
Until then, physical therapists were not considered eligible providers under most insurance contracts, said Colley, vice president for medical policy with Trigon Blue Cross Blue Shield in Richmond.
It is a universal truth, he said, that if a third party is paying for a service the demand for the service will go up regardless of whether the need for it increases.
Lucas said therapists are under the same pressure as other areas of health care to decrease treatment time. Insurance companies that used to allow six to nine months of visits for rehabilitation, with multiple visits per week even, now pay for only six to nine visits.
Nationally, the average charge per visit to a physical therapist is $84. Some patients get treatments once a week, some daily, depending upon doctors' orders.
Patient satisfaction is equally important, and patient surveys are routine, she said.
When, for example, a patient said the therapists couldn't be reached in an emergency, Lucas added voice messaging features to each of her offices' telephones and the therapists regularly check for calls when they are off-duty. When patients said they were concerned that they couldn't afford treatment, the company began helping patients determine what their insurance companies would cover.
Documentation of all kinds is especially important with patients recovering from injuries or conditions that prevent them from working.
In addition to trying to help the workers get better, Lucas' company also has to determine when, or if, they can return to work. Getting that information can be a test of imagination or the latest high-tech experience.
When the therapists were trying to determine if an injured mail carrier had recovered enough to again handle a bag of mail, Lucas created a mail pouch from a backpack. But to test a long-distance truck driver's physical ability, she uses a computerized machine costing more than $60,000.
Each hour of turning the machine's steering wheel back and forth is equal to two on the road.
Therapists' roles in the workplace are increasing. According to the American Physical Therapy Association, more and more employers are using physical therapists to evaluate work sites, develop exercise programs and teach safe work habits to employees, all in an effort to reduce injuries.
This is one of the reasons for the optimistic job outlook for the profession. Other factors are that the population is growing older and more debilitated and that the large group of baby boomers is reaching the age for heart attacks and strokes. Another is that medical developments make survival possible for babies with severe defects and accident victims with devastating injuries who need therapy to help with manage basic living skills..
No matter the circumstance in which a therapist is working, it always has to do with helping a person cope, Lucas said. As a teen-ager, Lucas watched a therapist help her father, who had Lou Gehrig's disease, deal with the progressive loss of physical functions.
It made her decide on the profession.
"Other doctors just told him bad news. He'd go to the therapist and she'd show him how to deal with his illness. She always let him be as active as possible," Lucas said.
"The best thing is to leave on a Friday and all your patients are doing well."
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