Clay Pots

In defense of my profession...

Photo by John Mukiibi Elijah on Unsplash

“I don’t understand. What does my head position have to do with my breathing?” a new patient of mine asked me this week during the evaluation.

“Let me show you,” I replied, reaching for the model of the human skull. My patience for this patient was fraying more with each minute. They started our time together with “I don’t know why I am here” and that “exercises never work.” They slumped in the chair like a sullen teenager, with arms crossed, side eyes, and eye rolls. I voiced assurance that at the end of the evaluation, if I didn’t think I could help, I would say so. I wasn’t there to waste anybody’s time and/or money.

“Here is a cross-section of the head and neck,” I said. “Here is the trachea, or windpipe. Here is your soft…”

“Wait,” they said. “That’s not my windpipe, this is.” Their index finger ran up and down the cervical spine. “Or, no, it’s that,” pointing to the esophagus.

I take a long breath in and let it out slowly. I point at the spine, “This is the spine, and this is the esophagus. And this is the trachea.”

“Well, what do I know?” they asked, slumping back in the chair, with an impressive arm cross/eye roll combo.

I took another deep breath, continued my evaluation, and explained why I think myofuncitonal therapy would indeed help their breathing and sleep problems.

“We have a lot to work with,” I said.

They still weren’t convinced, and at this point in my career, I have stopped trying to get people to engage in their own well-being and care. It rarely works. I open a door, and if patients walk through it, I am all in. If they decide to remain outside of the threshold, I no longer step outside and push them through. It is part of what has allowed me to last as long as I have.

As a Physical Therapist for over 30 years, my education, skill set, knowledge base, intelligence, treatment outcomes, methods, modalities, documentation, rationale, and ability to differentiate between anatomical landmarks have been called into question on the regular. I have been required to defend my decisions at every turn. Hospital administration, insurance companies, and patients have challenged my capabilities. The Center for Medicare and Medicaid Services, the federal agency that administers government-run insurance programs, creates rules and regulations that determine how much we get paid and how we can treat. We are told what ICD-10 diagnostic codes go with what CPT, or treatment, codes, and when our documentation doesn’t reflect those arbitrary rules, they take money back. We are told, as clinicians, how much we need to “produce” every day. Every minute of our workday needs to be accounted for.

Yet, we all continue to show up because there are those moments when a patient gains function after a stroke, a brain tumor resection, back surgery, a unilateral vestibular hypofunction, or even a run-of-the-mill total knee arthroplasty, when they are restored to themselves. They are moving and engaged in life, and free from pain, and we guided them once they crossed that threshold. Even after thirty years, there is nothing like it. It is sublime.

Last week, the Department of Education, as part of the Big Beautiful Bill, stated that as of July 2026, a degree in Physical Therapy is not a professional degree. We are in good company. Teachers, Social Workers, and Physician Assistants are also on the list. There are others as well. I am not sure how a Theologian is more professional than an Architect or a Nurse Practitioner or me, for that matter. But hey, if quoting St. Augustine helps build a bridge or manage diabetes or recover from Benign Paroxysmal Positional Vertigo, have at it.

Because of that designation, the amount of Federal Student Loans available to pursue one of these degrees has reduced dramatically–from $50,000/year to roughly $20,000. It is not enough to get someone through their three-year Doctor of Physical Therapy degree. It creates an insurmountable barrier for many who want to pursue one of these careers.

There is no reason for this, except for its blatant sexism, racism, and classism. Another manifestation of Project 2025. This designation, disrespect aside, will put untold and undue stress on Sisyphean systems. Our nation faces shortages of Nurses, Teachers, and Physical and Occupational Therapists already. Denying access to people who want to go into these professions will have catastrophic consequences downstream. Nursing shortages lead to poorer patient outcomes. Physical and Occupational Therapist shortages mean people don’t reach their functional potential. Fewer Social Workers mean people don’t get access to the services that can keep them healthy and safe. And those things matter. They matter to me. They matter to my colleagues. They matter to society, regardless of what the Secretary of Education, who confuses steak sauce with the ability of a computer to simulate human intelligence, says.

There is a story in the Chhandogya Upanishad about clay pots. It is a story told by a father, Udallaka, to his son, Shwetaketu. Shwetaketu has just returned from twelve years of study and is feeling flush with knowledge. Kind of like me, after my first year of PT school. I knew some stuff, and I had no idea what I didn’t know. Udallaka is trying to impart to his son the unity of all things and the unchanging nature that is within all of us. If we know clay, the story goes, then we know all the things made from clay–bowls, pots, etc. The different forms may change. The names of the objects can change. But the essence of the clay does not.

This is how I feel about my fellow PTs, my colleagues, and me.

We are the clay.

People come to us in pain. They come to us at their worst, their most vulnerable, when they are scared and uncertain. We meet them where they are and help them move to another place. One with less pain, more mobility, more certainty, more agency.

We Physical Therapists, and everyone else on that list, are human. Our jobs require us to show up for others physically, emotionally, intellectually, and psychologically while navigating our own messy lives. I have seen colleagues, and have done it myself, show up to work while relationships are falling apart due to illness, betrayal, divorce, and addiction. Colleagues have cried on each other’s shoulders before work and at lunch, wiped their tears, put on their big girl panties, and treated their patients with such respect and kindness and clinical excellence that it made my jaw drop and heart open.

I think about my former colleague Michelle, who delivered her expert care with such authenticity, respect, and sweetness that for the fifty-five minutes Parkinson’s patients spent with her, they could forget that they were suffering from a progressive neurological condition that robbed them of their previous life. Michelle made them feel whole and capable, with her Dolly Parton-esque East Tennessee accent and pouf of blonde hair. Her treatment sessions were a combination of excellent, evidence-based care and Appalachian hospitality. People left feeling seen, heard, held, and loved. Michelle is a walking Master Class in providing world-class care.

I am forever grateful to my daughter’s American History teacher and cross-country coach, who saw her brilliance and capability where others didn’t, because it wasn’t obvious and typical. Coach Osborne’s astute observations, care, and willingness to be honest created a new path for my daughter. It was this teacher’s professionalism that set my daughter on a positive, life-altering direction.

If I started regaling the thousands of ways my current colleagues show up for their patients, this piece would go off the rails. Too many stories and anecdotes to recount of how they do their job with respect, patience, skill, humor, and kindness, helping people suffer less with dignity. They make me proud of my job and of my profession.

The Department of Education can remove the designation of professional from my degree, but not from who I am and who my colleagues are and who the countless other individuals who have dedicated their lives and careers to the jobs on that list are. It is our essence. The name and designation are the forms, but not the clay. A change of designation won’t alter who we are. It will not change how we move through the world and how we show up for work.

However, it will alter where we decide to work and who decides to go into these professions. These crucial careers may be filled with people who do not demonstrate the same level of care, respect, kindness, dedication, and skill as those who currently fill those positions. Unless we let our voices be heard and vote accordingly, there may come a time when Physical Therapists can’t distinguish the trachea from the spinal cord. We can’t let that happen.