What speech-language pathologists, occupational therapists, and physical therapists told us is working, and what every practice needs to know
Not treating. Documenting.
If you're living that right now, this is no surprise.
The question is what the practices that have changed it are doing differently.
More than 500 PTs, OTs, and SLPs surveyed · 2026
See how much time you spend documenting
Key findings
The pressures hitting rehab therapy are not personal productivity problems. They are structural: a decade of flat reimbursement, rising practice costs, and documentation systems that were never designed for the pace clinicians are being asked to maintain.
And still, 60% of the clinicians in this survey are optimistic about the profession's future. The ones who are most optimistic are at practices that found specific, repeatable answers to the problems above.
86%
Experience burnout. The biggest driver is not caseload or clinical complexity. It is documentation.
68%
Say reimbursement pressure has reshaped how their practice operates.
Only 5%
of practice owners feel very well-prepared for the business realities of running a rehab therapy practice.
Start scrolling
Physical therapy
45%
are at risk of a major career change in the next 12 months. PT is the discipline most actively reconsidering its relationship with the profession.
Speech-language pathology
35%
plan to adopt AI documentation tools in the next 12 months, the largest planned adoption wave of any discipline.
Occupational therapy
33%
are prioritizing work-life balance as their top career goal, the highest of the three disciplines and six points above the field.
The pressure didn't stay in the front office.
For one in six practices, reimbursement pressure has moved past operations and into the treatment room.
The demand for AI documentation is real. So is the hesitation.
70% of clinicians say this is where the profession needs to go. Only one in five is already there.
Three decisions separate the practices pulling ahead.
They changed three things, and none of them required being bigger, better funded, or in a different market.
We asked:
What is the most difficult or frustrating part of your day-to-day work?“The documentation! Especially documentation! The amount of time we put in writing the evaluation does not come anywhere close to the reimbursement rate of evals.”
Lindsey Chappell, OTR/L
They reduced documentation time. They clarified their financial position. They systematized at least one business function they were handling manually. Most of the practices that pulled ahead began exactly where you might be right now.
The full research shows how those three decisions play out across this dataset: what changed financially, what changed for clinicians on the ground, and what it looks like for practices that had to get there from a difficult starting point.
For each section, there's a short action plan:
This calculator tells you where you stand in it.
Find out how many hours a week documentation is really costing you.
Move the slider to match the number of clients you see per week. Enter your own numbers, not your practice's.
That's about 26.7 hrs/month on documentation.
The average clinician spends
~7 hrs/week
How do you compare?
Based on responses from over 500 PTs, OTs, and SLPs surveyed in 2026.
That number is not permanent. The next three sections show what is driving it, who in this field has already changed it, and exactly what they did. Each section closes with one move for clinicians and one for owners. Start wherever matters most to you.
For years, flat or declining reimbursement was the kind of pressure that practices absorbed and worked around. Clinicians saw more clients. Owners renegotiated where they could. The gap between what insurance paid and what care cost was something the profession managed, even when it stung.
That era is ending. What our survey found isn't a field straining to absorb pressure. It's a field being actively reshaped by it. The decisions that practices are making right now, about which clients to take, which services to offer, which staff to keep, and which technology to invest in, are increasingly being made with one eye on the payer environment rather than on the clinical picture. For a meaningful share of respondents, that shift has already reached the client.
This section follows the shape of that pressure: what it's doing to practices, how they're responding, and where a technology that almost everyone believes in is struggling to earn the trust it needs to actually help.
"As the owner, the most difficult thing is being responsible for everyone's paycheck, while insurances are making it harder to get paid. Denials are increasing exponentially, often reimbursement rates are decreasing, patient monthly insurance premiums are at an all-time high while benefits are decreasing. The result is that small pediatric outpatient practices like mine struggle to stay in business."
Kristine K. Dickinson, MS, OTR/L
Reimbursement
Nearly 7 in 10 respondents say reimbursement pressure has affected their practice in some concrete way over the past 12 months.
For 20%, the impact has stayed on the business side: decisions about staffing, operations, and margins. For 32%, it has crossed into clinical territory. Payer dynamics are now shaping clinical recommendations, not just operational ones. And for 16% of respondents, it has gone further still.
16%
Care compromised
20%
Business impact only
32%
Business and clinical impact
68%
Total negative impact
Which of the following best describes how reimbursement pressure has affected your work in the past 12 months? Single response. N=442.
These aren't clinicians describing administrative friction or tighter margins. They're describing clients who received less care than was clinically indicated. Not because the need wasn't there, but because the reimbursement structure didn't support it.
There's a parallel data point worth naming alongside this. 23% of respondents say they have no visibility into how reimbursement affects their practice at all.
Not because the pressure isn't reaching them, but because the information isn't being shared with them. The impact is real whether or not clinicians can see it.
Owners vs. employed clinicians
Owners and employed clinicians are working from different information. 100% of respondents with no visibility into reimbursement's impact on their practice are employed clinicians. Zero are owners or practice leaders.
What makes flat reimbursement particularly hard to solve is that it doesn't stay in one place. The downstream effects compound. Flat rates create pressure to raise clinician productivity. Productivity pressure crowds out the time and focus clinicians need for complex cases. Service lines narrow toward what the payer mix will support. Technology investment gets deferred because the margin to fund it isn't there. And at the clinician level, that pressure doesn't register as a financial problem, it registers as exhaustion. We'll measure that directly in the next section. But the path from payer contract to burned-out clinician is documented here, in the operational data, before we ever get to the burnout questions.
The trap closes from both ends: the practices that most need efficiency tools to break the cycle are, in many cases, the least financially positioned to invest in them.
Revenue and operational response
88% of practices are actively pursuing at least one revenue protection strategy. That's an area that is not standing still. But what those strategies look like depends heavily on where a practice is starting from.
Financially stable practices are pursuing growth: referral expansion, new service lines, technology investment. Practices under financial strain are playing defense: claim performance, payer renegotiation, capacity reduction. Stable practices are building. Strained practices are defending. Both responses are rational given where each group is starting. But they lead to different destinations, and the gap widens with every quarter that passes without a change in trajectory.
Cash-pay and out-of-network options are being pursued by 25% of respondents. For some practices, this is a strategic choice, a deliberate move toward a higher-margin model that reduces payer dependency. For others, particularly small pediatric practices where Medicaid reimbursement has narrowed, and prior authorization requirements have multiplied, it isn't really a choice at all. It's what stays viable when the alternative stops making operational sense.
"I think moving towards more cash-based services is necessary as private insurance companies do not seem to be willing to re-negotiate reimbursements."
Kellie Banfield, PT, DPT, MTC
The 12% pursuing no strategy at all deserves attention even in a section about what practices are doing. These aren't necessarily failing practices. Some are absorbing pressure without a structured response because the pressure hasn't reached a breaking point yet. But the field is moving, and practices that haven't built a response strategy now will be choosing from a narrower set of options when the pressure intensifies.
When clinicians were asked to imagine their work life thriving 12 months from now, 15% named AI and technology adoption as the single decision that would make the biggest difference. Only work-life balance (17%) ranked higher. Practices investing in that pipeline now are building toward what their own clinicians are already asking for.
On the operational side, the most common response to reimbursement pressure is raising productivity expectations on existing clinicians. 40% of practices have done this or are actively planning to nearly double the share investing in new technology (23%). The logic is understandable: productivity is adjustable without capital investment, while technology requires both funding and implementation time.
Raising productivity expectations without investing in tools doesn't reduce the workload. It intensifies it. More sessions, same documentation requirements, same after-hours burden, less margin for error. Among practices that raised productivity expectations without any technology investment, burnout is worsening at the fastest rate in this dataset: a 42-point swing compared to practices that paired higher expectations with tool investment. The most common practice-level response to reimbursement pressure is the one most likely to accelerate the workforce crisis it's trying to outrun.
"The most difficult part is balancing the intense productivity demands with providing truly patient-centered care. I often feel rushed to see more clients knowing they need more time and attention."
Moagi Charmaine, MC, PT
AI adoption
AI Scheduling and reminder tools lead at 49% current adoption. AI-assisted documentation sits at 21%, despite being the category where the greatest forward pipeline exists. 32% of clinicians plan to adopt documentation tools in the next 12 months, the highest planned adoption figure of any category in the survey. And when clinicians were asked where they believe AI will have its greatest positive impact on rehab therapy, there was no contest.
Documentation cost model
Survey baseline (Q19, n=504). Weighted average of bucket distribution.
Illustrative modeling, not a direct survey finding. Range supported by Q22 verbatims from early AI adopters.
Without AI
Per week
7
hours
Per year
333
hours
Over career
9,996
hours
Career years lost
4.8
work years
With AI savings
Saved per week
2.1
hours
Saved per year
100
hours
Reclaimed over career
2,999
hours
Years reclaimed
1.4
work years
70% of clinicians say documentation is where AI will matter most. 21% currently use it there.
That 49-point gap isn't explained by access, cost, or awareness. It's explained by what clinicians say when asked directly why they haven't adopted.
When clinicians name the barriers to AI adoption in their workflows, cost ranks fourth. The top three are all versions of the same concern.
55%
Clinical
accuracy distrust
#1 overall
46%
Data privacy
concerns only
#2 overall
45%
Quality of
care concern
#3 overall
44%
Cost
#4 — behind
all three trust barriers
What are the primary barriers to adopting AI or technology tools in your rehab workflows? Multiple response. N=422.
Clinicians are holding AI to the same standard they hold themselves. In a profession where an inaccurate progress note can delay reimbursement and a poorly worded evaluation can affect a child's access to services for months, accuracy is not a nice-to-have. It's the baseline requirement for clinical practice. Until AI documentation tools can demonstrate that they consistently meet that bar, efficiency arguments are answering the wrong question.
The profession's own associations are working on the same question. In September 2025, APTA published a formal practice advisory on AI ambient scribe technology, covering documentation responsibilities, the evidence on both benefits and limitations, and what clinical standards AI tools need to meet. The fact that the largest PT association in the country has moved to formally address this signals that the accuracy question is being taken seriously at every level of the field, not just at the point of care.
At the same time, the conversation is playing out differently depending on role, and that difference has real implications for how organizations approach adoption.
Owners vs. employed clinicians
Among practice owners, the leading barriers are cost (55%) and system integration (53%) — financial and operational obstacles. Among employed clinicians, quality of care concern leads (49%) — a clinical accountability barrier. Getting both groups to adoption requires meeting each where they are.
The barriers also shift by discipline, and again the differences reflect the specific clinical and operational realities each group is navigating, not a difference in openness to the technology.
Physical therapists
Cost ranks first for PT clinicians at 53%, higher than any other discipline. That’s not a coincidence. PT operates in a fundamentally different payer environment: Medicare accounts for 37% of its mix, nearly double SLP (8%) and OT (10%), while workers’ compensation makes up 22%, compared to just 1–2% for the others.
That combination brings sustained Medicare rate pressure and complex workers’ comp authorization cycles, which are largely absent in pediatric SLP and OT. The result is thinner margins, tighter capital, and a very different baseline for evaluating AI investments.
It shows up in care delivery as well. 27% of PT respondents say reimbursement has significantly compromised their ability to provide needed care, the highest of any discipline and 11 points above the overall average (16%).
Occupational therapists
Quality of care concern leads for OT respondents at 51%, above the 45% overall. This isn’t generic caution about new technology. OT evaluation documentation carries specific legal and clinical standards: initial evaluations, progress notes, and discharge summaries that can inform school placement decisions, insurance coverage determinations, and legal proceedings.
For OT clinicians, a documentation error is not just a billing problem. It can have downstream consequences for a client that extends well beyond the clinical encounter. That standard doesn’t adjust to accommodate a product pitch.
The OT clinician willing to adopt AI documentation is the one who has seen it perform at a clinical level that matches what they would produce themselves.
Speech-language pathologists
35% of SLP respondents plan to adopt AI documentation tools in the next 12 months, the highest of any discipline and 13 points above the overall 32% planned adoption rate. That forward pipeline reflects a documentation burden that is structurally different from what PT or OT clinicians face.
SLPs writing IEP goals and progress summaries for school-aged clients navigate federal special education regulations, district-specific formatting requirements, and annual evaluation cycles that can generate hundreds of pages of documentation per caseload per year.
What makes the trust gap potentially bridgeable is that the proof points already exist.
The clinicians who have crossed the adoption barrier aren’t reporting minor improvements. They’re describing a fundamentally different relationship with the end of the workday.
“After we started using AI tools, my therapists and I began finishing their daily notes in half the time. Notes completion rates went from often staying late to catch up.”
Moagi Charmaine, MC, PT
“AI is allowing me to focus more on the client because I’m not as distracted to take notes. I can fully concentrate on the patient and know that AI will draft a 90% product. I’m very happy with that. With small corrections, it takes significantly less time to document so I can maintain my mental energy for one-to-one care.”
Tiffany Lee, OTR/L
The acceptance and resistance exist side by side in this data. What that tells us is that the conversation around AI adoption needs to change. Clinicians aren’t weighing time savings against inconvenience. They’re weighing technology’s clinical track record against their own professional reputation. That’s a much higher bar. The only way to clear it is with clinical evidence, not efficiency math.
What matters most
We asked clinicians to name the single most important thing every rehab therapy practice needs to do to thrive over the next 12 months. 377 people answered. The top response wasn’t technology adoption. It wasn’t operational efficiency. It wasn’t even financial management.
18% named reimbursement advocacy and payer reform as the most important priority, nearly double the second-place response. Technology adoption ranked second at 14%. These aren’t early-career respondents describing aspirational goals. They’re mid-career and veteran clinicians describing the gap between what the profession needs structurally and what it currently has. Advocacy, in this context, isn’t a philosophical position. It’s a survival requirement.
“Advocate for our professions! We must be a voice at all the tables, establish relationships for leverage, and be able to advocate so our patients can get the services they need.”
Candice Mullendore, MS, OTR/L
“Over the next 12 months, every rehab therapy practice needs to become relentlessly data-driven and tech-enabled — using smarter workflows, AI-assisted documentation, and consistent outcome tracking to protect clinician time and clearly prove value in a tougher reimbursement environment.”
Jennica Milstead, MOT, OTR/L
“PUSH BACK ON INSURANCE DENIALS. Hold insurance companies accountable for their unethical practices.”
Kristine K. Dickinson, MS, OTR/L
88% of practices are already taking action. The question this data raises isn’t whether the field is responding to pressure. It’s whether the response is matched to the actual problem. 32% of clinicians plan to adopt AI documentation tools in the next 12 months, the largest planned adoption wave in this dataset. The desire is there. Raising productivity expectations without investing in the tools that make higher productivity sustainable isn’t a strategy. It’s a delay.
The practices most likely to be in a different position 12 months from now are the ones closing the gap between productivity expectations and technology investment. That pairing already shows measurably better outcomes in this data. The ones still squeezing output without investing in tools are on a different trajectory, and it shows in their clinicians.
For clinicians
70% of your peers say documentation is where AI will matter most, but only 21% have tried it. The clinicians in this data who adopted AI documentation describe clearing one bar before they committed: The tool had to produce output they could have written themselves, in their discipline and their setting, on their most demanding note types. The ones who tried a tool and walked away attempted adoption without running that test first.
Action
Write down your three highest-stakes documentation types and ask the vendor for sample output on each. That is the evaluation this data points to.
For owners
The practices in this data that paired higher productivity expectations with documentation investment saw a 42-point better burnout outcome than the ones that did only one.
Action
Pull your documentation time data and your productivity targets for the past 90 days side by side. If productivity went up and after-hours documentation also went up, that is your business case for documentation tooling.
Burnout in rehab therapy isn't a crisis that arrived recently. It's the profession's baseline, something clinicians are managing every day, across every discipline, at every career stage.
For this research, burnout means emotional exhaustion, physical fatigue, and the feeling of not being able to keep up. Not a bad week. A persistent state.
86% of clinicians experience it at some frequency. 37% experience it daily or several times a week. After a full year of individual and organizational interventions, the needle has barely moved.
This section looks at what's driving it, which interventions are actually working, and what the data says about who's most at risk of leaving. It also captures something the headline number alone doesn't: even at the highest burnout levels, clinicians can still tell you, quickly and specifically, exactly why this work matters to them.
"The paperwork and length of time it takes to complete honestly takes away from my ability to be fully present for my session, at times, as I try to do point of service documentation so I can spend time with my family when at home."
Kaity Hopkins, OTR/L
Burnout
86% of respondents experience burnout at some frequency. For 37%, it happens daily or several times a week, a persistent state rather than episodic. For another 21%, it happens about once a week. The language of "burnout" can flatten these distinctions in ways that matter practically.
A clinician experiencing burnout several times a week is in a fundamentally different position from one who experiences it a few times a month, and the interventions that reach one group may not reach the other.
37%
Persistent
Daily or several times a week
21%
Frequent
About once a week
28%
Occasional
A few times a month
14%
No burnout
Rarely or never
How often do you currently experience burnout, including emotional exhaustion, physical fatigue, or feeling unable to sustain your workload? Single response. N=421. Response options collapsed into four tiers.
The burnout rate does not differ meaningfully by discipline. PT, OT, and SLP show similar burnout frequency and job change risk.
This is a story of documentation load, reimbursement pressure, and productivity expectations: conditions that operate the same way regardless of what letters follow a clinician's name.
What makes the burnout picture particularly concerning isn't the rate itself. It's the trajectory. When respondents were asked how their burnout had changed over the past 12 months, the answer was essentially: it hasn't.
43% of respondents say their burnout trajectory is unchanged. 29% say it has worsened. Only 28% report improvement. The field has not failed to try. Clinicians are using flexibility strategies, adjusting schedules, and setting limits on caseloads. The problem is that those interventions are reaching the clinicians who need them least and underperforming for the ones who need them most. We'll show that directly when we get to the intervention data.
Burnout drivers
Understanding what is actually driving burnout matters, because the solutions for administrative and system issues look very different from those that address emotional or physical strain. And when clinicians in this survey describe what is burning them out, they aren't pointing to the hardest parts of clinical care. They're pointing to the system built around it.
Documentation burden is the number one burnout driver overall. 59% of respondents call it a major factor. Only 7% say it isn't a factor at all. Reimbursement pressure follows at 44%, and the emotional weight of the work ranks third at 39% — common but rarely the thing that's actually draining them.
What matters about documentation ranking first as a burnout driver isn't just its position. It's that documentation is something that can be changed. Emotional weight is inherent to the work; clinicians chose this profession knowing it would involve bearing witness to difficulty. But documentation is a system requirement, and system requirements can be redesigned.
That finding isn't isolated to this survey. ASHA's 2024 Schools Survey, which collected responses from more than 3,270 school-based SLPs, found that large volumes of paperwork ranked as the number one challenge across every single facility type. High workload and caseload size ranked second. Two different surveys, two different populations, the same answer at the top of the list.
The biggest daily frustrations:
“The time required outside of work to complete documentation, as well as insurance declining services to children in need.”Ashley Ann Williams, OTR/L
“Productivity expectations and the lack of resources necessary to complete my job effectively each day, especially the availability of laptops in order to complete documentation and access medical records.”
Katherine Arthur, MA, CCC-SLP
Productivity quotas rank as a major burnout driver for 30% of respondents. That number is a direct downstream signal from Section 1: 40% of practices chose raising productivity expectations as their primary operational response to reimbursement pressure. The most common practice-level response to financial pressure is the fourth-ranked clinician-level burnout driver. The next section measures exactly where that pressure lands.
Documentation burden
41% of respondents spend 8 or more hours per week on documentation and administrative work outside direct client care. Only 7% spend under 2 hours. The average is 6.9 hours per week, or 329 hours per year.
The career cost of documentation
At 6.9 hrs/week, that's 4.7 full-time work years lost to documentation over a 30-year career.
What you get back
That reality reframes the AI adoption conversation. With AI-assisted documentation capable of reducing paperwork by around 30%, the opportunity isn't just working faster — it's getting years of your career back.
But the average conceals how unevenly the load is distributed.
For practice owners, the documentation burden follows them home.
Practice owners carry significantly more documentation load than employed clinicians. 63% of owners spend 8 or more hours per week on documentation and admin outside direct care. Among employed clinicians, that figure is 32%.
Interventions
Clinicians aren’t sitting with burnout passively. They are actively trying to manage it by deploying a range of individual and organizational strategies, then tracking what’s working. When asked which single intervention had made the most meaningful difference in the past 12 months, they were specific.
19%
Flexible work arrangements — the single most effective burnout intervention named by clinicians. Schedule autonomy is not a perk. It is the primary mechanism by which this profession stays functional.
11%
“None of these have made a meaningful difference.” At extreme burnout, that figure rises to 17% — the highest “nothing helped” rate of any tier. Standard tools fail where the crisis is concentrated.
Flexible work arrangements lead at 19%. Schedule autonomy is the main thing keeping a meaningful share of the profession functional right now.
11% of all respondents selected “none of these have made a meaningful difference.” That number is significant on its own. But when you look specifically at clinicians experiencing extreme burnout, it rises to 17%, the highest of any burnout tier. The interventions most widely available are reaching clinicians with moderate burnout. For the people in the most difficult situations, they’re falling short.
On the single change that made the most difference:
“I am working less hours to spend more time with my children. It makes my work days more enjoyable and something I look forward to.”Sharin Lane, PT, DPT
On managing documentation load outside clinical hours:
“Blocking off scheduled time between clients allows me to tackle some of the administrative load during business hours, with less to bring back home with me at the end of the day.”Ashley Ann Williams, OTR/L
The interventions that actually move the needle at extreme burnout are structural: staffing additions, caseload limits, real documentation relief. Those take organizational resources and commitment. The lighter-touch accommodations, like flexible hours and schedule tweaks, are the ones most commonly available, and most likely to underperform for the people who need the most help.
There’s one finding in the intervention data that stands out. Among clinicians who have already adopted AI documentation tools, 29% say it was the single most meaningful change in reducing their burnout. That is the strongest result for any tool category in the dataset.
The clinicians who have adopted these tools also tend to be the ones who were carrying the heaviest documentation load to begin with. That is not a coincidence. It points to where the impact is strongest and who has the most to gain.
When clinicians projected what a thriving work life would look like in 12 months, work-life balance and boundaries was the top answer (17%), followed by AI and technology adoption (15%) and documentation burden reduction specifically (9%). Together those three themes account for 41% of responses. The ask isn’t complicated: finish the notes, get home on time, and have a tool that helps make that possible.
Physical therapists
No other discipline is facing this same combination of pressures: documentation burden (64% cite it as a major factor), reimbursement pressure (44%), and physical strain (28% — the highest of any discipline by a significant margin). PT clinicians are managing the same administrative workload as their peers, on top of physically demanding care.
Burnout is also the most stagnant in PT. Over half (53%) report no change in the past year, while just 23% report improvement, the lowest of any discipline.
Occupational therapists
65% rate documentation as a major burnout driver, the highest of any discipline.
And yet, OT shows the lowest job change risk by a wide margin. Something is buffering the link between burnout and attrition — whether that’s greater autonomy, different caseload structures, or practice settings. The data points to a real difference, even if the “why” isn’t fully captured here.
Speech language pathologists
16% of SLP respondents describe themselves as very optimistic about the profession’s future, the highest of any discipline. SLPs share the same structural pressures as everyone else. But the SLP profession has a strong collective voice through ASHA, something that may be reinforcing both optimism and momentum.
SLPs also have the largest planned AI adoption pipeline: 35% plan to adopt documentation tools in the next 12 months — likely because anyone writing IEPs, evaluation reports, and prior auth justifications at scale knows exactly what documentation relief would mean for their day.
Workforce risk
27% of respondents are at risk of a major work change in the next 12 months: likely to leave their role, change professions, shift settings, or significantly reduce their workload. Of those with extreme burnout, that number climbs to 44%. Burnout severity is the single best predictor of exit intent in this dataset — stronger than role, career stage, or financial position.
One in four clinicians is actively considering a major work change in the next 12 months
The highest-risk profile in the data is a mid-career employed clinician experiencing extreme burnout. Burnout peaks in the mid-career stage, and employed clinicians are 11 points more likely to be at risk than practice owners, who often face greater barriers to leaving.
This group is under the most pressure: deeply burned out, likely thinking about leaving, and reporting that nothing has helped. And yet, when asked why their work matters, they respond with the same level of clarity and conviction as clinicians who aren’t burned out at all.
That’s the finding to hold on to. The profession isn’t losing its sense of purpose. It’s running out of time to fix the conditions before that purpose is worn down.
“I never doubt for a moment that my work matters and that it makes a meaningful difference.”
We asked every clinician, regardless of burnout level, to share one moment from the past year that reminded them why this work matters. Several below are from clinicians experiencing burnout daily or several times a week.
“When a client said his first words and his Mom had never heard him speak before! Priceless!”
“A parent telling me I am appreciated and a big hug from the kid, who said, ‘thank you for helping me!’ as they graduated from high school.”
Extreme burnout respondent
“A 7 year old client in a wheelchair who could only communicate by crying until we started trialing a AAC device… He saw the power it had and now he is on his way to be able to share with others his hopes and dreams. This little friend has a lot to say.”
Extreme burnout respondent
“Listening to a mother tell me through tears that she could now take her son to the store because he no longer is aggressive or throws tantrums.”
“I had a 21 year old patient who was in a motorcycle accident and had a BKA. He arrived in a wheelchair. When he was finished with physical therapy he walked out of the clinic. That is what matters most to me — making a difference in someone’s life.”
Extreme burnout respondent
“When a client was kicked out of school because the school was unable to ‘meet his needs,’ I was reminded why children and families of those with disability need support and advocates working to build a better society where inclusion and equity are a reality.”
Extreme burnout respondent
“Seeing a non-verbal child see me enter the room and address me by name in a complete sentence and give me a big hug.”
“Seeing my short-term rehab client with esophageal cancer go from tube feeding only, and nothing by mouth, to successfully returning to an oral diet. The joy and hope that he and his wife expressed will always stay with me.”
Extreme burnout respondent
“I had the ability to help a man go from a wheelchair to walking again.”
“Any time I get someone standing when they have been bedbound for days to weeks, and they start to feel human again. It’s one of my favorite parts of the job.”
The quotes above are the evidence, and the fact that they came just as readily from clinicians experiencing burnout daily as from those who aren’t is the most important thing in this section. What’s at risk isn’t why this work matters. It’s the conditions that allow it to be practiced sustainably. Section 3 looks at whether the practices they work in are built to hold that up.
For clinicians
The 59% of clinicians in this data who named documentation as their major burnout driver were not asking for easier caseloads. They were asking for a different system. You can make that same ask.
Action
Track your after-hours documentation for two weeks and write down the total. That is what you bring to your owner or clinical director, not as a complaint but as a proof point (along with this data).
The ask behind it is specific: documentation that ends when your shift ends. That could mean protected time between sessions, a documentation tool that cuts note time in half, or both.
For owners
The clinicians at highest departure risk in this field are the ones finishing notes after they leave. You cannot motivate your way out of a workload problem.
Action
This week, ask every clinician on your team one question: how much of your documentation happens after hours? Ask it in your next team meeting, not through a survey. The answer tells you more about retention risk over the next 12 months than any exit interview will.
As mentioned above, if productivity expectations have gone up without documentation investment, that is the pairing this data flags as highest risk. Start a trial of one AI documentation tool before the next productivity conversation. See if the math changes.
The first two sections of this research documented the same problem from two different angles. Section 1 followed the money: how reimbursement pressure is reshaping what practices can offer, what they can invest in, and what clinicians are being asked to produce. Section 2 followed the clinician: how that pressure translates into documentation burden, burnout, and a workforce that’s tired in a way schedule changes alone can’t fix.
Section 3 is where those two threads converge. It’s about the practice as an institution: whether it’s financially stable, whether the people running it were ever prepared to run it, and whether the clinicians inside it can see a future worth staying for.
“For staff PTs, reducing the time needed for documentation would greatly reduce burnout. For owners, getting the right systems in place to get reimbursed quickly would reduce financial stress significantly.”
Sandra J Stuckey, PT, MA, PhD
Financial position
More than half of respondents with visibility into their practice’s financial position describe themselves as strained: under pressure, struggling, or in crisis. Only 7% describe their practice as thriving.
7%
Thriving
Growing, financially stable, and investing in the future
31%
Healthy
Stable and meeting goals, though not without challenges
45%
Strained
Under pressure, struggling, or in crisis
17%
Unsure
Rarely or never
How would you describe your practice’s current financial position? Single response. N=407. The 17% “unsure” group is almost entirely employed clinicians without access to financial information.
Which clients to take, whether to hire, whether to invest in technology or hold cash. 45% of all respondents fall into the financially strained group.
The 17% who selected “unsure” deserve their own moment. They show up three times in this data, each time in the same structural position. 23% of respondents have no visibility into how reimbursement pressure has affected their practice. 17% couldn’t describe their practice’s financial position at all. And here in Section 3, 17% couldn’t name a practice goal.
It’s largely the same group each time: employed clinicians who are cut off from the business information that shapes their working conditions. They aren’t necessarily in crisis. They just don’t have access to the context that would let them see one coming.
For those with visibility into their practice’s financial position, financial position drives every decision. Strained practices and stable ones are running two completely different playbooks.
Owners vs. employed clinicians
Owners are significantly more financially strained than employed clinicians. Among those with visibility into finances, 59% of owners report being under strain, compared to 39% of employed clinicians. That’s a 20-point gap, and it’s consistent across the metrics in this section.
Financially strained practices are focused on wringing more out of what they already have: collecting better, pushing harder in payer negotiations, pulling back on capacity. Stable ones are adding referrals, expanding services, investing in tools. Both responses are rational given where each group is starting, but they lead to different outcomes, and the gap grows over time.
Financial position is also the strongest predictor of optimism in this dataset. Among stable practices, 74% of respondents are optimistic about the profession’s future. Among financially strained practices, that drops to 48%. A 26-point gap.
Financial health isn’t just an operational metric in this profession. It’s a hope metric.
The 38% of practices that describe themselves as stable aren’t operating in a different industry. They’re making different choices. Three patterns separate them from the rest.
They’re building pipeline, not just protecting margin. 54% are actively growing referral relationships, compared to practices in survival mode focused on claim performance and payer renegotiation.
They’re investing in tools. Technology investment is their leading operational response to reimbursement pressure, not a deferred item.
They’re expanding, not contracting. 31% are adding new service lines, creating revenue diversity rather than narrowing toward what the payer mix currently supports.
The result: 74% of clinicians in stable practices are optimistic about the profession’s future. Among strained practices, that drops to 48%. Financial position isn’t just a business metric in this field. It determines whether the people doing the work still believe it’s worth doing.
Practice barriers
When respondents named the barriers between their practice and its goals, one came in well ahead of the rest.
57% call reimbursement a major barrier, 10 points ahead of rising costs and more than 20 ahead of everything else. This tracks directly with what Section 1 found: reimbursement pressure isn’t just background noise, it’s actively driving how practices operate.
Administrative burden ranks third at 34% major. That number undersells it. Add the 46% who call it a minor barrier, and 80% of respondents feel it in some form, broader than any other item on this list. Reimbursement is the problem. Administrative burden is the friction caused by it.
“Fitting in meaningful therapy sessions and documenting them according to Medicare Part B regulations is very time-consuming, regardless of how many shortcuts I attempt. As documentation requirements and regulations continue to grow, payment and reimbursement keep decreasing, making it difficult to attract employees for this work.”
Janice Buziak-Smith, SLP
Business preparedness
Graduate school teaches you clinical skills. It doesn’t teach you to negotiate a payer contract, manage receivables, or make staffing decisions under financial pressure. For the majority of people now running rehab therapy practices, the business curriculum arrived on the job, or not at all.
Only 5% of practice owners describe themselves as very well prepared for the business realities of the profession. That’s fewer than 1 in 20.
Among practice owners and clinicians with operational responsibilities, 59% describe themselves as underprepared or significantly underprepared. And that gap doesn’t close with time in the field. It widens.
Early-career practitioners report 27% underprepared. By mid-career, it’s 49%. Among veterans (clinicians with more than 20 years of experience) it reaches 59%. The profession gives people time to practice clinical skills. It doesn’t give them a path to develop business ones. The longer they’ve been running a practice, the more clearly they can see what they were never given.
Owners understand the business gap most personally
73% report being underprepared for business realities. For them, unpreparedness is managing payroll, handling payer contracts, and choosing technology without any formal training in any of it.
That dynamic shows up in the goals data too. Among owners, 73% describe themselves as underprepared for business realities, and yet 34% say their top career aspiration is growing their existing practice. These aren’t people who feel ready. They’re people who feel committed, which is a different thing entirely.
Goals and career direction
When respondents named the single most important goal for their practice over the next 12 months, the top answer was stabilizing financially at 17%. Close behind it, also at 17%, was a response that wasn’t a goal at all: no visibility into what the practice is working toward. 1 in 6 respondents couldn’t name a practice goal.
The 17% who couldn’t name a goal aren’t failures. They’re mostly employed clinicians without access to the strategic picture (the same group that showed up in the financial position data as “unsure”). They can’t name a goal because they don’t have visibility into one.
Among those who could name a goal, stabilizing financially and maintaining current performance together account for nearly a quarter of all responses. Growing revenue comes in at 12%, expanding services at 7%. There’s genuine forward momentum in this data, just not at the center of gravity.
What does show up at 10% is improving client outcomes. The clinical mission doesn’t disappear under financial strain. It just gets harder to lead with when the practice is trying to hold ground.
At the individual level, the picture looks different. When respondents described their own career direction, not the practice’s goals, but their own. Balance was the dominant answer.
“Something with documentation shifted and I could go home at the end of treating DONE with it all — and it fit into my 40-hour work week.”
“A balanced work and life style. Able to do what I love and not feel pressured.”
“My personal private practice is growing and I am able to quit my current large therapy clinic that puts financial gain over therapists and clients.”
“With less documentation demands, I have more time to study new research so I can facilitate better patient outcomes.”
Four different people describing the same thing in different terms: work that fits inside a life. Finishing notes before leaving. Time to keep learning and give better care. The form varies, but the ask is the same.
Physical therapists
Balance is the top career aspiration across the full sample at 27%. For PT it’s 18%, the lowest of the three disciplines. That’s not because PT clinicians don’t want balance. It’s because a significant share have moved past that toward something more pressing. 45% are at risk of a major work change in the next 12 months. 20% are looking to expand beyond clinical roles. 9% are considering a setting change, three times the overall rate.
PT is the discipline most actively searching for a different relationship with the profession.
Occupational therapists
Balance leads OT career direction at 33%, the highest of the three disciplines and six points above the overall figure. OT also has the lowest job change risk at 15%, 12 points below the full sample. Those two figures together describe a discipline that has largely found a way to stay in the work and move toward sustainability rather than exit.
Speech language pathologists
SLPs have the highest undecided rate of the three disciplines at 15%. Combined with the 25% prioritizing balance, 40% of SLPs are either recalibrating or unsure about their direction.
Some of that uncertainty reflects the settings many SLPs work in. School-based career paths are structured differently than outpatient PT or OT. Moving toward ownership or leadership often means leaving the setting entirely. For SLPs who want more control over their work, the options available look different and sometimes narrower.
Professional outlook
Nearly half the field is financially strained. And even more, 86% are burned out. 3 in 5 decision makers never felt properly prepared for the business side of the work. And yet 60% of respondents are optimistic about the profession’s future.
60% remain optimistic about the future of rehab therapy
Optimism by career stage
How would you describe your outlook on the future of rehab therapy as a profession? Single response. N=401.
The optimism is there, but it isn’t uniform. It tracks closely with financial position and career stage.
By career stage, optimism erodes early and stays down. Early-career respondents come in at 73%, with 20% very optimistic. By mid-career, combined optimism drops to 56% and the very optimistic share falls to 7%.
Veterans land at 57%, a slight recovery from mid-career but nowhere near where the profession starts. Once the structural pressures of the work set in, the initial optimism of entering the field doesn’t fully come back.
The sharper warning here isn’t attrition. It’s that optimism erodes fastest in the first six years and never recovers. The profession is losing belief before it loses people. The 22% who are uncertain aren’t gone yet. What they’re waiting for is evidence that the conditions can change.
The optimism gap between owners and employed clinicians is 17 points:
48% of owners are optimistic, compared to 65% of employed clinicians. Owners are carrying more strain, more unpreparedness, and a narrower margin between effort and reward. Their lower optimism reflects their actual conditions.
“I believe in the power of rehab therapy to transform people’s lives. The challenges are real, but so is the potential. We need better systems and support — and I think that’s coming.”
The picture that emerges from Section 3 is one of a profession being asked to do more with less, for longer. Financial strain isn’t temporary for half the field, but is the day-to-day reality. And the people running practices often weren’t given the tools to run them.
But the data doesn’t show a profession that’s given up. The owners who are most strained, least prepared, and least optimistic are still choosing to grow. The clinicians exhausted by documentation can still clearly describe what a better year would look like. The 60% who are optimistic aren’t naïve. They understand the cost of the work and still believe in it.
For clinicians
The practices where clinicians describe the best outcomes in this data have three things in common: documentation that fits inside the workday, a financial picture that is visible to the clinical team, and at least one operational function that runs without someone holding it together after hours. You cannot force your practice to become that. But you can tell the difference between a practice moving in that direction and one that is not.
Action
In a review, in an interview, or in a conversation with your clinical director, ask about those three things directly, and use them to inform your next career decisions.
For owners
The gap between stable and strained practices is not about effort. It is about whether the practice is building toward something or defending what it has. Both are rational responses to where things are right now. Only one changes where you are a year from now. The practices that shifted started by getting one thing off their plate that was costing them time without earning it back.
Action
Name the one business function you are currently handling manually that does not need a human decision every time it runs. That is where the tool goes.
Raising productivity expectations without investing in documentation technology puts practices at measurable risk. Piloting one AI documentation tool before the next productivity conversation is a low-cost way to test whether the math changes. The cost-per-hour model in this report gives you a baseline to measure against.
You came into this research living some version of these numbers. The documentation hours, the reimbursement pressure, the business side nobody trained you for. You did not need a survey to confirm any of that. What the data does is name it, scale it, and put other people's voices next to yours so you can see it in context.
What the data also makes clear is that the people in this field know why they are in it. 60% of the clinicians in this survey are still optimistic about where the profession goes. Owners who are stretched and underprepared are still choosing to grow. The clinicians describing the hardest seasons in this data can still name, in one sentence, why they stay. That is not denial. That is a profession that has not lost sight of what it is for.
The practices getting there are not running on exceptional talent or exceptional circumstances. They reduced documentation time. They got clear on their financial position. They stopped managing at least one business function by hand. The data shows what changed when they did. What you build from here is yours.
About this research
The Future of Rehab Therapy Survey was conducted by Ensora Health to capture expert perspectives on the clinical practice and business of rehab therapy in the United States. The focus was on current beliefs about the state of rehab therapy care and how it will change over the next 12 months.
The survey consisted of 29 primary questions. Three screener questions were used at the start to ensure respondent eligibility. Qualified respondents were required to be currently practicing PT, OT, or SLP professionals; clinicians qualifying for the survey provide direct care or provide practice leadership with clinical oversight responsibilities.
Fielding was conducted online between March 18 and April 6, 2026. The survey included both Ensora Health customers and non-customers. Customers were invited directly through Ensora Health channels (e.g., via email and links placed in Ensora Health software), while non-customers were recruited via professional panels and verified by their clinical credentials.
To encourage participation, Ensora Health offered incentives based on respondent type:
A total of 504 qualified responses were collected and form the basis for all results in this report. Sample quality was assured through respondent screening, attention checks, and response quality checks across answers.
Unless otherwise noted, percentages are based on the full qualified sample. For multi-select and matrix questions, denominators are standardized across each block, with totals exceeding 100% where respondents could choose more than one option. Open-ended responses were coded thematically, with illustrative verbatim quotes included in the narrative.
The questionnaire covered three sections shaping the current state and near-term future of rehab therapy:
The evolution of rehab care
Reimbursement pressure, technology and AI adoption, care model shifts, and practice-level strategies for the next 12 months.
Clinician workload and burnout
Burnout prevalence and frequency, key drivers, documentation burden, and the estimated time and career cost of documentation inefficiency.
Achieving practice success
Financial position, business preparedness, practice goals, professional outlook, and what sustainable success looks like for clinicians and owners alike.
The survey used a variety of question formats including single-response, multiple-response, Likert scales, matrices, and open-ended questions.
Results were analyzed at both topline and segmented levels. Segmentation was based on professional role, discipline, career stage, practice size, burnout level, job change risk, financial position, and client population.
Percentages below may not sum to 100% due to rounding, in the case of multiple response questions, or otherwise as specified.
Professional status
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| Practicing PT, OT, or SLP (employed clinician) | 73% |
| Practicing PT, OT, or SLP who also owns or leads a practice | 27% |
Professional credential / clinical role
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| Speech-language pathologist (SLP, CCC-SLP, MS-SLP) | 39% |
| Occupational therapist (OT, OTR/L) | 34% |
| Physical therapist (PT, DPT) | 15% |
| Occupational therapy assistant (COTA, OTA) | 4% |
| Speech-language pathology assistant (SLPA) | 3% |
| Physical therapist assistant (PTA) | 2% |
| SLP clinical fellow (CF-SLP) | 1% |
| Other rehab therapy clinician or leader | 1% |
Years in practice
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| Less than 2 years | 8% |
| 2 to 5 years | 17% |
| 6 to 10 years | 24% |
| 11 to 20 years | 24% |
| More than 20 years | 26% |
Primary client population
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| Pediatric clients (under 18) | 77% |
| Mixed (both adults and pediatric) | 14% |
| Adult clients (18 and older) | 9% |
Practice size (number of clinicians)
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| 1 (Solo practitioner) | 8% |
| 2 to 3 | 10% |
| 4 to 10 | 36% |
| 11 to 19 | 26% |
| 20 or more | 21% |
Payer mix
Base: All qualified respondents (n=504). Multiple response.
| Response | Percent of respondents |
|---|---|
| Private insurance (commercial plans) | 76% |
| Medicaid or other public insurance | 67% |
| Client self-pay (cash pay, no insurance) | 39% |
| Medicare | 23% |
| School-based or IDEA funding | 18% |
| Workers' compensation | 5% |
| Not sure | 3% |
Age
Base: All qualified respondents (n=504). Single response.
| Response | Percent of respondents |
|---|---|
| Under 25 | 4% |
| 25 to 29 | 17% |
| 30 to 34 | 21% |
| 35 to 39 | 14% |
| 40 to 44 | 14% |
| 45 to 49 | 10% |
| 50 to 54 | 10% |
| 55 to 59 | 5% |
| 60 to 64 | 2% |
| 65 or older | 2% |
| Prefer not to answer | 1% |
Acknowledgments
Project sponsor
Lynn Carroll
Report authors
Nadésia Douté Lead writer
Dave Okenquist Lead researcher
Design and development
Ryan Harvey Lead designer
Pam Steffen
Jason Todrick Lead developer
Narges Navidi
Distribution
Julie Sommer
Brooke Schuster
Marissa Coughlin
Executive leadership
John Damgaard
Kevin McKenzie
Kevin Smith
Kimberly Sisnett
Kristen Aleksa
T Le
Bryon Thomas
Gary Peterson
Media contact: Stephanie Wright — stephanie.wright@ensorahealth.com
If you are a rehab therapy organization, journalist, or conference organizer and are interested in a briefing on the report from one of our team members, please inquire at: stephanie.wright@ensorahealth.com
If you are a PT, OT, or SLP therapist or practice leader and are interested in more insights, please subscribe to our newsletter where we can keep you updated on emerging insights and research findings: https://ensorahealth.com/newsletter/
