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The future we want; the future we get.

Outside the Shinto shrines of Japan there are small trees that seem to be perpetually in bloom, with oddly shaped white flowers made by human hands. The flowers actually are papers containing fortunes that are given in exchange for what we would call an offering. If you take the fortune home, it is supposed to come true. If you leave the fortune behind, it is not supposed to come true. The limbs of the trees are where all of the bad fortunes end up. To ensure a good future, then, all you need is enough money to keep buying new fortunes until you get the tomorrow you want today. Given the current state of physical therapy, a system such as this might be helpful. Suddenly our future does not seem as certain as it did only 1 or 2 years ago.

For several decades, some physical therapists argued—largely unheeded—that our future did not depend on meeting the demand for therapists as though we were the latest Christmas toy in short supply. A great profession cannot thrive on being this year's Beanie Babies or Tickle-Me-Elmo! Too much time and effort were spent on addressing what was clearly a short-term need. We took home the wrong fortune. We would have been better off leaving it behind, tied to one of those trees.

We gloried in the demand for our services and grew dependent on being courted with jobs and sign-on bonuses. In institutional settings we created therapist hierarchies that were antithetical to professionalism. We had as many titles as the hospital library! Efficiency took a backseat to therapist satisfaction because a lost employee was an economic nightmare, due either to missed charges or to the cost of contract workers. Demands for data on outcomes and on effectiveness were viewed as pie-in-the-sky requests …