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"We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor Lentz
Dr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value.
In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession.
The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume.
What you'll hear:
- Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.
- The challenge of fostering critical thinking and comfort with uncertainty in clinical education.
- Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.
- The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.
- How Duke's Joint Health Program built a longitudinal care model before the payment model existed.
- Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.
- The AIM-Back trial and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care.
Chapters:
00:00 Introduction
00:23 Trevor's background and path to research
03:00 Day-to-day at Duke
03:54 Inductive vs. deductive reasoning in clinical practice
05:39 The No-Copay Revolution study
09:30 Horizontal vs. vertical value and the time-horizon problem
12:44 Rethinking incentives and longitudinal care
17:28 Why one bad PT experience ends the relationship forever
20:53 The identity crisis and language problem
26:57 Phenotyping and tiered, personalized care
39:32 The Pain Navigator program and AIMBAC trial
46:23 Navigators in the commercial space
48:14 Closing: the whole-person argument
About the guest:
Trevor Lentz, PT, PhD, MPH is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care.
About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.
Hosts: Alex Bendersky and Dana Strauss
Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."
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