Does Travel Therapy Really Pay Better?

People ask all the time if it’s really true that working as a traveling therapist pays better than working as a permanent employee. The easy answer is “yes,” as a traveler you make much more money hourly than as a permanent employee. But I have often wondered if the costs of moving frequently, unpaid time off, and more expensive temporary housing eat so far into the net gain that we come out about even. After additional costs, I think travel therapists likely end up taking home about the same as permanent therapists, but let’s do a little math and see if we can reach a semi-scientific answer. As I begin to write this blog, I have no idea what the answer is going to be – this will be fun.

We’re going to have to make some assumptions to get a rough estimate of what a traveling therapist takes home each year – there are a lot of factors that can drive the take-home up or down significantly. I will make assumptions based on what I would consider a typical year in a traveler’s life:

  • Let’s assume 3 contracts in one year. This allows for either one longer 6 month contract or one contract extension during the year. Also, most people can’t keep up consecutive 13-week contracts for more than a couple years, it gets tiring.
  • I know some people jump right from one assignment to the next with little, if any break. I tended to take 3 or 4 weeks between contracts to visit family, take road trips, or go on vacation – that’s probably more leisurely than most. If you have trouble finding a contract, you may find yourself out of work a little longer than expected. Let’s go with 2 weeks between contracts, this is more time than some will take, but it allows some wiggle room for travel and job-finding.
  • Let’s assume we’ll take the housing stipend and find housing for cheaper than the agency would give it to us – it’s the smart and frugal thing to do.
  • We’re going to have to agree on “typical” pay for a traveling therapist, this is tough because geography and setting cause great differences in pay everywhere. With pay in desirable destinations being as low as $1450/wk and a really good paying jobs being up around $1850 or higher, I think the middleground and a typical travel contract pays about $1650/week. This number is after taxes and with that housing stipend that we have decided to take.

So, at $1650/wk for 48 working weeks, that’s 79,200 after tax – or the equivalent of a $110,000 salary taxed at 28%. Whoa, that’s more than I thought it would work out to, an impressive salary for a staff PT. So these are the base numbers that makes travel look appealing compared to permanent work – now let’s do some subtraction and bring these numbers closer to reality:

  • As a traveler, you’re not going to get paid for sick days and there might be some holidays your facility takes that your agency doesn’t recognize (local, state, and other frivolous holidays). There’s also the common circumstance that your desired start date doesn’t quite line up with the facilities needs, or some extra work days are lost to travel. Maybe you miss a day or two at a continuing ed course or conference. Perhaps, you are waiting for your new state license to come through. Anyways, doing some rough math, let’s say there are 10 other work days in a year that you will miss – 2 weeks. -$3300
  • The actual transportation part of moving can vary wildly in cost. Road trip? Probably. Fly there? Depends. Ship a vehicle? Maybe. Will you need a couple nights in a hotel, or at least campground fees? Food on the road is not usually cheap. The saving grace is that as a traveler, you will get some sort of relocation reimbursement. It’s unlikely to cover all of your costs, but it will cover a good portion. Let’s say the average traveler on the average assignment will spend $250 of their own money on relocation if they travel wisely (getting to 3 assignments this year)  -$750
  • Also included in moving costs are all the things you need in a home when you move: TP, cleaning products, staple foods, condiments, etc. I typically spend about $500 at target at the start of every assignment stocking up on the things I’ll need to live comfortably. -$1500
  • In this scenario, we’re going to take the housing stipend so we can get furnished housing for less than the stipend and keep the extra tax free money. But, the furnished, short-term housing is going to cost us more than we would spend with a typical long-term lease in an unfurnished space. I believe it’s reasonable to say we will spend $400/mo more in short-term, furnished housing. -$4800

$10,350 less for our estimated traveling costs brings us down to $68,850 after taxes, or the equivalent of a $95,625 taxed salary.

I’m honestly surprised that the salary equivalent of what we’ve just calculated as a typical traveling job is so high. We can see from the pseudo-math above that the great boost in pay for travelers is the tax free money. To make the most of the tax free advantage, it is vital that you have an established tax home. Also, I believe this scenario represents someone who is being financially conscious and making attempts to get back to work in a timely manner, find inexpensive housing, and live within his or her means.

There is going to be a lot of variation to these numbers based on whether your assignment pays more or less and a number of personal factors.There are years I took 10 weeks off throughout the course of the year – that affects pay. I’ve heard of people renting cars on assignment, that’s a lot of money (comparable to a second housing rent). You can be frugal with your choice of housing, or you could be frivolous – you could even take the housing provided by the agency rather than the stipend. All of these choices greatly affect how much money you are left with at the end of the year.

Clearly, if you want to make more money through traveling PT, you could find the high paying assignments in the high paying states, live a frugal lifestyle, and rake it in. If you are doing traveling PT for the money as your first priority, do us all a favor and don’t. Travel PT should be about traveling. Enjoy seeing the places you go to work. Take time between assignments to relax and soak in some leisure time. Maybe you do a couple contracts as a traveler to explore different employment options or get a variety of experiences. But don’t do it for the money. The extra money is a nice addition to a lifestyle that you should enjoy for other reasons. Travel to travel, you’ll be a lot happier than slaving away in a terrible facility that will pay anything to anyone because it’s an awful place to work. My recommendation would be the same with permanent jobs. Money should not be the only factor – quality of life, work-life-balance, enjoying your job, being supported by your employer to provide the best care you can to your patients – these are good universal reasons to work anywhere as a therapist.

If you have an interest in doing traveling therapy to see the different ways to practice in a variety of settings and a bunch of different places, get out there and do it! You are in for an unbelievable experience and lifestyle. You’ll meet all kinds of different people, expand your clinical skills, and see some really cool places. As it turns out, while you’re scratching that travel itch, you could make a good chunk of cash while you’re at it.

Canoe Club

A typical outrigger canoe – the #3 paddler happens to be a PT I worked with on the Big Island. Aloha, Therron. Serious Paddler Dudes.

Last time Kate and I did a travel assignment in Hawaii, we joined the Molokai Canoe Club and paddled every week during our 6 months there. We were scheduled to practice 2 days per week, but the paddling really hinged on whether enough people showed up. To paddle an outrigger canoe, you need at least 4 people to have any fun at all – there are 6 seats, and it’s best if you have them all filled. Also, we couldn’t go at all without one of the steersmen, someone trained in steering the canoe – a steerswoman in this case. I haven’t shared enough about this experience. I try to avoid too much talk about Molokai on this site, because it’s a quiet and special place, and I’d like it to stay that way. But I was recently reflecting on my evenings in the canoes and at the canoe shack. They were special times. The kind of times only had when you step a bit outside your comfort zone.

The first thing you need to know is that the entire club is centered at “the canoe shack”. The shack is kind of a big deal. There’s several canoe clubs on the island, but the Molokai Canoe Club is the only one with a roofed structure. About 10 yards down the beach is another club, Club Va’a – they are the more competitive canoe club, but they don’t have a shack, just a couple storage containers. Molokai Canoe Club has been run by generation-after-generation of paddlers. When one generation of the Rawlins family ages out of the daily operations of running a canoe club, the next generation takes over. As with any respectable canoe club in Hawaii, they have a koa wood canoe. Here, with the time I have to write, and with your limited attention span, I cannot properly explain the great significance of the koa canoe. It is brought out for parades, big events, and only paddled during the most important races – the koa canoe is special, it’s spiritual. The major paddling events all have Koa divisions reserved only for clubs racing koa wood canoes.

Paddlers getting ready for the 2014 Kaiwi Channel crossing.

Molokai is a mecca for Outrigger Canoeing. The biggest interisland races in Hawaii either start or finish on Molokai including the Kaiwi Channel Crossing – 40 miles of open ocean considered the world championship of Outrigger Canoe Races. Being first time paddlers, we were relegated to the recreational group, very recreational. Whether we had 6 people to fill all the seats in the canoe was always up to chance. Luckily, the recreational group got together on the same nights as the Uncles. “Uncle” and “Auntie” are respectful terms in Hawaii – best compared to using Ma’am or Sir. The Uncles at the canoe shack were legends back in their day. The local bar, Paddlers, has pictures on its walls of all the old teams that had won races and competed in the Kaiwi Channel Crossing – younger versions of the Uncles were littered through the pictures on the bar walls. Many of the Uncles are serious about their Hawaiian heritage and still take their paddling seriously, but they are more of a drinking club with a canoe problem. The canoeing is secondary to the comradery and social gathering that takes place every Tuesday and Thursday night after a solid paddle. Being with the recreational paddlers on the same nights, Kate and I got to know the Uncles well. We’d often hang out with them at the canoe shack after our paddle where someone showing up with dried octopus (taco in Hawaiian) or some fresh caught raw fish was commonplace. Frequently, we would combine numbers with The Uncles to make a full boat of 6 people – or to complete 2 boats of 6. Those evenings hanging at the shack with The Uncles were the most Hawaiian times I ever had. Even having worked in Hawaii 4 times previously, there were a couple of the Uncles that I couldn’t understand with their thick Pigeon English. Over the months, we built up hours and relationships with The Uncles, at some point I began to understand them all easily.

The Uncles share a celebratory shot before sailing their canoe 60 miles to the North Shore of Oahu.

On two occasions, the number of paddlers and water conditions were just right so that the Uncles wanted to go surf a canoe. On the first time Kate and I did this with them, conditions were perfect. We paddled out to some flat water beyond the wave break and enjoyed some beers from a cooler in the back of the canoe before surfing. We paddled into some waves a few feet tall breaking on the reef and let them lift the boat, carrying us in quite a ways. We paddled back out and repeated. Surfing the canoe was a much bigger rush and joy than I ever had surfing on a board.

The second time I went surfing with the Uncles, only myself and one other woman from the recreational group had shown up, but luckily there were four Uncles there who wanted to go surf some waves. In the boat that day were a couple of the local Molokai-grown Uncles, Uncle Clayton and Uncle Russell steering the boat; Sully, a transplant from the North Shore of Boston via Colorado who was a very serious paddler who had come to Molokai specifically to paddle with this group of guys; And Marty, a long-time Molokai transplant from the West Coast who must have been completely nuts as a younger guy, because all the local-Uncles respected him. These guys have all paddled together for years, making channel crossings between island and continuing to sail canoes great distances in races throughout the Hawaiian chain. I was in good hands that evening.

Closing out the canoe season with a final race followed by a full afternoon party at the canoe shack.

We paddled out in a channel on the left of the waves past the sets of big waves coming in and breaking on the reef – much bigger this time around, perhaps 6 or 7 foot waves. We made the big righthand U-turn to align the incoming waves behind us and paddled like crazy, there was a lull in the surf and we failed to catch any wave. We repeated our moves – made another righthand turn, paddled back out past the big waves and once again made our approach. Again, nothing. We repeated this one more time, again failing to catch a wave. We rested and decided on one last attempt. As we paddled out the fourth time, huge waves rolled past us – 10 or 12ft? We made our turn into the set between two of these huge waves. Being tired from the previous attempts, we didn’t get enough speed and ended up surfing IN the wave instead of ON the wave. The boat filled with water and the 6 of us were left sitting ducks with the walls of the canoe submerged underwater. We remained in our seats, water level at our waists and paddled like crazy with every ounce of energy to avoid the next oncoming waves. Somehow, we got out of the path of the breaking waves, back to the deeper water and had to get out of the boat to dump the water out. This dumping maneuver, rolling the canoe onto its side, got about half the water out of the boat and got the top of the canoe up out of the ocean – the rest of the water would have to come out through frantic bailing using hands, paddles, and two 1/2 milk jugs that had come with us for this exact purpose. As we all exhausted from swimming and bailing, someone noticed we had drifted back into the break. Another 10ft set was approaching off the right side of the canoe and it was time to GO! Everyone scrambled to get out of the water, into our seats, and paddle like our lives depended on it to get out of there. Maybe our lives did depend on it. We paddled like crazy and as the big set rolled in, our boat was gently lifted and dropped off the edge of the first wave as we scooted out from its path. I continued to bail the remaining water as the others paddled our soggy canoe and crew back to shore. I later learned that if that set of waves had caught us, we would hardly have been the first canoe to sink on that reef.

We skipped drinks and snacks (pupus) after that particular paddle. But out there, a half mile off shore, swimming around a sinking boat in a bad situation, I had a memorable experience with the Uncles. It wasn’t the kind of situation you could (or would ever want to) manufacture, but for me it was so unique. This was hardly the Uncles first time in that situation, but it was an experience I will remember forever.

The canoe shack was special, and I will remember it fondly. From sending racers off to open ocean races, to the big bash at the end of the canoe season, to near-catastrophe on the reef, to the simple evenings with the Uncles sharing pupus and Natty Light – the canoe shack left me with some of my favorite memories that leave me yearning for a return to Hawaii. Someday we’ll get back, some day. If you ever make it to Hawaii, join a local canoe club.

A quick video I shot one night out on the water paddling:

Reykjavik Marathon Supporting Challenge Aspen

I’ve long know Aspen is where Kate and I would eventually settle when we were finished with our lives as traveling physical therapists. We’ve been working here for the last 10 winters and have established a community of great friends around us. For several years, I’ve been patiently waiting to run the summer trails around here. There’s a great paved trail tracing along the old Rio Grande Railroad that stretches up and down our entire valley. There are hundreds of other trails shooting up every peak and valley. Until now, I haven’t known any of the summertime trails, but I’m quickly learning.

Over the past several winters, Kate has been working in a slopeside clinic on Snowmass Mountain where ski patrol brings in the injured directly from the mountain. (Fun fact, the rate of injury in recreational alpine skiing and snowboarding is 2-3 per 1000 ski days. Meaning for every 1,000 skiers on the mountain, you’ll have 2 to 3 patients.) Kate is able to offer her help to Ski Patrol managing on-slope injuries in between scheduled outpatients coming specifically for PT – it’s a very cool practice setting. Also based in the base village at Snowmass is Challenge Aspen, a charity that provides really exceptional outdoor recreation experiences for the physically and cognitively challenged. Over Kate’s time in Snowmass, she has gotten to know much of the Challenge Aspen staff and has learned about the work they do. One big event they do every year for their annual fundraising is a marathon, typically held in a different country. When I was thinking about a lot of running this summer, and Kate was hearing from her Challenge Aspen friends that the marathon will be in Iceland this year. We knew we had to consider the trip. With a new house, a new baby, and establishing a new summer routine in Aspen, we have a lot on our plates, but the opportunity to travel to Iceland while supporting a fantastic cause is too much to pass up. The $3,950 goal that each runner must raise will be a challenge, but I know we can do it and hope to exceed that goal.

I have known Challenge Aspen primarily for their adaptive skiing and snowboarding opportunities. Certified Adaptive Instructors are out every day of the winter teaching skiing and snowboarding to participants in Challenge Aspen’s programs. But, much like the summer trails in Aspen that I am learning about for the first time, I am beginning to learn more about Challenge Aspen’s summer work as well. What they do on a daily basis for skiing and snowboarding in the winter, they do for horseback riding, rock climbing, river rafting, fishing, and hiking in the summer. One particular summer program that stands out to me is a retreat for female service members through the Challenge Aspen Military Opportunities (CAMO). The retreat focuses on yoga, meditation, and counseling for veterans who experienced sexual abuse while serving our country. The retreat is just one of a great variety of programs and retreats that Challenge Aspen provides, but it’s unlike anything else I have ever heard of – very, very powerful work. The breadth of what Challenge Aspen does is too much to list here succinctly, and they do it with small staff and very low overhead. Challenge Aspen is not a large operation, but they involve hundreds of participants each year while remaining a very lean operation.

I hope you’ll consider joining me in supporting Challenge Aspen. They are truly a charity unlike any I have seen before. The results of their work can be seen on the faces of any one of their participants as they enjoy sports they never thought they would have the opportunity to enjoy. Please contribute whatever you are able by clicking this link or any of the logos scattered around this page.

Thank you and please feel free to comment with any questions you might have about Challenge Aspen or this fundraiser.

HoD/NEXT Wednesday Morning Run

A clearly typical Boston Sunset

Join me for a run in Boston this Wednesday. The run will be around 5 miles and at 6 AM sharp.  I hope to be back to the convention center at 7.

We will leave from the front of the convention center on Summer St and head through Downtown Crossing to Boston Common and the Public Garden, past the ORIGINAL Cheers to run along a stretch of the Charles River by the Esplanade and Hatch Shell. We will run past the Museum of Science, City Hall, and Quincy Market on our return to the conference center.

I’m from Boston originally, so I’m thrilled to be back running in the city – particularly along the Charles where I ran the majority of my miles when I was just beginning to run – I love that dirty water! I should be able to keep us pretty close to the intended path, but if you’ve looked at a map of Boston, I think you’ll understand if we go a tiny bit astray. It’ll be an adventure!

I’m currently training for the Reykjavik Marathon which I am running with Challenge Aspen, a nonprofit that provides adaptive outdoor recreation for people with disabilities of all kinds – skiing and snowboarding in the winter, and a huge variety of activities in the summer. Please consider a $10 donation to Challenge Aspen: bit.ly/2pymexC

Join me! It will be a fun way to see a big chunk of the city on foot!

Update: A great run! Thanks to everyone who joined. I’ve shared some pictures below.

Samuel Adams statue in front of Quincy Market. The ocean front was at this location in the past. Fanuel Hall was Boston’s version of Ellis Island.

Love this dirty water. The Charles Rivah.

Boston City Hall

The ORIGINAL Cheers. The actual pub the TV series Cheers was based on. 5,000 points if you know the name of this pub before they recently changed it to Cheers.

The Hatch Shell and Esplanade

The Holocaust Memorial and the old State House building peeking out.

 

Traveling Therapist Q&A: Considering Travel

This recent post on the discussion board from a new traveler had so many good questions in one place that I thought I would take the time to answer a little more in depth and share the dialogue more broadly. I hope this helps other therapists who are new to traveling!


I’m a Respiratory Therapist with 5 years of experience and am considering doing Travel Therapy for a few years. The thought of traveling to new states and having increased income is very attractive. However, I do have a few concerns that I was hoping someone with experience could assist me with.

Housing/Insurance

On paper, it appears traveling is a tremendous increase in pay versus permanent jobs and with allotments boost the net even further. My question is if I elect to have housing provided to me and to have health insurance coverage, does that negate the increase in pay? To those who have traveled before: where else could you live short-term (3-6 months) and come out ahead instead of electing to have housing provided?

Yes, taking health insurance through your employer and allowing them to place you in housing will cut into your hourly pay. Insurance will only minimally cut into your pay. For most of my time traveling, I carried my own insurance and was only able to get $1 extra per hour worked into my contract. So, figure $1/hr out of your contract for insurance,

There are a lot of different options for housing, and in my opinion, taking the housing assigned by the agency is the worst option. If you do take housing through the agency, as I did on my first travel assignment, you will find it very convenient. The agency will arrange a nice apartment for you with furniture, ready to move in, but it will cost you considerably. It will take a little more footwork to find a furnished space on craigslist or by looking up local classified ads in the community you are headed to, but you will be able to choose a living space in a neighborhood of your choosing, and you will likely be able to beat what the agency will charge you for housing.

The camper I lived in on Martha’s Vineyard. We had considered a houseboat initially…. maybe next time.

The final, more eccentric option, is living in a camper. A lot of people who plan to travel for a a while in temperate places take their whole life on the road with them. This can also be a more convenient option for travelers with pets. If this appeals to you, the facebook group Highway Hypodermics can be a great resource.

Taxes/Reimbursement

If I work in multiple states as a traveler, are there any tax exemptions? I don’t want to owe a great deal at the end of the year. Will I be reimbursed for travel, new licenses, uniforms?

One of the main benefits as a traveler is the tax free monies you can receive. First is your housing stipend. If you don’t take the agency’s housing, they provide you a tax free stipend – hopefully you find housing for less than the stipend so you can pocket the rest of the money. The second main source of tax free money is your per diem. The IRS regulates both the housing stipend and per diem – a cap is set on each by cost of living in the area code you are working in. If the per diem or housing stipend is low compared to your hourly pay, there may be an opportunity for you to negotiate some taxed hourly wage into a tax free category. It’s one way to maximize your take home without too big of a hit to the agency. However, too low hourly pay compared to your tax free monies can be a red flag for an IRS audit of your employer, so many agencies will have a limit to how far they will push that barrier. With all of this said, income tax laws vary wildly by state and you may find you owe states a certain percentage of your earnings at the end of the year – but this only applies to your taxed hourly wages, not your tax free money. 

It’s good to ask for any potential reimbursements prior to signing your contract. Licensure fees are typically reimbursed. You will usually get a set amount for relocation – anywhere from $500 to $2000 at most (another good area to target for negotiations to squeak in a little more money. I’ve never had uniforms reimbursed, but it sounds like a very reasonable item to ask your recruiter for reimbursement on.

I’m an adult RT therapist with experience in acute and an LTACH, are the opportunities less if my Peds experience is limited?

As long as you are open to new experiences and settings, I think you will find your options wide-open. Traveling has been a wonderful way for me to gain experience in settings I otherwise never would have worked in. After a couple of assignments, my breadth of experiences had expanded greatly and even more opportunities were available to me. After those initial experiences, I could confidently step into almost any setting.

Cancelled Contract

Has there ever been a time when a contract is rescinded prior to start? In that case what does the company do?

I have never had a contract cancelled in 10 years of traveling – except for one time when I broke my arm and couldn’t work. However, it does happen. That is the main risk in traveling and you just have to be willing to roll with the punches and be flexible to adapt. Typically, there is a clause in your contract that allows you to leave a contract with 30 days notice, but you do not necessarily receive the same protection from an employer cancelling the contract (ask your recruiter about the policy for your company). Typically, a facilities staffing needs are well thought out. They don’t hire a traveler unless they need one. If you are a good employee and good fit for the facility, you shouldn’t have to worry about your contract being cancelled.

Recruiters

Since I have a lack of experience in traveling, I also don’t know which companies are the favorable ones. Any suggestions?

I’m going to refer you to this blog post on your first travel job for a couple tips on selecting a recruiter. Basically, if you don’t feel well taken of, move on to another company. There are many, many agencies and a lot of them recognize that the clinician is the commodity. Without us working, willing to take travel jobs, there would be no travel industry and there would be no recruiters – find one that’s willing to make you feel needed.

Surfing Waikiki after work one day. Traveling therapy is the best thing ever.

Overtime

Can you sign up for overtime?

If you are considering overtime, take that into consideration when arranging your contract. Typically, overtime is paid at 1.5 times your regular hourly rate. However, your hourly is going to be pretty low because of all the tax free money you will also be receiving. On one job, I knew I would be working some overtime, so I was able to negotiate a flat rate for any overtime hours to make sure I was making reasonable overtime pay for overtime hours.

It is really going to depend job-to-job on whether overtime is available – make sure to ask during any interviews you have.

Overall, I’d like a good experience and to be able to earn enough to pursue my dream location. I just want to know it’s worth it.

Traveling therapy is awesome. Pay can vary greatly place-to-place. Just weigh your priorities and if getting out and seeing new states and facilities is one of your priorities, then travel is definitely for you!

For other therapists trying to figure out where to start, this link is a great place to get started with travel therapy. Also, don’t forget to follow HoboHealth on Facebook and on Twitter @HoboHealth.

Search With One Travel Recruiter or Several?

Introduction

HoboHealth:

When I first started traveling, I worked with just one company, I had steady health benefits, I would accumulate PTO, and I even got a free wifi printer as a loyalty bonus. The printer was too big to travel with, but I still use it when I have it with me. The company I worked with initially has big name, and they were always able to find me a job. But, when I started looking around, I realized the deal I was getting might not be as good as I thought. Other companies were offering me as much as $200 more per week for similar jobs and seemed a lot more attentive to my needs. $200, that’s one wifi printer per week! That started me down a path of searching with multiple companies about 7 or 8 years ago.

The Vagabonding DPT:

I started traveling about 2 years ago as a new grad.  I was fortunate to have a Travel PT mentor who set me up with my current recruiter.  Yes, that’s singular.  I have one recruiter.  I know that the majority have multiple recruiters, but for now, having one recruiter has helped me build my career as a physical therapist. My recruiter is fully aware of my abilities, professional goals, minimum pay rate, and setting preferences.  He’s submitted me for positions that I may not “qualify” for (i.e a requirement of 5+ years for a job assignment) because he was confident in my skills and that the position would be a perfect fit for me. Even as a new graduate with my first assignment, I’ve stood firm on negotiation of time off as well as pay rates.  I got exactly what I wanted because I had a recruiter who was willing to negotiate those terms on my behalf.

What are the advantages of having one recruiter vs. multiple recruiters?

HoboHealth:

Compare pay rates between companies. It becomes clear very quickly whether what you have been making is competitive with other companies’ rates or not. Knowing what other companies are able to pay you in a given area can be a great negotiating tool if you do decide to stay with just one company.

Different companies have different jobs. You will see many of the same jobs posted across most agencies – the jobs that are the same across agencies are all listed on databases that many facilities contract with to fill their jobs. The databases sell subscriptions to the staffing agencies to have access to their jobs (the databases also charge 3-4% of the total contract price to the recruiters). To beat this system, agencies have gone out of their way to make contracts to exclusively staff particular facilities. So, it is possible that you can’t find a job in a particular area because you aren’t looking with the agency that has an exclusive contract with a facility in the area. Also, some agencies rely solely on what comes across the databases; Other companies are willing to call around for you. All recruiters will say they are willing to canvas an area for you, but less will actually do it (the smaller agencies tend to be more willing to put in the footwork of tracking down novel contracts). Broadening your agencies, may open up additional options.

The Vagabonding DPT:

Each travel company provides different perks the more time you spend with them.  The benefits listed below are solely representative of one company:

Paid Time Off: My company provides paid time off for 40 hours after working 2,080 hours and 1 year with them.  A travel therapist would be free to cash out that PTO to fill any requested time off during an assignment or in between assignments. From that point thereinafter, you accrue some PTO for every hour you work.

New Grad Bonus: A new grad who works 3 consecutive contracts with this company will earn a $1,000 bonus.

Continuing Education Bonus:  When you’ve stayed with this company, you receive $400 of continuing education credit valid also for conferences such as Combined Sections Meeting or NEXT.

Less Paperwork: Every company has a set of protocols that they must follow to be compliant with TJC including BLS certificate, licensing, NPI number, vaccinations, physical exams, TB tests, drug screen and physical examination. In addition, each company will have a mound of paperwork in regards to the company’s policies and procedures about expectations, benefits, clinical competency, etc.

Staying with one company allows you to focus on what you need: less paperwork and more time to invest in your passions and interests.

Health Insurance: If you choose to go with one company and choose to go with their health insurance, you won’t have to worry about switching health insurance companies.  Travel PT companies will typically allow you a 30 day grace period in which you will be covered by the company while you’re between assignments.

Consistency: Some larger Travel PT companies will bounce you around with various recruiters who manage a particularly region.  If this is the case, then you will have to take the time to let each recruiter know your preferences and want-list.

Do you feel there are any disadvantages to the approach you have taken?

HoboHealth:

The obvious downsides to working with multiple agencies are the benefits you don’t get for being loyal to one agency and the extra paperwork you do get – as April mentioned above.

If you do work with multiple companies, remember this cardinal rule: “You take a particular job with whichever agency offers it to you first.” Meaning, you can’t take an assignment offered by one agency, and tell a different agency about it to try to get a higher pay rate. Things can get sticky fast.

It takes some management to work with multiple companies. At one time, I was searching with 6 or 7 different agencies. One job came up and they had received my resume from multiple different agencies, each claiming I was “their guy”. While I went with the first agency to present the job to me (the only agency who had permission to submit me for the assignment), another agency bullied the facility into only accepting my interview through them. I was unable to go with the agency I liked best and who had presented me the assignment first. It was embarrassing and it’s why I now limit my searches to 2 or 3 agencies. When you are working with multiple agencies, you have to be clear that you need to be contacted before being submitted to a job, otherwise you may end up in my situation with companies bickering over ownership of you with the facility – it’s embarrassing and a good way to blow the interview before you even have it.

The Vagabonding DPT:

As James mentioned above, working with one company requires much trust in one person to provide you with the best pay rate, location, and setting.  By doing so, you may limit your options for future possibilities.  You must trust that your recruiter is negotiating the terms of your contract to the best of his/her ability to provide you with the best overall package.  To decrease this, you could also ask other Travel Therapists about their pay rate for that setting in that specific region.

The same facility may be working with several travel recruiting companies to fill a need. So when you work for multiple companies, you may be offered the same position via two different companies which can actually work against you. In the end, you may not end up with the assignment.

Conclusion

We present you with the advantages/disadvantages to assist you in making the best informed decision for your travel career path.  We’ve each done our research to negotiate our contracts.  Stay informed and ask around.

This is the second blog HoboHealth and The Vagabonding DPT have done together, you can link here to our first blog together about whether or not to travel as a new grad.

Check out our websites: www.hobohealth.com and www.thevagabondingDPT.org. Follow us on Twitter @HoboHealth and @AprilFajardoDPT. Finally, follow our Facebook Pages to keep up on our latest blogs and what/where we’re up to: HoboHealth and The Vagabonding DPT

 

PT Compact Update – The first 10 are in!

The PT Compact is no longer just a dream of travelers – it’s happening! Washington State’s Governor just signed the PT compact into law making Washington the 10th state to adopt the compact. Before you go on reading this, take a look at the current status of states working on adopting the compact: https://www.fsbpt.org/FreeResources/PhysicalTherapyLicensureCompact.aspx

Ten states and counting!

The compact needed 10 states to go live. The compact commission will now be formed which will develop and maintain the specific rules and regulations for the compact. With 10 states having adopted the compact, it is now a reality – but, there’s another 8 states currently considering the compact in their legislatures. I assume licensure reciprocity between compact states will be a reality sometime during 2018 – only a guess. I also suspect that by that time, we will be somewhere in the neighborhood of 25 to 30 states participating in the compact. If the states that aren’t yet talking about the compact haven’t realized it yet, they are going to be at a big disadvantage for recruiting PTs to their states. This will be especially true in states with less PTs graduating from programs than the public demand for PT; There are very few states that are able to supply their full PT workforce independently. If your state is not pursuing the compact yet, get on it! States not involved with the compact are going to be losing PTs to compact states that allow licenses to be easily transported across state lines.

I’m psyched. I first started letters to FSBPT in March of 2010 suggesting improved reciprocity between states. Later that year, in October, FSBPT leadership charged their Board of Directors with researching the development of an interstate licensure compact – coincidence? I’d like to think not (so I can take credit for the whole thing), but I guess we’ll never know the full truth. Although, Rachel Jermann reached out to me this week with a quote from Lucy Blair’s 1971 McMillan Lecture, “Several recent studies have contained challenges that licensure and registration on a state basis are barriers to the movement of personnel from state to state and are handicapping adequate distribution.” …I guess we’re all about 45 years late to the party.

Colorado HB17-1057 PT compact testimony #coleg

Me testifying to the House Health, Insurance, and Environment Committee sitting next to Rep. Larry Liston who sponsored the PT Compact bill. Picture taken by and stolen from Cindi Rauert. P.S. Cindi is killing it in PT Advocacy (twitter: @cindirauert)

As I have pushed for the compact to be pursued here in Colorado, I have learned a lot about the legislative process. Here in Colorado, the compact legislation was introduced to the house of representatives in January. In Colorado, a bill can be introduced to either chamber of the state congress (House or Senate). Once it passes one chamber of congress, it then progresses to the next. Most states have a similar system. Depending upon the content of the bill, it is required to be reviewed by particular committees in each chamber. I got the chance to testify before the “Health, Insurance, and Environment Committee”. I have long looked forward to doing this kind of work, but lacked the passion for any one particular topic. The compact gets my juices pumping – it hits close to home with travel therapy and I feel like I’m very well versed in the topic of interstate PT licensure. Describing my experiences with licensure in travel PT to the committee of 11 state representative was both very rewarding and extremely terrifying. I was well prepared, which got me through, but I became very, very nervous while testifying despite all the very nice things said about PT by the Representatives on the committee. We can’t forget that our profession touches many peoples’ lives, including politicians. I suspect with repetition in testifying my nervousness will subside, I hope I get the chance to continue this kind of work in the future.

There were a couple other PTs testifying that opened my eyes to the PTs and patients outside of the traveling world that will benefit from the interstate compact:

  • Military families who move often without warning would benefit greatly from improved licensure portability.
  • PTs entering telehealth are running into licensure issues because: Are they practicing physical therapy where the PT is located? Or where the patient is located? The answer to this question is unclear at this time.
  • Newly graduating PT students who are at school out of their home state and are unsure of where they will practice – stay and practice where they are in school or return to their home state? These students would be helped by being able to more freely take their license between states.
  • And, of course, let’s not forget all of the employers and, most importantly, the patients who would benefit from having easier access to PTs, especially in rural communities where PT recruitment can be difficult and on state borders where an available PT may live just a few miles away but be limited by the lack of state reciprocity. (see other letters of endorsement from other businesses, consumer advocates, and policy organizations)

So what are the arguments against the PT compact?

Apparently there aren’t many, since the compact is bulldozing its way across the country. It just makes good sense that in this time of internet and air travel that PTs and PTAs should be allowed to transport their licenses across state lines more easily – I think state legislators see that practicality. It is easy for them to see that increased license portability is good for therapist, patient, and business alike.

But, there are a few legislators that do vote against the compact. Let’s entertain for just a minute that there might be significant opposition to the compact (which there is not). I can think of two reasons passing the licensure compact might be opposed:

  1. The 10th Amendment to the Constitution protects states’ rights to govern licensure within their borders. There could be a perceived loss of individual state control through the compact. Although, the way the compact is set-up allows a state to repeal the compact legislation at anytime to return to their individual governance of PT licensure. Also, this is the way driver’s licenses work – a driver’s license interstate compact is what allows you to drive across state borders. Compacts are nothing new.
  2. Cost. There can be some costs with implementing the compact. It requires fairly strict licensing standards – background check, finger printing, etc which can cause cost to the state or increase the cost of being licensed. Some states are simply absorbing this cost through increased licensure fees. The way I see it, the compact would remove a host of administrative burdens which, in turn, would increase efficiency and recoup cost from the current antiquated, cumbersome process.

I’m so excited about the compact. It’s a system I have pictured for many years and believe it will tear down one of the great barriers travel PTs and PTAs face. I foresee the states that are involved in the compact will become prime-targets for travelers while the non-compact states may struggle to find the temporary and permanent help they need. So, get your state in. I don’t care if it’s your home state, the state you are working in, or the state you are at school in. Start talking about it to people in your state that can create legislation and make it happen.

I’m excited to have been a part of the process here in Colorado but would like to do more. For now, I’ll do everything I can to keep moving the PT compact forward and make sure it passes here – we’re getting close. Working on this topic that I care about and know deeply is a great first step to being more involved in PT legislation. State legislatures are ultimately the gate-keeper for a patient’s ability to access our full scope of practice in each state. We need to continue to demonstrate to them the commonsense quality and cost-effectiveness of the services that Physical Therapists provide across the country.

Tax Time, Again

Crunch time. Taxes are due very, very soon. No matter how much I work throughout the year to be prepared for tax season, it still takes hours to get everything organized when April rolls around. Don’t let me fool you, Kate’s the one who handles the finances around here – very smart of her. But, every year, I hope taxes will be painless, they never are. It is an awful, dreadful process, and being a traveling therapist does not help simplify the matter. I hope you’ve filed your taxes already, but if not, here are a few tips that will help make your tax season a little less painful:

Hire someone who specializes in taxes for travelers

An actual bill I received from the IRS in the middle of writing this very blog…. apparently we made a mistake two years ago. Whoops, my bad.

Having someone do my taxes who understands health care travelers and their financial arrangements is priceless – actually, it’s only $300. A traveler’s taxes are complicated. I work in multiple states each year, have a rental property in Maine, live in Colorado, occasional work as an independent contractor, and receive a lot of tax-free money each year. In my first years of travel, I tried using TurboTax, which charged me a lot of money for all the extra forms I needed. I also tried using someone at H&R Block – he said he could handle my taxes, but clearly had no idea what he was talking about when it came to travel stipends and reimbursements. Hiring a professional who can handle all the moving parts of travel therapy is money well spent.

A quick Google search will find a long list of people who specialize in taxes for travelers. Searching for “travel nurse tax preparation” yields the most results. A tax professional who specializes in travelers should also be able to help you answer all the questions you likely have about your tax home. A good tax-guy/gal should also be able to advise you of the things you can do in advance to help secure your tax home status in the event you are eventually audited. Speaking of which, make sure you ask any potential tax preparer what their responsibility is in the event you are audited. A few tax professionals warranty their preparations so that an audit is done on their time, others will charge you an hourly rate to defend your audit on their preparation.

Track your mileage

It’s easy, but few actually do it. Just keep a memo-pad in your glove box and write down any mileage that pertains to work – for 2016, you can deduct 54 cents for every mile you drive. It’s that simple.

Mileage you can include in your deduction:

  1. Mileage driving between assignments.
  2. Any driving between clinics or other work locations.
  3. In home care, all mileage between the office and patient visits can count towards your deduction.
  4. People living in permanent places commuting to permanent jobs are not allowed to deduct their commute mileage. However, because a travel work-place is temporary, I believe we are allowed to deduct the mileage on our commutes. That mileage can really add up! (You may want to see what your tax professional before committing to this one.)

The exception to the above categories is if you are already reimbursed for your mileage, you cannot claim it as a deduction on your taxes. For example, if an agency reimburses you specifically for your mileage to relocate, you cannot then deduct that mileage from your taxes. Similarly, if you are paid per mile in home health (which I recommend you do negotiate into any home health contract), you cannot claim that mileage. Although, with a federal deduction of 54 cents per mile, if your job reimbursed you less than 54 cents you can claim the remainder. These little bits do add up to a deduction that could make difference over the course of a year.

Keep track of your tax deductible items throughout the year

We have a big envelope that we put receipts in throughout the year. We keep track of the costs of various trips, the price of continuing ed courses, the price for APTA membership, and anything else that could be tax deductible. Frequently we make notes right on the front of our large tax-envelop so when tax season rolls around we aren’t spending hours trying to find the prices we paid for deductible items – this is where the majority of tax-prep time goes in our household. If you can truly be disciplined and keep track of your work-related costs throughout the year, tax preparation is far less painful when tax day comes.

Keep your tax records available to you, wherever you are

We have a fire-resistant file box that always traveled with us. It had everything important in it including our old tax records. The firebox is really heavy, maybe 20 pounds when empty… 35 pounds when full. It never fit quite right behind the front seat of the car on roadtrips. It basically has always been a pain to manage.

In the age of online data, it makes much more sense to scan all of your tax documents into the computer and store them online. If you ever have your taxes questioned in the future, you’ll be glad you have a readily accessible copy of your tax return. There is nothing worse than receiving an unexpected bill or audit from the IRS and having your tax returns back home, hundreds of miles away. When you need proof of your returns, you want it quickly. The general rule is to keep tax records for 7 years, but if it’s all online, I see no downside to keeping them longer… indefinitely.

Good luck, may this tax season be easy on you!

The Big Settle Down

Kate driving our first camper, “Champ,” through Denali National Park. Champ was awesome and had so much character. I think our new camper, “Mabel” (named before us), will give Champ a run for his money.

Kate and I were travel PTs for over 10 years. We had a good run – no, “good run” doesn’t begin to describe it. We have lived all over the country, driving to both the East and West Coasts most years. We have lived in a camper on Martha’s Vineyard, explored Alaska, found serenity in rural Hawaii, and have accumulated over 500 ski days each in Colorado. We have had a great run.

We’ll be having a kid in about 4 weeks. When we decided we wanted to have a child, we weren’t sure if it would end our travel careers. Until even a couple months ago, we had a backup plan that included the three of us living in a camper taking short contracts all over the Western US – it seems a single traveler salary could stretch further than most permanent salaries. With travel pay, one of us could work while the other home-schooled the little one. We remained very undecided about whether we would stay in Colorado following the baby’s birth or see just how far we could take this traveling thing. We have a couple friends here in Aspen who are raising a one-year-old between Asheville, NC in the summer and Aspen in the winter – sounds pretty awesome, and with an established life in each place, very manageable. We had visions of a similar life… seemed reasonable.

So what gives? Life as a travel PT really has been living the dream. We never made a formal decision to stay here in Aspen – it just happened.

Over the years, we began returning to Aspen for winters yearly. We have long said if we were to settle down, it would be here. Over the years, we’ve casually looked at properties with a friend who is a realtor. About 3 years ago, we took snowmobiles to check out some land on the back of Aspen Mountain. It would have been awesome. (It would still be awesome) But, it would be expensive, and we would have to snowmobile to our house through avalanche terrain every day in the winter – not the most practical set-up. There’s been a couple other things we’ve casually looked at over the years. Within days of showing up in town this December, our realtor friend insisted, “Hey, there’s this house you should really check out.” We dilly-dallied, didn’t pay much attention, and again, “Hey, there’s this house you should really check out.” Within 2 weeks of returning to Aspen this winter, we were under contract on the house and have been working to buy it since.

Our first winter in Aspen, 2007. We figured we’d live slopeside, because “You only live in Aspen once. Right?” This was one of the many on-mountain fireworks shows that first year when we could stroll out our front door and watch. We certainly don’t live slope-side anymore, but we’re close enough.

It just happened. There was no conscious decision to stay in Aspen, but here I am sitting by my cozy wood fire typing, in my house, trying to process the fact that I’m not a travel PT anymore. The longest job I’ve held in the last 11 years was my first travel assignment that I extended out to 10 months. Before that, my entry-level PT program at Northeastern University was structured so that we were constantly rotating between a few months in class and a few months in clinic. The last time I did one consistent thing for over a year was high school! But, I guess it’s time to settle-down. All this came together and happened so naturally that I have to believe the timing is right and that it’s meant to be. I honestly see a lot of advantage to being in one place. There are definitely areas of my life where I’ll gain traction and finally be able to make some headway. Don’t get me wrong, traveling PT has been a dream-life and I can’t picture doing anything different with the last 10 years. One sign of more stability is that I’ve already committed more time to the Colorado Chapter of the APTA. My first project is getting the PT licensure compact to pass here – clearly travel-driven idea.

So what now? I guess I’ll keep writing about traveling and the path-less-taken by therapists. I’ve learned a lot about traveling over the last decade and will continue to share what I can for as long as I can. I recognize that my knowledge and advice probably have an expiration date, maybe a couple years. You’ll likely start to see me taking on more generalized PT and rehab topics, but travel PT will stay central for now. In life, traveling is not even close to done. We recently bought a 1970 Shasta camper that we are going to put some serious miles on this summer driving through the mountains and into the desert. The mind-set in Aspen affords a lifestyle full of continuing adventure. Many of our coworkers routinely take 3 week international vacations – many of our coworkers and friends are of international origins themselves. I’d eventually like to see a large chunk of the globe, but Australia, Japan, Iceland, and much of Europe stand out as places that I need to get to more immediately. A steady job affords the opportunity to increase participation in global-health projects and international service learning for which there are many opportunities in healthcare. Aspen has exchange programs with several sister cities (Bariloche, Argentina; Chamonix, France; and Christchurch, New Zealand to name a few of our sister cities). I’m not really sure what having a child, owning a home, and accepting a permanent job means, but it definitely doesn’t mean the end of travel.

Stay tuned, this is the start of a new adventure. A very different, new adventure.

Doubling Down on Non-Surgical Conservative Care

In recent years I have gone out of my way to educate clients, colleagues, and others on the success of non-operative, conservative care for a variety of conditions. The #GetPT1st campaign has been a big motivator for me and is a great resource for PTs wanting to educate those around them on the potential to avoid surgery for a variety of conditions through PT. In my own clinical practice, in a ski town, I have become somewhat obsessed with the idea that the majority of clients with ACL tears should be put through a mandatory 6 week waiting period before electing surgery. Here, the tendency is for skiers to elect immediate surgical reconstruction for their ACL-deficient knees. The thought is “surgery will add stability and decrease the likelihood of premature arthritis,” “skiing is different than other sports, you need an ACL,” and “our population is just different here, everyone is extremely active.” I have been fighting these misconceptions for a couple years now, but change is slow – some of my PT colleagues still don’t buy that there is a percentage of people who can live an active, fruitful, physically elite life without an ACL (if you guys are reading this, I will get you eventually… you’ll see). I think the idea of the active non-surgical ACL is gaining some traction – if not yet with the medical community in town, at least more patients are starting to self-select a waiting period before surgery. Just to be clear, evidence tells us that there is a significant percentage of the population that can return to full function without an ACL – this percentage includes division I athletes and downhill skiers. Studies have specifically been done on ACL deficient elite athletes, there is a significant percentage who return to sport without an ACL – in fact, for those with a well informed sports medicine team, the non-surgical option can be a quicker way back to competition. Repairing your ACL does not decrease your chance of early arthritis – the life of a knee without arthritis following ACL reconstruction is about 15 years according to the literature. So there. People just don’t want to be patient and do 6 weeks of strengthening for a less than 50% shot at avoiding surgery – hey, if that’s the choice they want to make, I don’t really blame them…. But I feel strongly that they should be accurately informed.

We’ve had a couple injuries in the Spencer household lately and we’ve had to choose conservative care over surgical intervention.

Here I am pressing my thumb into the counter to keep it extended while I work to re-tape the splint for support. The morning ritual takes longer than you’d think and has evolved to my using 10 separate pieces of tape each time.

I had an unfortunate water polo accident (said no one else ever). Goofing around between actual play, I had a shot blocked and my thumb went tip first into a swatting palm. I immediately knew something wasn’t right – I instinctively grabbed my thumb. There wasn’t much pain at all, but I had heard a small pop and my thumb would no longer actively extend – I could easily push it straight with the other hand, but could not hold it there without assistance. I don’t do a lot of hand therapy (I’m spoiled by having some great hand therapists around me), but I knew enough to know immediately that some sort of tendon no longer existed. The next day, I got bootleg-assessments from one of our talented OTs and a trusted Orthopaedic Surgeon next door – the good doctor diagnosed mallet thumb. Mallet thumb? “Yes, it’s mallet finger but in your thumb,” he said frankly. This is not common. The extensor pollicis longus tendon is broad, thick, and fibrous – it doesn’t usually rip. Because it’s relatively rare, there’s not a whole lot of research on mallet thumb – but I did find some case studies. It seems I could surgically have a pin put down the length of my thumb bones for 8 weeks and have a return of most of my thumb extension pretty much guaranteed …or… I could wear a splint on my thumb for 8 weeks – no bending the thumb, ever. I can take the splint off to clean the thumb with the tip pressed against a counter-top for extension, but if the thumb bends, the 8 weeks starts over. Most people do well with the conservative treatment, but full return is not as guaranteed as with surgery. I figure with a small army of OTs, PTs, and Orthopaedists at my disposal, I should do well – we’ll find out in about 3 more weeks. The idea with both the surgical and conservative treatments is that the tendon will scar down to the bone wherever it is – hopefully it scars down somewhere useful. I’m just happy that I’m able to keep working, and, more importantly, continue skiing.

But my little thumb injury has been put to shame by Kate who went out and tore her ACL. I need to pause here and quickly explain that Kate is pregnant and we are excited to be adding a baby girl to our gypsy caravan in April! So, needless to say, many exciting changes ahead. I’ll do a separate blog soon about how this will affect our traveling life – for now, let’s stick to the current topic.

Kate had been skiing cautiously and picking her ski-days judiciously. She was simply coming to meet me for breakfast on the mountain and for one ski run. She was skiing on a wide open run 5 minutes after the mountain opened when she was clipped by another skier. The fall wasn’t bad, but it was enough to tear Kate’s ACL (no other injuries to momma or baby). After struggling through our planned breakfast, we called ski patrol, and Kate got a ride down the mountain.

What we have here is a situation where we have no choice, Kate won’t be having surgery (at least not until after the baby is born) – we must try our luck at conservative management of Kate’s knee. Although, I did receive a call at work this week from another pregnant woman in town who had torn her ACL. She had tried skiing on it again already, but “it didn’t feel right” so she stopped. Her OB, suggested that she should have the ACL repaired soon, so she would avoid crutches while super-pregnant or while caring for a tiny baby. I guess it just goes to show the persistence of the myth that an ACL is absolutely necessary.

Anyways, Kate’s knee swelled up pretty big and there was some visible bruising. Kate did get an X-ray just to make sure there is no fracture. As we have progressed only a few weeks from the injury, Kate has started formal PT with one of our coworkers and she is already hiking lightly without a brace. So, she’s doing all she can do and hopefully when this summer comes, more vigorous hiking is not a problem. Perhaps next winter, she will ski comfortably without an ACL – her early success at walking without a brace seems encouraging.

Onward we both go. We’re doubling down – no surgery here unless we absolutely need it. Surgery is, and should always be, a last resort.