year Archives - Health Mettler Institute

March 27, 2023

How Online Learning Can Increase Your Salary By Thousands Per Year

Your education doesn’t have to stop once you graduate college. Brushing up on in-demand hard skills like data analytics and programming languages, or soft skills like leadership and communication, can help you bring valuable knowledge to your workplace and get a leg up in your career.

However, if you want to take the first step in learning a new skill, economic uncertainty can make it hard to commit to investing in your education. Due to the state of the economy, including factors like inflation, rising interest rates and recession fears, 10 percent of people have delayed furthering their education, according to Bankrate.

Luckily, upskilling doesn’t always require a costly graduate degree. Higher education is a meaningful way to boost your career and personal development, but many online courses offer certifications and teach new skills for free. By taking advantage of online courses, you can affordably learn valuable, career-boosting skills that may open opportunities for your future.

Key online learning statistics

Higher education is worth the cost for many. 59{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of student loan borrowers who graduated say higher education improved their career opportunities and/or earning potential. (Bankrate)
Skill development is expected by nearly all employers. In 2020, 94{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of business leaders reported that by 2024, they expect employees to pick up new skills on the job. (World Economic Forum)
Skill development can result in a significant income increase. U.S. workers gained an additional 8.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in annual income, or an average of $8,000, after participating in upskilling programs, as of June 2021. Those who pay for their own skill development are at an advantage: 15.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of workers who paid for their own skill development received a salary increase, while 5.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of workers whose skill development was paid by their employer received a salary increase. (Gallup)
Computer science employees are hungry to learn. 72{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of workers in computer and mathematical fields say they’re interested in training or education to upgrade their skills, or in learning new skills, the most of any industry. (Gallup)
Skill development isn’t just for entry-level workers. 65{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of those in managerial roles are interested in training or education to upgrade their skills or learn new skills. (Gallup)

Online courses and skill-building are growing in popularity

Upskilling, or learning new skills for career development, is highly sought after by workers. As of 2021, 52 percent of American workers surveyed by Gallup said they had participated in an upskilling program in the past 12 months.

Workers whose jobs or income were affected by COVID-19 were even more likely to be interested in upskilling: 63 percent said they were “extremely” or “very” interested, according to Gallup, compared to 42 percent of those not impacted who said the same.

Generally, online learning on sites such as Coursera have exploded since COVID-19 and the subsequent increase in remote work. The number of students registered for Coursera online classes rose to 71 million in 2020, up from 44 million in 2019, according to the World Economic Forum. As of 2021, 92 million learners are registered for classes on Coursera, a trend that the World Economic Forum says reflects the global acceptance of online teaching.

If you’re looking for a way to gain new skills without your employer footing the bill, paid certifications can offer personalized training and career coaching. Luckily, the same subjects are often taught in free classes you can take on your own time. Here are a few examples:

When looking for ways to open career opportunities, a college degree is still a valuable tool, and it may be worth the investment. However, the cost burden means some students wish they had sought other ways of paying for education, according to a Bankrate survey:

Source: Bankrate

The average undergraduate student loan borrower has $37,787 in student loan debt, according to Bankrate. Still, nearly one-third (31 percent) of student loan borrowers wouldn’t have changed their college decisions, even though they borrowed student loans. Some students, however, wish they would have made other financial choices in light of their student loan debt.

The second-largest percentage of borrowers (23 percent) wish they’d applied for more scholarships than they did, while 20 percent wish they had worked more while in school. Nearly 1 in 5 (17 percent) wish they’d attended a cheaper school.

How upskilling can boost your salary

Workers who take an upskilling program earn on average $8,000 more than their peers who did not, about an 8.6 percent increase, according to Gallup. Self-funded upskilling tends to result in even higher results: Those who funded their own development received an average salary increase of 15.3 percent. Those who received training from their employer received a 5.2 percent increase.

In addition, 64 percent of workers surveyed by Gallup who recently completed skill development courses say it had a positive impact on their standard of living. Three-fourths (75 percent) of those who have participated in skill development report some kind of career advancement. Most commonly, 39 percent of people reported they advanced at their current job.

High earners are also likely to seek skill development, according to Gallup: 73 percent of those making $120,000 a year or more say upskilling is important to them. These high-demand fields are largely in technology, and tech skills dominate the top hard skills that employers are looking for. The tech industry is facing layoffs and lost 25,000 jobs in February 2023, according to the Bureau of Labor Statistics. But the industry has still been growing in recent years, according to Robert Half’s 2023 salary guide, which stated that job vacancies outpace the number of available candidates. In turn, that drives up salaries. There’s a need for more skilled workers: 88 percent of tech employers say it’s challenging to find skilled technology professionals.

Robert Half’s data shows tech workers’ salaries can grow as much as 69 percent as they gain more knowledge and experience:

Role	25th percentile of salaries	50th percentile of salaries	75th percentile of salaries
Data analyst	$90,500	$110,250	$130,500
Software engineer	$106,500	$127,000	$149,000
Web developer	$89,250	$113,000	$132,750
Network security administrator	$103,750	$123,500	$147,250
DevOps engineer	$108,250	$133,730	$157,500

Source: Robert Half

Note: Those in the 25th percentile of salaries tend to have the least experience, and income rises as workers gain experience and are promoted, according to Robert Half.

Jobs in data, programming and cybersecurity have introductory salaries of around $89,250 to $108,250. Those salaries can grow as high as around $157,500 when workers gain more experience and knowledge of their field. The need to hire the best workers before they can be hired elsewhere means 58 percent of tech managers add starting salary premiums of 5 percent to 10 percent for in-demand jobs to make sure they hire the best talent before the competition does.

6 in-demand hard and soft skills you can learn at a low cost

The top hard skills sought by employers, as determined by LinkedIn research of its users, are largely software development and data management skills. To meet that demand, entry-level courses on these skills are widely available:

1. SQL. SQL, or structured query language, is a programming language used to analyze data. As businesses seek more information to make better decisions, data analytics and business analytics jobs are becoming more popular. Free SQL courses usually teach the basics of using a database or beginner’s SQL. The average U.S. salary for a business analyst is roughly $78,000 per year, according to Indeed.

2. Finance. Learning basic finance and bookkeeping isn’t just for accounting majors. A free course won’t give you a certified public accountant license, but you can learn more about accounting and personal finance. Free courses can also teach you how to understand tricky financial concepts like reading corporate financial statements. The average U.S. salary for a financial analyst is roughly $72,000 per year, according to Indeed.

3. Python. Python is a common first programming language for those looking to learn how to code, and it can be used in developing websites or data visualization, among other purposes. You can jump into learning Python through a free course, but check out more advanced courses if you already have some programming knowledge and you want to develop your skills. The average U.S. salary for a programmer is roughly $58,000 per year, according to Indeed.

LinkedIn also lists management, communication, customer service, leadership and sales as the top soft skills requested by employers. The following skills are valuable in almost any field:

1. Management. If you’re looking to move into a management-heavy role, you may need tips on managing people or projects for the first time. Most fields need managers, but the average U.S. salary for a business manager, including profit sharing and other additional pay, is roughly $73,000 per year, according to Indeed.

2. Communication. Communication skills aren’t just for public relations. Better communication can help you negotiate, build better relationships and be a thoughtful listener and messenger for your team. Communication is a valuable skill whenever you work with others, but the average salary for a communications-heavy role, such as a human resources specialist, is roughly $58,000, according to Indeed.

3. Sales. Online sales training can help employees learn to negotiate or provide certification in popular software like Salesforce. The average U.S. salary, with additional pay such as commission, for sales representatives is roughly $68,000, according to Indeed.

3 inexpensive ways to learn career skills

If you’re ready to take the next step and learn something new for your career, or just for fun, finding the right method can help you get the knowledge you need without spending too much money.

1. Take a free online class. If you want to learn something, the internet probably has the answer. You can learn beginner or advanced coding languages on Codeacademy or learn personal development skills —such as conflict resolution— on Alison. Many Ivy League universities also offer massive open online courses, which are free or low-cost courses on everything from history and art to programming and sciences. Consider a class on the biology of sharks from Cornell University or on intellectual property law from the University of Pennsylvania.

2. Sign up for subscriptions. If you know you’re interested in multiple courses and want to make a small investment in your learning, consider a subscription service to take multiple classes for a monthly fee. Most companies, such as LinkedIn Learning ($39.99 monthly) and Coursera Plus ($59 monthly), allow you to start with a free trial so you can see if the programs offered are right for you.

3. Go local. If online learning isn’t your style, many local libraries offer free classes on financial literacy, foreign languages and other subjects. For those who need more practical classes, libraries often offer free classes on how to use a computer, English as a second language or preparation for the U.S. naturalization test. Also, consider joining a local learning group on Meetup or joining a local professional organization for development opportunities. Organizations like Toastmasters also teach soft skills like leadership through local chapters nationwide.

Bankrate.com commissioned YouGov Plc to conduct the survey on financial milestones. All figures, unless otherwise stated, are from YouGov Plc. The total sample size was 2,442 adults. Fieldwork was undertaken between October 19-21, 2022. The survey was carried out online and meets rigorous quality standards. It employed a nonprobability-based sample using quotas upfront during collection and then a weighting scheme on the back end designed and proven to provide nationally representative results.

Bankrate.com commissioned YouGov Plc to conduct the survey on student loan debt. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 3,939 adults, among whom 1,442 have, or had, student loan debt for their own education. Fieldwork was undertaken on March 29 – April 1, 2022. The survey was carried out online and meets rigorous quality standards. It employed a non-probability-based sample using both quotas upfront during collection and then a weighting scheme on the back end designed and proven to provide nationally representative results.

February 27, 2023

U.S. Physical Therapy Reports Fourth Quarter and Full Year 2022 Results

Patient Volume Remains Strong

Company Provides 2023 Guidance and Raises Dividend

HOUSTON, February 23, 2023–(BUSINESS WIRE)–U.S. Physical Therapy, Inc. (“USPH” or the “Company”) (NYSE: USPH), a national operator of outpatient physical therapy clinics and provider of industrial injury prevention (“IIP”) services, today reported results for the three months and year ended December 31, 2022 (“2022 Fourth Quarter” and “2022 Year”, respectively).

FULL YEAR AND QUARTER HIGHLIGHTS
**The Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.

Adjusted EBITDA, a non-GAAP measure, was $17.9 million for the 2022 Fourth Quarter, an increase of $0.5 million, or 2.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, from $17.4 million, excluding Relief Funds, for the three months ended December 31, 2021 (“2021 Fourth Quarter”). See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedules on pages 16 and 17.
Adjusted EBITDA was $73.7 million for the 2022 Year, a decrease of $0.1 million, or 0.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, from $73.8 million, excluding Relief Funds, for the year ended December 31, 2021 (“2021 Year”).
For the 2022 Fourth Quarter, USPH’s net income attributable to its shareholders, a GAAP measure, was $2.6 million as compared to $10.2 million for the 2021 Fourth Quarter. The 2022 Fourth Quarter included a goodwill impairment charge, further described below, of $4.8 million, net of taxes and allocation to non-controlling interest. For GAAP purposes, a charge for the revaluation of redeemable non-controlling interest, net of taxes, is included in the computation of earnings or loss per diluted share. Loss per diluted share on a GAAP basis, net of taxes, was $0.01 for the 2022 Fourth Quarter as compared to earnings per share of $0.73 for the 2021 Fourth Quarter.
For the 2022 Year, USPH’s net income attributable to its shareholders, a GAAP measure, was $32.2 million as compared to $40.8 million for the 2021 Year. Earnings per diluted share, which includes a charge for revaluation of redeemable non-controlling interest, was $2.25 for the 2022 Year, as compared to $2.41 for the 2021 Year.
Operating Results, a non-GAAP measure, was $0.58 per diluted share for the 2022 Fourth Quarter compared to $0.72 per diluted share, excluding Relief Funds (defined under “Impact of COVID-19/Relief Funds” below), for the 2021 Fourth Quarter. See definition, explanation and calculation of Operating Results, a non-GAAP measure, in the schedules on pages 16 and 17.
Operating Results was $2.70 per diluted share for the 2022 Year. For the 2021 Year, Operating Results, excluding Relief Funds, was $3.17 per diluted share.
Average visits per clinic per day were 29.1 for the 2022 Fourth Quarter and 28.7 for the 2022 Year, the second highest average visits per day for each period in the Company’s history, surpassed only by 29.8 average visits per day in the Fourth Quarter 2021 and 29.1 in the 2021 Year.
Net patient revenue from physical therapy operations was $120.1 million for the 2022 Fourth Quarter, an increase of 5.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $113.5 million for the 2021 Fourth Quarter. Net patient revenue from physical therapy operations was $464.6 million for the 2022 Year, an increase of 6.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $438.3 million for the 2021 Year.
For the 2022 Fourth Quarter, total patient visits were 1,152,139, an increase of 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from 1,096,389 for the 2021 Fourth Quarter. For the 2022 Year, total patient visits were 4,483,282, an increase of 6.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from 4,219,576 for the 2021 Year.
The net rate per patient visit was $104.28 in the 2022 Fourth Quarter, a $0.75 per visit increase from $103.53 in the 2021 Fourth Quarter. For the 2022 Year, the net rate per patient visit was $103.63 as compared $103.88 in the 2021 Year. The net rate per patient visit increased throughout 2022, from $103.00 in the first quarter of 2022 to $103.18 in the second quarter, $104.01 in the third quarter and $104.28 in the fourth quarter.
Physical therapy total operating costs were $84.05 per visit in the 2022 Fourth Quarter, a decrease of 1.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $85.14 in the third quarter of 2022, and an increase of 2.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $82.30 per visit in the Fourth Quarter 2021. Physical therapy salaries and related costs were $60.04 per visit in the Fourth Quarter 2022, a decrease of 1.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $60.99 in the third quarter of 2022, and an increase of 1.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $59.20 in the Fourth Quarter 2021.
For the 2022 Year, physical therapy total operating costs were $83.34 per visit, an increase of 4.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from $79.71 for the 2021 Year. Total salaries and related costs were $59.52 per visit, an increase of 4.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $57.20 for the 2021 Year.
IIP services revenue increased 37.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to $18.4 million in the 2022 Fourth Quarter as compared to $13.4 million in the 2021 Fourth Quarter. For the full year, IIP services revenue increased 75.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to $77.1 million in the 2022 Year as compared to $43.9 million for the 2021 Year. Excluding the Company’s IIP Acquisition in November 2021 (“IIP Acquisition”), IIP services revenue increased 9.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the 2022 Fourth Quarter and 20.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the 2022 Full Year as compared to the same periods in 2021.
The Company completed two acquisitions in the 2022 Fourth Quarter, resulting in five total acquisitions in the 2022 Year. On October 31, 2022, the Company acquired 60{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the equity interest in a fourteen-clinic physical therapy practice with approximately $9.2 million in annual revenue and approximately 84,000 patient visits per year. On November 30, 2022, the Company acquired 80{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the equity interest in a thirteen-clinic physical therapy practice with approximately $12.0 million in annual revenue and approximately 120,000 patient visits per year.
The Company’s Board of Directors raised the Company’s quarterly dividend from $0.41 per share to $0.43 per share, an increase of 4.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, effectively immediately, and declared a quarterly dividend for the first quarter of 2023 at the higher rate.
Management currently expects the Company’s Adjusted EBITDA for 2023 to be in the range of $75.0 million to $80.0 million. The guidance represents projected Adjusted EBITDA from existing operations and excludes future acquisitions. See “Management Provides 2023 Guidance” below for more information.

Management’s Comments

Chris Reading, Chief Executive Officer, said, “I am proud of the work by our partners, clinicians, and leadership team despite significant macroeconomic headwinds present in the second half of 2022. We are making good progress around contract renegotiations, development has been strong, and staffing has begun to improve. Volumes to start the new year have been ahead of our initial expectations. Our team will continue to work on all these important items as we go forward in 2023.”

Carey Hendrickson, Chief Financial Officer, said, “We are pleased to raise our quarterly dividend rate once again in the first quarter of 2023, which we have raised each year since the inception of our dividend in 2011. While we again have some Medicare rate headwinds as we enter 2023, we have tremendous confidence in our team to produce EBITDA growth this year through increased volumes, continued momentum in rate renegotiations and an ongoing focus on making our operations as efficient as possible.”

Fourth Quarter 2022 As Compared to Fourth Quarter 2021
**As noted above, the Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.

Reported total revenue for the 2022 Fourth Quarter was $141.2 million, an increase of 8.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $129.8 million for the 2021 Fourth Quarter. See table below for a detail of reported total revenue (in thousands):

	Three Months Ended
	December 31, 2022		December 31, 2021
Revenue related to Mature Clinics	$	105,655	$	106,955
Revenue related to 2022 Clinic Additions		7,759		–
Revenue related to 2021 Clinic Additions		6,383		5,304
Revenue from clinics sold or closed in 2022		349		1,252
Net patient revenue from physical therapy operations		120,146		113,511
Other revenue		883		717
Revenue from physical therapy operations		121,029		114,228
Revenue from management contracts		1,761		2,242
Revenue from industrial injury prevention services		18,392		13,363
Total revenue	$	141,182	$	129,833

Revenue from physical therapy operations increased $6.8 million, or 6.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $121.0 million for the 2022 Fourth Quarter from $114.2 million for the 2021 Fourth Quarter. The average net patient revenue per visit was $104.28 for the 2022 Fourth Quarter as compared to $103.53 for the 2021 Fourth Quarter. Total patient visits increased 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 1,152,139 for the 2022 Fourth Quarter from 1,096,389 for the 2021 Fourth Quarter.

Net patient revenue related to clinics opened or acquired prior to 2021 and still in operation on December 31, 2022 (“Mature Clinics”) decreased slightly. Visits for Mature Clinics (same store) for the 2022 Fourth Quarter decreased by 2.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to the 2021 Fourth Quarter while net patient revenue per visit increased by 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} over the comparable period.

Total operating cost was $113.4 million for the 2022 Fourth Quarter, or 80.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, as compared to $102.7 million, or 79.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, for the 2021 Fourth Quarter. Operating cost related to Mature Clinics increased $0.3 million, or 0.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, for the 2022 Fourth Quarter as compared to the 2021 Fourth Quarter. Operating cost related to the IIP services business increased by $4.5 million for the 2022 Fourth Quarter as compared to the 2021 Fourth Quarter, of which $3.5 million related to the IIP Acquisition. See table below for a detail of operating cost (in thousands):

	Three Months Ended
	December 31, 2022		December 31, 2021
Operating cost related to Mature Clinics	$	84,846	$	84,539
Operating cost related to 2022 Clinic Additions		6,136		59
Operating cost related to 2021 Clinic Additions		5,399		4,437
Operating cost related to clinics sold or closed in 2022		455		1,191
Operating cost related to physical therapy operations		96,836		90,226
Operating cost related to management contracts		1,411		1,814
Operating cost related to industrial injury prevention services		15,104		10,610
Total operating cost	$	113,351	$	102,650

Total salaries and related costs, including all operations, were 58.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Fourth Quarter versus 58.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. Rent, supplies, contract labor and other costs as a percentage of total revenue were 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter versus 20.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The provision for credit losses as a percentage of total revenue was 1.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2022 Fourth Quarter and 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2021 Fourth Quarter.

Gross profit for the 2022 Fourth Quarter was $27.8 million as compared to $27.2 million for the 2021 Fourth Quarter. The gross profit percentage was 19.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Fourth Quarter as compared to 20.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage for the Company’s physical therapy operations was 20.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage on management contracts was 19.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 19.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The gross profit percentage for industrial injury prevention services was 17.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter as compared to 20.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. The table below details the gross profit (in thousands):

	Three Months Ended
	December 31, 2022		December 31, 2021

Physical therapy operations	$	24,193	$	24,002
Management contracts		350		428
Industrial injury prevention services		3,288		2,753
Gross profit	$	27,831	$	27,183

During the 2022 Fourth Quarter, the Company recorded a charge for goodwill impairment of $9.1 million related to the IIP Acquisition. The impairment is related to a change in the IIP Acquisition’s current and projected operating income as well as various inputs based on current market conditions, including the higher interest rate environment.

The change in revaluation of put-right liability was $0.8 million for the 2022 Fourth Quarter. The put right relates to the potential future purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to the Company in approximately five years from November 2021. The value of this right will continue to be adjusted in future periods, as appropriate.

Interest expense on debt and other, primarily from the Company’s $150 million term loan entered into in June 2022 and to a lesser extent the funds drawn on the Company’s revolving credit facility, amounted to $2.2 million for the 2022 Fourth Quarter. The effective interest rate on the Company’s debt was 5.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter. See discussion of Other Comprehensive Income below for information related to the Company’s interest rate swap agreement. For the 2021 Fourth Quarter, interest expense, primarily from the Company’s revolving line of credit, was $0.2 million.

The provision for income tax was $1.2 million for the 2022 Fourth Quarter and $3.9 million for the 2021 Fourth Quarter. The provision for income tax, as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate), was 31.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Fourth Quarter and 27.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Fourth Quarter. Excluding the impact of the impairment charge discussed above, the effective tax in the Fourth Quarter 2022 was 27.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} See computation of 2022 Year tax rate in next section. See table below ($ in thousands):

	Three Months Ended
	December 31, 2022			December 31, 2021
Income before taxes	$	4,560		$	18,389

Less: net loss (income) attributable to non-controlling interest:
Redeemable non-controlling interest – temporary equity		318			(2,689	)
Non-controlling interest – permanent equity		(1,059	)		(1,541	)
	$	(741	)	$	(4,230	)

Income before taxes less net income attributable to non-controlling interest	$	3,819		$	14,159

Provision for income taxes	$	1,212		$	3,946

Percentage		31.7	{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}		27.9	{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}

The net loss attributable to redeemable non-controlling interest (temporary equity) was $0.3 million for the 2022 Fourth Quarter as compared to net income attributable to redeemable non-controlling interest of $2.7 million for the 2021 Fourth Quarter. Net income attributable to non-controlling interest (permanent equity) was $1.1 million for the 2022 Fourth Quarter and $1.5 million for the 2021 Fourth Quarter. During the 2022 Fourth Quarter, $2.7 million of the goodwill impairment charge related to redeemable non-controlling interest (temporary equity).

For the 2022 Fourth Quarter, the Company’s net income attributable to its shareholders was $2.6 million as compared to $10.2 million for the 2021 Fourth Quarter. In accordance with GAAP, the revaluation of redeemable non-controlling interest, net of taxes, is not included in net income but charged directly to retained earnings; however, the charge for this change is included in the earnings per basic and diluted share calculation. Inclusive of the charge for revaluation of noncontrolling interest, net of taxes, the amount is a loss of $0.1 million, or $0.01 per diluted share, for the 2022 Fourth Quarter, and income of $9.4 million, or $0.73 per diluted share, for the 2021 Fourth Quarter.

For the 2022 Fourth Quarter, the Company’s Adjusted EBITDA, a non-GAAP measure, was $17.9 million as compared to $17.4 million (excluding Relief Funds) in the 2021 Fourth Quarter. See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedules on pages 16 and 17.

For the 2022 Fourth Quarter, the Company’s Operating Results, a non-GAAP measure, was $7.5 million, or $0.58 per diluted share as compared to $9.3 million (excluding Relief Funds), or $0.72 per diluted share, for the 2021 Fourth Quarter. See definition, explanation and calculation of Operating Results, a non-GAAP measure, in the schedules on pages 16 and 17.

2022 Year As Compared to 2021 Year
**As noted above, the Company is still completing its evaluation of the income tax expense for the 2022 Fourth Quarter and 2022 Year. As a result, the Company’s presentation of earnings per share, operating results per share and its provision for income taxes may change as a result of this evaluation. Set forth below are the Company’s current estimates for these amounts. The Company will promptly announce any changes upon the completion of the evaluation.

Reported total revenue for the 2022 Year was $553.1 million, an increase of 11.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to $495.0 million for the 2021 Year. See table below for a detail of reported total revenue (in thousands):

	For the Year Ended
	December 31, 2022		December 31, 2021
Revenue related to Mature Clinics	$	421,806	$	420,093
Revenue related to 2022 Clinic Additions		14,779		–
Revenue related to 2021 Clinic Additions		25,211		12,638
Revenue from clinics sold or closed in 2022		2,794		5,143
Revenue from clinics sold or closed in 2021		–		456
Net patient revenue from physical therapy operations		464,590		438,330
Other revenue		3,407		2,939
Revenue from physical therapy operations		467,997		441,269
Revenue – Management contracts		8,095		9,853
Revenue – Industrial injury prevention services		77,052		43,900
Total revenue	$	553,144	$	495,022

Revenue from physical therapy operations increased $26.7 million, or 6.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $468.0 million for the 2022 Year from $441.3 million in the 2021 Year. The average net patient revenue per visit was $103.63 for the 2022 Year as compared to $103.88 for the 2021 Year. Total patient visits were 4,483,282 for the 2022 Year and 4,219,576 for the 2021 Year, an increase of 6.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}.

Net patient revenue related to Mature Clinics increased $1.7 million, or 0.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, to $421.8 million for the 2022 Year, as compared to $420.1 million for the 2021 Year. Visits for Mature Clinics (same store) for the 2022 Year increased 0.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as compared to the 2021 Year. The increase in visits was partially offset by a 0.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} reduction in the net patient revenue per visit.

Total operating cost was $441.1 million for the 2022 Year, or 79.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, as compared to $377.8 million, or 76.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue, for the 2021 Year. Operating cost related to Mature Clinics increased by $16.7 million for the 2022 Year as compared to the 2021 Year. Operating cost related to the IIP services business increased by $27.9 million for the 2022 Year as compared to the 2021 Year, of which $22.4 million related to the IIP Acquisition. See table below for a detail of operating cost (in thousands):

	For the Year Ended
	December 31, 2022		December 31, 2021
Operating cost related to Mature Clinics	$	337,606	$	320,882
Operating cost related to 2022 Clinic Additions		12,425		74
Operating cost related to 2021 Clinic Additions		20,792		10,299
Operating cost related to clinics sold or closed in 2022		2,810		4,561
Operating cost related to clinics sold or closed in 2021		–		512
Operating cost – Physical therapy operations		373,633		336,328
Operating cost – Management contracts		6,402		8,306
Operating cost – Industrial injury prevention services		61,085		33,206
Total operating cost	$	441,120	$	377,840

Total salaries and related costs, including all operations, were 57.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year versus 56.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. Rent, supplies, contract labor and other costs as a percentage of total revenue were 21.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year versus 19.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The provision for credit losses as a percentage of total revenue was 1.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2022 Year and 1.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for 2021 Year. The Company experienced pressure on labor rates and other costs in 2022 due to the inflationary economic environment.

Gross profit for the 2022 Year was $112.0 million, a decrease of $5.2 million, or 4.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, as compared to $117.2 million for the 2021 Year. The gross profit percentage was 20.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year as compared to 23.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage for the Company’s physical therapy operations was 20.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 23.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage on management contracts was 20.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 15.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The gross profit percentage for industrial injury prevention services was 20.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year as compared to 24.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. Gross profit in the 2022 Year was affected by pressure on labor rates and other costs due to the inflationary economic environment. The IIP margin in 2022 was impacted by the lower margin profile of the IIP Acquisition. The table below details the gross profit (in thousands):

	For the Year Ended
	December 31, 2022		December 31, 2021

Physical therapy operations	$	94,364	$	104,941
Management contracts		1,693		1,547
Industrial injury prevention services		15,967		10,694
Gross profit	$	112,024	$	117,182

Corporate office costs were $46.1 million for the 2022 Year as compared to $46.5 million for the 2021 Year. Corporate office costs were 8.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total revenue for the 2022 Year as compared to 9.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. The decrease was primarily due to lower estimated bonus expense in the 2022 Year than the 2021 Year.

For the 2022 Year, the valuation of the put-right liability remained relatively the same. The put right relates to the potential future purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to the Company in approximately five years from November 2021.

Interest expense on debt and other, primarily from the $150 million term loan and revolving credit facility entered into in June 2022, amounted to $5.8 million for the 2022 Year. The effective interest rate on the Company’s debt was 3.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year. See discussion of Other Comprehensive Income below for information related to the Company’s interest rate swap agreement. For the 2021 Year, interest expense, primarily from the Company’s revolving line of credit, was $0.9 million.

The provision for income tax was $12.2 million for the 2022 Year and $15.3 million for the 2021 Year. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate) was 27.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2022 Year and 27.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} for the 2021 Year. See table below ($ in thousands):

	For the Year Ended
	December 31, 2022			December 31, 2021

Income before taxes	$	55,571		$	73,196

Less: net income attributable to non-controlling interest:
Redeemable non-controlling interest – temporary equity		(6,902	)		(11,358	)
Non-controlling interest – permanent equity		(4,347	)		(5,735	)
	$	(11,249	)	$	(17,093	)

Income before taxes less net income attributable to non-controlling interest	$	44,322		$	56,103

Provision for income taxes	$	12,164		$	15,272

Percentage		27.4	{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}		27.2	{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}

Net income attributable to redeemable non-controlling interest (temporary equity) was $6.9 million for the 2022 Year as compared to net income attributable to redeemable non-controlling interest (temporary equity) of $11.4 million for the 2021 Year. Net income attributable to non-controlling interest (permanent equity) was $4.3 million for the 2022 Year and $5.7 million for the 2021 Year. During the 2022 Year, $2.7 million of the goodwill impairment charge related to redeemable non-controlling interest (temporary equity).

The Company’s net income attributable to its shareholders was $32.2 million for the 2022 Year, and $40.8 million for the 2021 Year. Inclusive of the charge for revaluation of non-controlling interest, net of taxes, the amount is $29.3 million, or $2.25 per diluted share, for the 2022 Year, and $31.1 million, or $2.41 per diluted share for the 2021 Year. See table on page 17.

For the 2022 Year, the Company’s Operating Results, a non-GAAP measure, was $35.0 million, or $2.70 per diluted share, as compared to $40.8 million (excluding Relief Funds), or $3.17 per diluted share, for the 2021 Year. For the 2021 Year, the Company’s Operating Results including Relief Funds was $43.7 million, or $3.39 per diluted share. See table on page 18.

For the 2022 Year, the Company’s Adjusted EBITDA, a non-GAAP measure, was $73.7 million, as compared to $73.8 million, excluding Relief Funds, for the 2021 Year. See definition, explanation and calculation of Adjusted EBITDA, a non-GAAP measure, in the schedule on pages 16 and 17.

Other Comprehensive Income

The Company entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million notional value adjusted concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, the Company pays a fixed one-month SOFR rate of interest of 2.815{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. The total interest rate in any period also includes an applicable margin based on the Company’s consolidated leverage ratio. In the 2022 Fourth Quarter and 2022 Full Year, the Company’s interest rate including the applicable margin was 4.665{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. Unrealized gains and losses related to the fair value of the interest rate swap are recorded to accumulated other comprehensive income (loss), net of tax. The fair value of the interest rate swap at December 31, 2022, was $5.4 million, which has been included within Other assets (current and long term) in the accompanying Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized loss of $0.4 million, net of tax, for the 2022 Fourth Quarter, and an unrealized gain of $4.0 million, net of tax, for the 2022 Year.

Quarterly Dividend

The Company’s Board of Directors increased the Company’s quarterly dividend on February 21, 2023, from $0.41 per share to $0.43 per share, an increase of 4.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. The Board of Directors subsequently declared a quarterly dividend of $0.43 per share payable on April 7, 2023, to shareholders of record on March 10, 2023.

Impact of COVID-19

Relief Funds
In March 2020 in response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. For the 2021 Year, the Company recorded income of approximately $4.6 million of payments under the CARES Act (“Relief Funds”). Under the Company’s accounting policy, these payments were recorded as Other income – Relief Funds. These funds are not required to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, the Company can attest and comply with the terms and conditions. The Company will continue to monitor the evolving guidelines and may record adjustments as additional information is released.

Medicare Accelerated and Advance Payment Program (“MAAPP Funds”)
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing MAAPP funds during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval to receive MAAPP Funds from Centers for Medicare & Medicaid Services in April 2020. The Company recorded the $14.1 million in advance payments received as a liability. During the quarter ended March 31, 2021, the Company repaid the MAAPP funds of $14.1 million rather than applying them to future services performed.

Management Provides 2023 Earnings Guidance

Management currently expects the Company’s Adjusted EBITDA for 2023 to be in the range of $75.0 million to $80.0 million. The range considers that the previously announced 2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} reduction in the Medicare rate, which we estimate to impact our revenues by $3.1 million, as well as the 2023 impact of the phase-out of sequestration relief during 2022, which we estimate to be $1.2 million, are expected to be offset by increases in commercial rates from renegotiations completed in 2022 and those anticipated to be accomplished in 2023.

Please note that the earnings guidance represents projected Adjusted EBITDA from existing operations and excludes future acquisitions. The annual guidance figures will not be updated unless there is a material development that causes management to believe that Adjusted EBITDA will be significantly outside the given range.

Fourth Quarter and Year Ended 2022 Conference Call

U.S. Physical Therapy’s management will host a conference call at 10:30 a.m. Eastern Time, 9:30 a.m. Central Time, on February 23, 2023, to discuss results for the Company’s 2022 Fourth Quarter and Year ended December 31, 2022. Interested parties may participate in the call by dialing (866) 952-8559 Primary or (785) 424-1743 Alternate and entering reservation number USPHQ422 approximately 10 minutes before the call is scheduled to begin. To listen to the live call via webcast, go to the Company’s website at www.usph.com at least 15 minutes early to register, download and install any necessary audio software. The conference call will be archived and can be accessed until May 23, 2023, at U.S. Physical Therapy’s website.

Forward-Looking Statements

This press release contains statements that are considered to be forward-looking within the meaning under Section 21E of the Securities Exchange Act of 1934, as amended. These statements contain forward-looking information relating to the financial condition, results of operations, plans, objectives, future performance and business of our Company. These statements (often using words such as “believes”, “expects”, “intends”, “plans”, “appear”, “should” and similar words) involve risks and uncertainties that could cause actual results to differ materially from those we expect. Included among such statements may be those relating to new clinics, availability of personnel and the reimbursement environment. The forward-looking statements are based on our current views and assumptions and actual results could differ materially from those anticipated in such forward-looking statements as a result of certain risks, uncertainties, and factors, which include, but are not limited to:

the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of COVID-19 and its variants, for which the total financial magnitude cannot be currently estimated;
changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status;
revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction;
changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients;
compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply;
competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets;
the impact of COVID-19 related vaccination and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations;
changes as the result of government enacted national healthcare reform;
business and regulatory conditions including federal and state regulations;
governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs;
revenue and earnings expectations;
some of our acquisition agreements contain contingent consideration, the value of which may impact future financial results;
one of our acquisition agreements includes a Put Right for a potential purchase of a company and we may or may not have the capital necessary to satisfy this obligation;
legal actions, which could subject us to increased operating costs and uninsured liabilities;
general economic conditions, including but not limited to inflationary and recessionary periods;
availability and cost of qualified physical therapists;
personnel productivity and hiring, training and retaining qualified personnel;
competitive environment in the industrial injury prevention services business, which could result in the termination or nonrenewal of contractual service arrangements and other adverse financial consequences for that service line;
acquisitions, and the successful integration of the operations of the acquired businesses;
impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interest (minority interests);
maintaining our information technology systems with adequate safeguards to protect against cyber-attacks;
a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act;
maintaining clients for which we perform management, industrial injury prevention related services, and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected;
maintaining adequate internal controls;
maintaining necessary insurance coverage;
availability, terms, and use of capital; and
weather and other seasonal factors.

In addition to the above, see Risk Factors in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2021 and the additional risk factors below:

Our debt and financial obligations could adversely affect our financial condition, our ability to obtain future financing, and our ability to operate our business.

We have outstanding debt obligations that could adversely affect our financial condition and limit our ability to successfully implement our business strategy. Furthermore, from time to time, we may need additional financing to support our business and pursue our business strategy, including strategic acquisitions. Our ability to obtain additional financing, if and when required, will depend on investor demand, our operating performance, the condition of the capital markets, and other factors. We cannot assure that additional financing will be available to us on favorable terms when required, or at all.

Our loan agreements contain certain restrictions and requirements that among other things:

require us to maintain a quarterly fixed charge coverage ratio and minimum working capital ratio;
limit our ability to obtain additional financing in the future for working capital, capital expenditures and acquisitions, to fund growth or for general corporate purposes;
limit our future ability to refinance our indebtedness on terms acceptable to us or at all;
limit our flexibility in planning for or reacting to changes in our business and market conditions or in funding our strategic growth plan; and
impose on us financial and operational restrictions.

Our ability to meet our debt service obligations will depend on our future performance, which will be affected by the other risk factors described in our Annual Report on Form 10-K for the year ended December 31, 2021, filed on March 1, 2022. If we do not generate enough cash flow to pay our debt service obligations, we may be required to refinance all or part of our existing debt, sell our assets, borrow more money or raise equity. There is no guarantee that we will be able to take any of these actions on a timely basis, on terms satisfactory to us, or at all.

If we fail to satisfy our debt service obligations or the other restrictions and requirements in our loan agreements, we could be in default. Unless cured or waived, a default would permit lenders to accelerate the maturity of the debt under the credit agreement and to foreclose upon the collateral securing the debt.

Our outstanding loans bear interest at variable rates. We are exposed to certain market risks during the ordinary course of business due to adverse changes in interest rates. The exposure to interest rate risk primarily results from our variable-rate borrowing. Fluctuations in interest rates can be volatile and the Company’s risk management activities do not eliminate these risks. In May 2022, we entered into an interest rate swap agreement to manage these risks. While intended to reduce the effects of fluctuations in these prices and rates, these transactions may limit our potential gains or expose us to losses. If our counterparties to such transactions or the sponsors fail to honor their obligations due to financial distress, we would be exposed to potential losses or the inability to recover anticipated gains from these transactions. Some of our acquisition agreements contain contingent consideration, the value of which may impact future financial results.

Some of our acquisition agreements include contingent earn-out consideration, the fair value of which is estimated as of the acquisition date based on the present value of the expected contingent payments as determined using weighted probabilities of possible future payments. These fair value estimates contain unobservable inputs and estimates that could materially differ from the actual future results. The fair value of the contingent earn out consideration could increase or decrease, as applicable. Changes in the fair value of contingent earn-outs will be reflected in our results of operations in the period in which they are recognized, the amount of which may be material and cause volatility in our financial results.

Our business depends upon hiring, training and retaining qualified employees.

Our workforce costs represent our largest operating expense, and our ability to meet our labor needs while controlling labor costs is subject to numerous external factors, including market pressures with respect to prevailing wage rates and unemployment levels. We compete with rehabilitation companies and other businesses for many of our clinical and non-clinical employees, and turnover in these positions can lead to increased training and retention costs, particularly in a competitive labor market. We cannot be assured that we can continue to hire, train and retain qualified employees at current wage rates since we operate in a competitive labor market, and there are currently significant inflationary and other pressures on wages. If we are unable to hire, properly train and retain qualified employees, we could experience higher employment costs and reduced revenues, which could adversely affect our earnings.

One of our acquisition agreements contains a Put Right related to a potential future purchase of a majority interest in a separate company.

One of our acquisition agreements includes a Put Right for the potential future purchase of a majority interest in a separate company at a purchase price which is derived based on a specified multiple of the separate company’s historical earnings. The exercise of the Put Right is outside of our control. In the event the Put Right is triggered, we are required to purchase the aforementioned equity interest at the calculated purchase price described above. The resulting purchase price may be greater than the fair value of such equity interests at the time, and we may or may not have the capital necessary to satisfy such contractual purchase obligation, in which case we could be in breach.

Many factors are beyond our control. Given these uncertainties, you should not place undue reliance on our forward-looking statements. Please see the other sections of this report and our other periodic reports filed with the Securities and Exchange Commission (the “SEC”) for more information on these factors. Our forward-looking statements represent our estimates and assumptions only as of the date of this report. Except as required by law, we are under no obligation to update any forward-looking statement, regardless of the reason the statement may no longer be accurate.

About U.S. Physical Therapy, Inc.

Founded in 1990, U.S. Physical Therapy, Inc. currently operates 640 outpatient physical therapy clinics in 40 states. The Company’s clinics provide preventative and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurologically-related injuries and rehabilitation of injured workers. In addition to owning and operating clinics, the Company manages 40 physical therapy facilities for unaffiliated third parties, including hospitals and physician groups. The Company also has an industrial injury prevention services business which provides onsite services for clients’ employees including injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity evaluations, and ergonomic assessments.

More information about U.S. Physical Therapy, Inc. is available at www.usph.com. The information included on that website is not incorporated into this press release.


U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF INCOME (IN THOUSANDS, EXCEPT PER SHARE DATA) (unaudited)

	Three Months Ended						For the Year Ended
	December 31, 2022			December 31, 2021			December 31, 2022			December 31, 2021

Net patient revenue	$	120,146		$	113,511		$	464,590		$	438,330
Other revenue		21,036			16,322			88,554			56,692
Net revenue		141,182			129,833			553,144			495,022
Operating cost:
Salaries and related costs		82,317			75,296			319,191			278,469
Rent, supplies, contract labor and other		29,678			25,971			116,381			94,066
Provision for credit losses		1,356			1,383			5,548			5,305
Total operating cost		113,351			102,650			441,120			377,840

Gross profit		27,831			27,183			112,024			117,182

Goodwill Impairment		9,112			–			9,112			–
Corporate office costs		11,925			10,718			46,111			46,533
Operating income		6,794			16,465			56,801			70,649

Other income and expense
Relief Funds		–			4,597			–			4,597
Resolution of a payor matter		–			–			–			1,216
Settlement of a legal matter		–			(2,635	)		–			(2,635	)
Change in fair value of contingent earn-out consideration		520			–			2,520			–
Equity in earnings of unconsolidated affiliate		192			112			1,175			112
Other and interest income		69			41			859			199
Change in revaluation of put-right liability		(776	)		–			(5	)		–
Interest expense – debt and other, net		(2,239	)		(191	)		(5,779	)		(942	)
Total other income and expense		(2,234	)		1,924			(1,230	)		2,547
Income before taxes		4,560			18,389			55,571			73,196

Provision for income taxes		1,212			3,946			12,164			15,272

Net income		3,348			14,443			43,407			57,924

Less: net loss (income) attributable to non-controlling interest:
Redeemable non-controlling interest – temporary equity		318			(2,689	)		(6,902	)		(11,358	)
Non-controlling interest – permanent equity		(1,059	)		(1,541	)		(4,347	)		(5,735	)
		(741	)		(4,230	)		(11,249	)		(17,093	)

Net income attributable to USPH shareholders	$	2,607		$	10,213		$	32,158		$	40,831

Basic and diluted earnings per share attributable to USPH shareholders	$	(0.01	)	$	0.73		$	2.25		$	2.41

Shares used in computation – basic and diluted		13,002			12,912			12,985			12,898

Dividends declared per common share	$	0.41		$	0.38		$	1.64		$	1.46


U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (IN THOUSANDS, EXCEPT PER SHARE DATA) (unaudited)

	Three Months Ended						For the Year Ended
	December 31, 2022			December 31, 2021			December 31, 2022			December 31, 2021

Net income	$	3,348		$	14,443		$	43,407		$	57,924
Other comprehensive loss
Unrealized gain on cash flow hedge		(564	)		–			5,378			–
Tax effect at statutory rate (federal and state) of 25.55{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}		144			–			(1,374	)		–
Comprehensive income	$	2,928		$	14,443		$	47,411		$	57,924

Comprehensive income attributable to non-controlling interest		(741	)		(4,230	)		(11,249	)		(17,093	)
Comprehensive income attributable to USPH shareholders	$	2,187		$	10,213		$	36,162		$	40,831


U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES CONSOLIDATED BALANCE SHEET (IN THOUSANDS, EXCEPT PER SHARE DATA)

	December 31, 2022	December 31, 2021
ASSETS	(unaudited)
Current assets:

February 10, 2023

Impact of online learning on sense of belonging among first year clinical health students during COVID-19: student and academic perspectives | BMC Medical Education

Online student cross-sectional survey

Demographic characteristics

A total of 179 out of the possible 663 students (27{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} completion) completed the online survey in June 2020. Median age of students was 19 years (IQR 18–28 years) and there were approximately three times as many females as males (Table 1), reflective of the undergraduate health sciences cohort (70{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} female). Student numbers were also reflective of the broader enrolment numbers in the programs (i.e., occupational therapy is the largest program). Just over half (53{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}; n = 94) of students had no prior experience in undertaking a Bachelor degree, and 76{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students had not completed any online courses prior to enrolment.

Table 1 Demographic characteristics

Quantitative results to the sense of belonging questionnaire

In terms of students’ sense of belonging to the university, the majority felt ‘quite’ or ‘extremely’ happy with their choice of university (74{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) and felt ‘quite’ or ‘extremely’ welcomed by the university (68{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}). While most students felt respected by both staff (70{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) and students (60{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) at the university, students reported less connectiveness (23.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) to the university. Only 20{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students reported they felt they were understood as an individual, and only 13{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} felt they ‘quite’ or ‘extremely’ mattered to others at the university (Table 2).

Table 2 Online learning and Sense of Belonging to the University [1]

Table 3 shows how the online learning experiences impacted on students’ perception of the course; 27{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students felt ‘quite’ or ‘extremely’ connected to staff while 16{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students felt ‘quite’ or ‘extremely’ connected to other students. While 49{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students rated 4 and above for the level of respect that they received from other students and their contribution towards the subject, students who had prior higher education felt less respected than students who had no prior higher education (p = 0.03). When asked how the online subject had contributed to understanding, knowledge/skills in their chosen health profession, about half of the students rated the online subject highly (rating 4 and above). Students who had prior higher education indicated higher ratings of understanding and knowledge/skills compared to students without prior higher education (p = 0.07 and p = 0.03 respectively). There was also a significantly higher proportion of students with no prior higher education who identified the online learning experience as either ‘quite’ or ‘extremely’ likely to impact their intention to continue with their current course (p = 0.001).

Table 3 Impact of online profession-specific subject on perception of the course

Qualitative results

Qualitative findings provided insight into experiences of staff and students during the rapid, unplanned transition to online learning. Student questionnaire responses included two open-ended questions expanding on enablers and barriers to sense of belonging. These yielded 145 enablers and 254 barriers to students’ feeling a sense of belonging. Data were subjected to qualitative content analysis by two authors and categories are presented in Additional file 1.

Three focus groups were conducted: two student sessions, each with two students enrolled in Speech Pathology and Paramedicine, and one academic session with five participants. Four full time academics and one casual academic participated from a total population of nine eligible academics. Using the processes described in the methods, focus group analysis was compared with the survey content analysis and the authors identified synergies between them. Findings were then integrated under a global theme, underpinned by organising and basic themes. The following themes reflect triangulation between academic and student focus group data in addition to survey responses.

Global theme—navigating belonging during the COVID-19 crisis: a shared responsibility

“We are in this together…making the best of this”

This theme explores sense of belonging creation during this period as a shared process, where participants perceived they worked together to get through the crisis. Students and academics encountered many challenges as they transitioned to online learning but despite hard times, were able to engage positively. The global theme revealed students and academics were navigating belonging during the COVID-19 crisis, and this journey was a shared responsibility. Both groups were working to achieve positive student engagement that would in turn create a sense of belonging in first-year students. A strong commitment of working hard to make the best out of this was mutually acknowledged.

Students perceived academics had done “a really good job at making sure we belonged…in those first few weeks that we were on campus but even more so probably while we were in Zoom” (Student-Astrid-Focus Group). Academics perceived students were actively engaged in making online learning work and were collegial and collaborative.

The shared experiences about navigating belonging during the COVID-19 crisis, have been captured under four organising themes: dimensions of belonging, individual experiences and challenges, reconceptualising teaching and learning, and relationships are central to belonging. Within each organising theme, basic themes were identified that provide depth to the organising theme (Fig. 1). Additional files 1 and 2 present a summary of the quotes obtained from the open-ended surveys and focus groups respectively, that contribute to the themes in Fig. 1.

Organising theme: dimensions of belonging

This theme outlines that belonging is a multidimensional experience with several facets underpinning participants’ experiences. Students and academics identified several dimensions of belonging in relation to first year students’ experiences, as illustrated by two basic themes that sit under the organising theme: what it means to belong, and layers of belonging.

Basic theme: what it means to belong

This theme explores the idea that belonging at university is underpinned by feeling valued and connected. Academics and students agreed that having a sense of being valued by the university and a desire to have an active connection across all aspects of university life was important for students.

Belonging as a student was gained through a connection with the “vocation” (Student-Claire-Focus Group) or the course and career, and with people who will “be there” (Student-Claire-Focus Group) for them. Furthermore, support of academics was critical to gaining a sense of belonging. It was noted by academics and students, that when students feel they belong at university, they are actively engaged in their learning, and this sense of belonging in turn shapes their overall identity. Students can then “actually sort of relax and become themselves” (Staff-Brooke).

Belonging to their cohort, their course, their future profession, and their university was important for students. One academic noted that the “concept of acceptance” is part of the sense of belonging and goes “both ways” (Staff-Brooke).

Both academics and students agreed that the rapid change to online learning due to COVID-19, meant that developing a sense of belonging was challenged.

Basic theme: layers of belonging

This theme identified layers of belonging reflected in participants’ experiences. Peer, academic and professional layers each contributed to an overall sense of belonging and key examples are provided below.

Peers

Belonging to peers was described as “having that connection to someone that’s going through exactly the same thing as what you’re going through” (Student-Astrid-Focus Group). Students were concerned that when learning moved online that this sense of belonging would be jeopardised by less opportunities for in-person interaction.

Academics

Being connected to academics was perceived by students as directly impacting learning, with one student commenting: “…when they’re not connecting with the teacher, they’re not connecting with the content, they’re not connecting with the feedback. That’s when you develop this sense of feeling like you just don’t belong” (Student-Emily-Focus Group).

Academics perceived it was also important for students to develop a sense of belonging to the university community.

Profession

Belonging to a profession was identified as an important feature of belonging by academics and students. Studying a degree with a clear professional identity facilitated first year students to feel they belonged compared to those undertaking general health science degrees which may have multiple pathways and career options less directly aligned to first year studies.

One academic actively encouraged first year students to belong to their professional association as a way of fostering belonging in first years.

Organising theme—Individual experiences and challenges

This theme outlines that while there are similarities in participants’ experiences, individuals have unique contexts and factors shaping their experiences. Academics and students reflected upon personal impacts of the COVID-19 pandemic on their teaching or learning and how they responded as individuals to the ensuing challenges. Two basic themes emerged: Challenges of transition and recognising different learning preferences.

Basic
theme
—challenges of transition

This theme explored the significant challenges of transitioning to online teaching and learning. For some students, the transition to online learning offered potential benefits of flexibility and reduced travel time. Two of the four students in the focus groups opted for online learning opportunities available in other subjects of study prior to the pandemic to efficiently manage their study and external commitments. Nonetheless, the pandemic brought a raft of personal challenges that diminished these expected benefits. Covid-related changes to family employment, reduced access to childcare support and non-optional home schooling presented new concerns.

Clearly, students missed the opportunity to focus attention on their learning needs when balancing childcare demands and home-schooling during lockdowns.

Unlike a conventional online courses where students choose or plan to be online, the sudden, unexpected, and unplanned move to online study was prefaced by a short period (four weeks) of in-person class time. This initial in-person time was identified as being key to relationship building.

Academics identified positive experiences and challenges during the transition to online learning. The rapid change presented a problem to be solved and individuals could “embrace it and to work effectively…as a team” (Staff-Jane). Quickly strategizing and responding to the demands of online learning required team knowledge, experience, and support. Hence, enhanced team culture was a further positive for academics, being “present for each other” (Staff-Brooke).

Basic
theme
:
recognising different learning preferences

This theme identifies experiences of online learning influenced by personal attributes, individual expectations and learning preferences. Such key factors impacted students’ capacity to maintain focus on academic goals after the rapid change to online learning. Some students reflected that barriers were not solely a feature of online learning environments, reporting that competing priorities, including work commitments and limited contact time with staff as pre-existing challenges to belonging. However, some students directly attributed their limited engagement and reduced motivation to the online learning environment.

Students suggested that active engagement “comes down to personality” (Student-Astrid- Focus Group). If a student was not shy they were comfortable to come forward and participate online. Some students perceived clear links between personal discipline, engagement, commitment, and achievement in online learning environments.

Further, students perceived effective (and ineffective) online group functioning reflected personalities of individual members, with some groups/personalities seen as being able to organise whilst other groups lacked leadership and cohesion.

Students who perceived themselves as active engagers reported being drawn towards other students who demonstrated motivation to interact and learn. Other students perceived their personalities or learning preferences were misaligned with the expectations of belonging in online learning environments and focussed upon tasks rather than connection.

Academics recognised student diversity and a need to reflect and re-evaluate expectations of students in online environments. They accepted that some students may be quietly engaging and learning to belong, but this was harder to observe in online compared to in-person learning environments.

Organising theme—relationships are central to belonging

This theme identified the relationship between all parties as a fundamental aspect of creating a sense of belonging. Two basic themes were influential in shaping perceptions of how relationships and connections contribute to belonging: collaboration with peers is fundamental, and effective and regular communication with staff is necessary.

Basic
theme
—collaboration with peers is fundamental

This theme revealed collaboration with student peers was a key element of creating a sense of belonging. The degree of social interaction with student peers and opportunities to create friendships contributed to feelings of belonging. Accordingly, students found it problematic when peers neglected to turn cameras on during classes, making interaction very difficult. Visualisation of peers and use of cameras in online classes impacted students’ opportunities to get to know each other.

Challenges posed by online learning were further highlighted in the student survey through a focus on non-academic aspects of university and campus life. Typically, university campuses offer interactional opportunities through clubs, sport, and shared spaces to learn and socialise. Campus life, students suggested, may facilitate learning and personal development. Absence of this type of interaction was linked to barriers in developing friendships and consequently a lesser sense of belonging as reflected in Additional file 1.

Basic theme—
communication
with academics is necessary

This theme outlined that communicating with academics was a key component of creating a sense of belonging. With less opportunities for peer support, there was stronger reliance on the academic-student connection, although students reported positive and negative interactions with academics during online learning.

Positive interactions and individualised communication with academics enhanced student sense of satisfaction and belonging. Furthermore, students in the focus groups reported a feeling of trust and a bond created by a shared challenge. Survey responses echoed this sentiment, noting that academics were “non-judgmental and supportive” (Student Survey 18) and created a sense of camaraderie. However, when students perceived impersonal communication from academics, they felt less connected or believed that teaching had become a “transaction” (Student-Astrid- Focus Group). Perceived levels of enthusiasm and engagement from academics influenced student’s perceptions of connection and belonging.

Students identified the online environment as a barrier to communication with academics. While systematic and university level communication was perceived as a useful source of information, students prioritised individualised communication from academic staff as key to belonging.

Academics concurred that effective communication was challenged in online environments, missing non-verbal cues and responsivity that characterises a classroom environment. Although the online learning environment provides an opportunity for academics to connect professionally with students, there were students who left their cameras off, with one academic noting they didn’t push this issue because there are many reasons for students choosing this option.

Organising theme: reconceptualising teaching and learning

This theme reveals how academics and students reconceptualised their expectations and modes of teaching and learning, to manage the crisis. It was not easy for academics or students, and many strategies were employed to make it work, with two basic themes emerging: challenges to online teaching and learning, and strategies to engage and connect.

Basic theme:
challenges
of online teaching and learning: “how do I make this work?”

This theme outlined many challenges faced by both academics and students during a rapid change to online mode. With the rapid change to online learning, academics asked themselves, ‘How do I make this work?’.

Managing workload

Academics reported their workload increased significantly, and they “found it a juggling act” (Staff-Louise) to meet their teaching requirements. Administrative loads consequently increased when reduced in-person contact with students led to more electronic communication. Academics needed to up-skill in online teaching in a short time frame and perceived this responsibility as all encompassing.

The rapid switch to online learning attracted significant academic workload, implementing and adapting content to see how material “might play out in a Zoom environment…[where]…everything takes longer” (Staff-Natalie).

Some students noticed a temptation to disengage from online learning, which meant balancing their workload and study demands became a challenge as they also faced significant workload and stressors in their personal lives due to COVID-19.

Class dynamics

Academics and students spoke about the change to classroom dynamics. The online environment was noted as being one in which it was difficult to read the room to see how students were progressing with their work. Others tried to use humour to enliven a class, only to have the Zoom frame freeze, killing the mood they were trying to create. Hence, staff felt teaching online was less conversational, flexible and responsive compared to face-to-face. Moreover, academics missed hands-on practical elements; a big shift for some programs.

Technological challenges

Academics learnt new skills quickly, but often these skills would be challenged when technology failed. Some academics reported a sense of vulnerability due to technological ineptitude but acknowledged that making mistakes in front of students could humanise the experience. Academics also acknowledged that some students did not have adequate technological resources to meet changes in their learning requirements when classes were placed online.

Basic theme: strategies to engage and connect

This theme reflected the strategies academics and students employed to remain engaged and connected. Academics worked hard to enhance online learning and hoped to connect with students and engage them in activities. Students too were active and appreciated academics’ efforts to facilitate engagement and connection. Underlying many of the strategies adopted by academics was a deep concern for student welfare during this time. Therefore, many academics aimed to ensure students were engaged and connected with each other and with the academic team. Academics built in small group opportunities during online teaching so students could connect, learn, and socialise.

Staff also spoke about informing students they could contact staff for support. One staff member described crossing the divide and actively discouraging a ‘them and us’ dynamic between students and staff.

A variety of teaching tools were identified by staff to build connection and promote engagement. Such tools included interactive quizzes, ice breakers activities, integrating reflective practices into activities and ‘drop in’ sessions. Staff also encouraged students to establish social media groups or other group experiences outside the classroom. Some staff members arrived early to zoom classes and left late to enable students to connect informally.

Students appreciated staff attempts to provide these activities. Students found these initiatives helpful, recognising staff placed effort into knowing students personally and focussing on student wellbeing and achievement. Students cited examples of provision of extra resources, mini-lectures, additional question and answer sessions, and fast response times to student queries. Students also initiated their own engagement strategies, including using group and personal messaging over platforms such as Facebook messenger.

January 3, 2023

Child referrals for mental health care in England up 39{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in a year | Children

The number of little ones in England needing remedy for really serious mental wellbeing difficulties has risen by 39{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in a calendar year, formal knowledge displays.

Industry experts say the pandemic, social inequality, austerity and on-line harm are all fuelling a disaster in which NHS psychological well being treatment method referrals for beneath-18s have improved to much more than 1.1m in 2021-22.

In 2020-21 – the first 12 months of the pandemic – the determine was 839,570, whilst in 2019-20 there ended up 850,741 referrals, in accordance to evaluation of formal figures by the PA Media.

The figures contain children who are suicidal, self-harming, struggling severe depression or panic, and these with ingesting issues.

Dr Elaine Lockhart, chair of the boy or girl and adolescent psychiatry school at the Royal University of Psychiatrists, stated the increase in referrals reflected a “whole range” of health problems.

She reported “specialist providers are needing to reply to the most urgent and the most unwell”, including younger individuals struggling from psychosis, suicidal views and extreme stress and anxiety disorder.

Lockhart mentioned targets for seeing small children urgently with ingesting problems were sliding “completely” and that much more team ended up essential.

“I think what’s disheartening for us is [that] if we could see them more speedily and intervene, then the problems could possibly not develop into as critical as they do due to the fact they’ve had to hold out,” she extra.

Lockhart mentioned children’s psychological wellbeing experienced been obtaining worse in advance of the pandemic, with escalating social inequality, austerity and on the web damage taking part in a purpose.

“When the lockdowns and pandemic struck, that really experienced such a damaging impact on a whole lot of little ones,” she extra. “Those who experienced been performing well turned vulnerable and individuals were being vulnerable turned unwell.

“And part of that was about young children them selves feeling quite untethered from the working day-to-working day existence that supports them … but also observing their possess moms and dads wrestle, and then that collective heightened feeling of anxiety and loss of command we all experienced really affected little ones.”

Tom Madders, director of campaigns at YoungMinds, stated the figures were being “deeply concerning”, incorporating: “The past yr has been a person of the most tough for this age group, emerging from the pandemic to a lot more minimal potential customers for their futures, coupled with an enhance in academic strain to catch up on missing understanding, and the affect of the cost of residing crisis.

“The recent point out of engage in can not continue. The authorities should get a grip of the condition.”

Meanwhile, separate NHS Digital details reveals hospital admissions for consuming disorders are increasing amongst children. Among underneath-18s, there were 7,719 admissions in 2021-22, up from 6,079 the prior yr and 4,232 in 2019-20 – an 82{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} increase throughout two several years.

The NSPCC explained the figures as “alarming”.

A Office of Health and Social Care spokesperson said: “We are by now investing £2.3bn a year into psychological health and fitness services, indicating an more 345,000 youngsters and younger individuals will be capable to obtain support by 2024 – and we’re aiming to increase the mental well being workforce by 27,000 much more staff by this time much too.”

December 29, 2022

2022 Health Sciences Year in Review: UNM Newsroom

The University of New Mexico’s Health Sciences Center (HSC) had quite a year as reflected by several construction projects including the new Critical Care Tower and the College of Nursing and Population Health Building. Not only were construction workers busy throughout the year, but so were HSC scientists conducting research involving the hazards of wildfire smoke to non-invasive brain stimulation to a new MRI technique to create time-lapse images as the brain responds to experiences and the arrival of the Omicron variant in New Mexico. In addition, several HSC staff members were recognized for a variety of achievements from retirement to leadership.

Below is a select list based of HSC’s 2022 Year in Review highlighting UNM students, faculty, and staff accomplishments. Click on the headline to read the full story for each listing.

New Hospital Tower

In 2021, UNM Hospital broke ground on a seven-level, 96-bed critical care tower. Over a decade in the making, this contemporary medical facility will help UNMH further its mission of caring for more New Mexicans in New Mexico when it debuts in 2024. Now, UNMH is taking construction on the tower to new heights. Earlier this year, the New Mexico Higher Education Department and State Board of Finance gave UNMH the green light to move forward with a vertical expansion of the new tower. This ambitious development adds two additional floors and even more hospital beds to the tower.

Studying the Hazards of Wildfire Smoke

University of New Mexico researchers have received federal funding to study how exposure to wildfire smoke creates signs of premature aging in the brain – and look for ways to inhibit the process. Thanks to a five-year, $3.7 million grant from the National Institute on Aging and the National Institute of Environmental Health Sciences, a multi-disciplinary team led by Matthew Campen, Regents’ professor in the UNM College of Pharmacy, will investigate how inhaled smoke particles travel from the lungs to erode the blood-brain barrier.

College of Nursing’s MSN Program Highly Ranked

The University of New Mexico College of Nursing’s master of science in nursing and doctor of nursing practice are again ranked among the best nursing programs in the nation and the top in New Mexico, according to the latest ranking from U.S. News & World Report’s 2023 edition of America’s Best Graduate Schools. UNM’s master of science in nursing program is ranked 61st in the nation and fourth in the Mountain West. The doctor of nursing practice program is ranked 80th nationally and fifth in the Mountain West. Both programs earned the top spot in the state of New Mexico.

Physical Therapy Student Jessica Yeaton Competes in the Winter Olympics

Whenever she takes a break from her studies in The University of New Mexico Physical Therapy program, Jessica Yeaton likes to strap on her cross-country skis and head to the snowy upper reaches of the Sandia Mountains for a workout. But this week, Yeaton will heading to Beijing for the 2022 Winter Olympics as a member of Australia’s cross-country ski team. It’s the 30-year-old’s second Olympic appearance: in 2018 she was in South Korea for the winter games.

Researchers Study Non-Invasive Brain Stimulation for Mild Traumatic Brain Injury

University of New Mexico researchers are leading a multi-center study to see whether noninvasive brain stimulation can improve the cognitive symptoms of traumatic brain injury in veterans. The three-year $4 million trial, funded by the U.S. Department of Defense, will recruit participants from Veterans Affairs hospitals in Albuquerque and Minneapolis, said Davin Quinn, professor in the UNM Department of Psychiatry & Behavioral Sciences, who serves as principal investigator.

Project ECHO Launches Program to Boost Vaccine Confidence in Rural New Mexico

Project ECHO at The University of New Mexico Health Sciences Center is launching a new program to increase COVID-19 vaccination rates in New Mexico’s rural and underserved communities. The program will help front-line health workers gain essential skills in listening techniques, motivational interviewing and effective messaging. They will also learn how to help their clients find vaccination sites and transportation, overcoming some of the difficulties in accessing vaccines in rural areas.

UNM Health Sciences Received Record $239 in External Research Funding in FY 2022

The University of New Mexico Health Sciences was awarded nearly $239 million in external funding in FY 2022, a new record that builds on year-over-year increases in grant funding for 17 of the past 18 years. In addition, UNM Health Sciences researchers have for the first time collectively received more than 1,000 active grants.

UNM Health Sciences Receives Grant to Support Diversity in Young Biomedical Researchers

The University of New Mexico’s Biomedical Sciences Graduate Program (BSGP) has been awarded a five-year $2.71 million grant from the National Institute of General Medical Sciences to develop a diverse pool of Ph.D. researchers. The Initiative to Maximize Student Development (IMSD) program is part of the National Institutes of Health T32 funding mechanism. It joins three other UNM Health Sciences T32 awards, said Nancy Kanagy, chair of the Department of Cell Biology & Physiology and principal investigator for the new grant.

UNM Health Sciences Redesignated a World Health Organization Collaborating Center

The Office of International Health at The University of New Mexico Health Sciences has been redesignated as a collaborating center by the World Health Organization/Pan American Health Organization (WHO/PAHO). Arthur Kaufman, vice president for Community Health, and Amy Clithero, principal lecturer in the Department of Family & Community Medicine, will serve as co-directors of the Collaborating Center for Innovative Health Workers Education, Service and Research Models

UNM Sandoval Regional Medical Center Designated a Level III Trauma Center

The New Mexico Department of Health EMS Bureau has certified The University of New Mexico Sandoval Regional Medical Center (SRMC) as a Level III trauma center. Going forward, SRMC will be equipped to handle the needs of lower-level trauma patients whose injuries can be treated by a general surgeon or an orthopedic surgeon. Patients with traumatic brain injury and other acute conditions would be transported to the Level I trauma center at UNM Hospital.

UNM Physician Volunteers in Ukraine to Help with Refugee Crisis

More than two million people have fled the Russian invasion of Ukraine over the past two weeks, pouring into neighboring central European countries. University of New Mexico physician Matthew Wilks, chief medical officer and chief quality officer at Sandoval Regional Medical Center in Rio Rancho, has headed in the opposite direction, crossing into Ukraine to establish aid stations manned by volunteer health providers. Wilks belongs to Team Rubicon, an international disaster relief organization

UNM Scientists Use New MRI Technique to Create Time-Lapse Images as the Brain Responds to Experiences

Magnetic resonance imaging (MRI) has transformed the field of neuroscience over the past 40 years, enabling scientists to create clear snapshots of living brain structures and even detect functional changes associated with certain activities. Unlike X-rays or CT scans, MRI does not rely on beams of radiation. Instead, powerful magnetic fields and radio waves are used to temporarily align the hydrogen atoms in the body’s water molecules, meaning it can create a clear picture of soft tissues, like the brain.

More Rodent Species in New Mexico Found to Carry Deadly Hantavirus

Each spring, as rodents emerge from their burrows, Four Corners residents cleaning out storage sheds or woodpiles know to be on the lookout for tiny deer mice, which can carry the deadly Sin Nombre hantavirus. Steven Bradfute, an associate professor in The University of New Mexico Center for Global Health and Department of Internal Medicine, and an expert in virology, immunology and microbiology, has spent years teasing out the secrets of the virus, which kills nearly 40{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of those who become infected.

UNM Cancer Center Participates in National Bladder Cancer Clinical Trial

Bladder cancer affects nearly 84,000 people in the United States each year, making it the sixth most common cancer. Most people survive it, but unfortunately, many lose their bladders. Dr. Neda Hashemi, and her team at The University of New Mexico Comprehensive Cancer Center are now offering several clinical trials, including one that will give people with bladder cancer a chance to fight their disease and keep their bladders.

UNM Among First to Receive ACGME Accreditation for Neuro-Critical Care Fellowship

The University of New Mexico Department of Neurology is among the first programs in the nation to receive full accreditation for a fellowship in neurocritical care. Recognition of UNM’s two-year fellowship program by the Accreditation Council for Graduate Medical Education (ACGME) is a major accomplishment because “neurocritical care is a subspecialty that has been in existence for 30 years, but has had to tackle many hurdles as it grew beyond the major coastal universities,” said fellowship program director Dr. Diana Greene-Chandos, associate professor of Neurology.

UNM Health Extension Regional Officers Assist People Displaced By Massive Northern New Mexico Blaze

Within a moment’s notice, they knew it was their responsibility to act. Now, in the thick of it, some Health Extension Regional Officers (HEROs) from The University of New Mexico Office for Community Health (OCH) are on the front lines, helping people afflicted from the Hermit’s Peak-Calf Canyon wildfire that is burning through the southern reaches of the Sangre de Cristo range. Many people living in rural communities near Las Vegas, N.M., have been displaced from their homes and are having to stay at evacuation sites.

UNM Center for Native American Health Joins National Network of Public Health Institutes

The University of New Mexico Center for Native American Health (CNAH) has been approved as a public health institute by the National Network of Public Health Institutes (NNPHI). CNAH will further expand its public health activities in its new PHI, the Public Health Institute for Indigenous Knowledge and Development. CNAH becomes the third indigenous PHI nationally and the second program in New Mexico to join the NNPHI network, said CNAH director Tassy Parker, professor in the UNM Department of Family & Community Medicine.

UNM Division of Physical Therapy Creates Women’s Health Residency Program

Across New Mexico, people with pelvic floor disorders who need help managing pain and discomfort are on a months-long waiting list to see a specialized physical therapist. To help address this growing need, The University of New Mexico Division of Physical Therapy recently announced a new residency program. The UNM Women’s Health Physical Therapy Residency Program, which was granted candidacy from American Board of Physical Therapy Fellowship and Residency Education (ABPTFRE) this summer.

UNM Scientists Detect Arrival of Omicron in New Mexico

Detecting new COVID-19 variants as they start to spread is a massive scientific and logistical challenge. But thanks to two University of New Mexico scientists who have studied and tracked the spread of SARS-CoV-2 (the virus that causes COVID-19) since the beginning of the pandemic, genomic surveillance is how we knew when the Omicron variant was first brought into New Mexico.

Groundbreaking for UNM College of Nursing and Population Health Building

The University of New Mexico Health Sciences hosted a groundbreaking ceremony in August for the new College of Nursing and Public Health Excellence Building (CON-PHE), which will enable the capacity to graduate more students. The 93,740-gross-square-foot building will be located on Tucker Avenue, just west of the Domenici Center for Health Sciences Education, on what is currently the M-Family Practice parking lot. The three-story building will include classrooms, offices, community hubs and a research wet lab.

UNM ASAP Clinic Treats Substance Use Disorders with Medication, Therapy and Empathy

Substance use is a significant public health issue in New Mexico, which for decades has ranked among the worst states in the nation for alcohol- and drug-related deaths. Cases of substance use disorders continued to skyrocket in 2020 during the COVID-19 pandemic, where the isolation and loneliness that accompanied lockdowns, often exacerbated people’s mental health challenges.

NOTABLE NEWSMAKERS

Ava Lovell Retires as Health Sciences Senior Executive Officer

“Doing the work and being a part of something that makes a difference is where the fun is.” This joy in advancing the operations and growth of The University of New Mexico has been a defining characteristic of Ava Lovell’s career. After nearly 28 years of service to UNM, Lovell, who is currently the HSC Senior Executive Officer for Finance & Administration, has announced her retirement. She has been at the helm of the UNM Health Sciences finances and operations since 2007.

Emeritus UNM Professor Robert “Bob” Otto Valdez Named to Head Agency for Healthcare Research & Quality

Robert “Bob” Otto Valdez, an emeritus professor of Family & Community Medicine and Economics at The University of New Mexico, has been appointed director of the federal Agency for Healthcare Research and Quality (AHRQ). In 2008, Valdez was the founding executive director of the Robert Wood Johnson Foundation Center for Health Policy at UNM. He previously had served as founding dean at the Drexel University School of Public Health.

Patricia Finn Named New Dean of UNM School of Medicine

Dr. Patricia W. Finn, professor, head of the Department of Medicine, associate dean for Strategic Initiatives and associate program director for the Medical Scientist Training Program (MSTP) at the University of Illinois College of Medicine in Chicago, has been named dean of The University of New Mexico School of Medicine. In addition to her leadership roles, Finn is a noted clinician, teacher and physician scientist.

Dr. Steve McLaughlin Named Chief Medical Officer at UNM Hospital

Dr. Steve McLaughlin will assume the role of chief medical officer at The University of New Mexico Hospital, starting Jan. 1, 2023. McLaughlin is currently chair of the UNM Department of Emergency Medicine, as well as the interim senior associate dean for Clinical Affairs in the UNM School of Medicine.

Gina Urias-Sandoval Named a Woman of Influence by Albuquerque Business First

Gina Urias-Sandoval, chief of staff for The University of New Mexico Health Sciences, has been named one of 24 Women of Influence by Albuquerque Business First. The honorees, selected from a list of more than 100 nominees, were recognized at an awards ceremony on Feb. 28 at Sandia Resort & Casino.

December 28, 2022

Improve Your Mental Health in the New Year With These 7 Daily Habits

Generating ambitions for the new yr is a ritual we all consider portion in proper soon after the holidays pass. Probably this 12 months you have created a resolution to get out of credit card debt or commit extra time and energy to eating improved. But after a lengthy and annoying 2022, some of us just want to treatment for our minds and nourish our mental health in 2023.

Our psychological well being is the basis for almost everything we do, like our social and psychological very well-remaining. It impacts each component of our everyday living. Remaining intentional about valuing your mental health will assist you connect deeper with some others, minimize panic and raise your self-assurance. Start off your 12 months suitable with these very simple day by day behaviors.

Also, see how to the natural way relieve panic without the need of medication and suggestions for bettering your mental well being devoid of therapy.

Very simple mental well being habits to start for better psychological health

Make leisure a routine

Really several things in lifetime are promised. Instances of anxiety are, however, a single of them. There will be times when you experience overcome or stressed out. However, you can handle how you answer to the strain. Implementing leisure methods into your daily program can assist you regulate strain.

Meditation is a well known way to unwind as it can assistance arrive at a state of relaxed, decrease strain and improve your temper. Some folks even use songs to guide them via their meditation sessions. If meditation isn’t your matter, deep breathing, looking through or taking a bubble bathtub are also common rest approaches. No make a difference how you opt for to relax, just make it a routine.

Read far more: The Best Meditation Apps for Leisure

Exercise gratitude

Which include gratitude in your everyday living is a way to develop a beneficial outlook on your daily life. A lot more than that, it has tangible rewards for your psychological health, which includes minimizing strain, lessening depression signs or symptoms and boosting your mood.

Gratitude is a simple principle, but often complicated to preserve up with. In 2023, choose time for self-reflection and share your gratitude with the people all-around you. If you like to journal, regularly publish down a listing of factors you’re grateful for.

Two young women sitting on a patio, drinking coffee and laughing. — Catherine Delahaye/Getty Pictures

Value social interaction

Sharing our time with other people is sometimes just what we want to strengthen our mood or transform our standpoint on points. By creating time for close friends and loved ones, you will reduce thoughts of loneliness and make sure you have an psychological aid procedure at your fingertips. If you are unable to on a regular basis meet in human being, text messages and zoom calls are all significant strategies to join with many others with out essentially observing each other.

The other side of valuing social conversation is recognizing when you’ve got had more than enough. Boundaries are an critical section of mental wellbeing that assist you from pushing your self as well significantly. Sense empowered to say no or shift strategies around when your physique tells you to.

Acquire treatment of your actual physical overall health

Psychological health is instantly tied to physical well being — just one can not flourish without the need of the other. The a few major parts to goal for 2023 are rest, nutrition and training.

Let’s dig into each goal spot:

Snooze: The state of your mental wellness is influenced by the snooze you get. If you you should not get more than enough snooze, your mind won’t have the likelihood to rest and get well. Snooze deprivation will make it more challenging to regulate your thoughts and cope with pressure, which can amplify the signs of current mental sicknesses. Staying intentional about prioritizing your slumber is a basic way to benefit your mental wellness.
Food and hydration: Supplying your entire body the vitamins and minerals and hydration it wants to perform is yet another essential portion of mental health and fitness. In addition to consuming perfectly-balanced meals, try out adding meals to your diet plan that increase joy. And make certain you consume adequate h2o hydration is connected to lessened threat of stress and anxiety and melancholy.
Work out: Being lively is one more way to enhance your temper and make you really feel good. Adding exercising to your plan provides you a probability to bond with many others, cut down stress and boost your self esteem. It won’t have to be weighty lifting or intense routines standard walks or bike rides can also strengthen your mental wellness.

Keep track of your social media intake

Our phones are our lifelines. Most of the time, they are beside us, preserving us linked to the exterior earth by means of phone calls, texts and social media. The hrs expended scrolling by social media, evaluating ourselves to the snapshot of perfection individuals article, can seriously effects our self-check out and stain our psychological well being. Constant social media use has been linked to worsened panic and depression indicators, inner thoughts of inadequacy and harmful sleeping behaviors.

You can use social media in a way that would not deplete your psychological well being. Use these techniques to make social media work for you:

Place a restrict on how prolonged you can shell out on social media.
Will not start or stop your working day with social media.
Use the time you utilized to devote on social media to do something that provides you pleasure or peace.

Journal your inner thoughts

Journaling is a potent instrument to cope with psychological wellness ailments by performing through feelings and channeling views. A 2018 study discovered that journaling for 15 minutes every day noticeably lowered stress and emotions of anxiousness. Other investigation has linked it to encouraging perform by way of PTSD symptoms or melancholy.

There is no proper or improper way to journal. Lots of people journal every day. Many others may only journal when stressed or will need to function through something. No make any difference how you use it, journaling is a way you can keep track of your progress and development in the course of the 12 months.

Young woman with curling hair laughing while standing against a wall. — Westend61/Getty Illustrations or photos

Make you giggle

Sometimes, laughter is the finest medicine. When you’re experience pressured or down, do points that will make you snicker to minimize panic and tension. Enjoy your beloved Television set show or motion picture to give your temper a boost. Or obtain the supply within on your own. Sing whilst you are in the shower or dance while cleaning your house. Dancing minimizes the worry hormone cortisol in the human body.

Increasing your psychological overall health is a journey it would not materialize right away. You can make lasting tweaks to your well-getting by intentionally adding behaviors to your plan.

The data contained in this article is for academic and informational needs only and is not meant as well being or healthcare advice. Generally talk to a medical doctor or other experienced health company relating to any questions you may well have about a health-related ailment or health and fitness objectives.