Open Letter to the PT Compact Commission

The Physical Therapy Compact is marching forward which is good news for a lot of PTs and PTAs currently practicing in compact states. But, by my interpretation, the currently proposed rules which will be voted on next weekend leave a lot of therapists who could utilize the compact out in the cold. Basically, therapists who call any compact state their permanent home will have access to compact privileges, but therapists hoping to access the compact whose permanent address is not in a compact state, or who have no permanent address at all, will not be able to take advantage of the PT licensure compact.

Here is a ink to all current info on the compact including the proposed rules and info on compact commission meetings: http://www.fsbpt.org/FreeResources/PhysicalTherapyLicensureCompact.aspx

Enough of an intro – Below, you will find the letter I have written to the PT Compact Commission about my concerns regarding the new rules and my ongoing concerns about the suspension of Colorado from the compact.

——————————————-

The most current PT Compact map from FSBPT.org. At the start of the new legislative cycle this winter, more states should be introducing the compact.

To Whom It May Concern,

I write from a point of frustration today, but hope that my comments can be productive to the process of developing a compact system that is available and useful to as many Physical Therapists and Assistants as possible.
First, just a brief background on me to help you understand my view points and my frustrations. My wife and I worked as traveling Physical Therapists for 10 years, over that time we held licenses in 7 states each (8 states total). Our permanent address changed frequently due to a variety of reasons including us each coming from different states individually, our parents living in different states, and a flow of life over 10 years that caused our permanent address to change independently of our federal “tax home” address which also changed several times. During my early years of traveling, I was based in Massachusetts, that later changed to Florida, Maine, and Colorado. For several of those early years traveling, I was the lone PT sitting on FSBPT’s Exam Administration Committee. Because of those experiences within with FSBPT, in 2012, I felt at liberty to write a few emails to FSBPT about developing some sort of national licensure registry – later that year, FSBPT leadership had its first conversations (that I am aware of) about pursuing what would eventually become the licensure compact. Earlier this year, my wife and I, now with newborn, settled permanently in Colorado where I made the case to my local APTA leaders to pursue the licensure compact and later testified before state legislators in support of adopting the compact. Over the past several years, I have offered to contribute to the compact development process through FSBPT and also through APTA where I have served in a number of leadership positions through Sections and Chapters, but I was never offered any real opportunities to take part in the compact development. To this point, I have not found the process transparent or easily accessible, so a phone call or a couple emails may be all it takes to explain commission processes and ease my concerns which are listed below.

1. My biggest and most predictable concern is regarding the suspension of Colorado. My information regarding the suspension came to me through asking questions to people who were closer to the initial compact commission meeting and reading the meeting minutes – it seems the initial decision to suspend Colorado came following an executive session and did not consist of much open, transparent conversation. In the months since, I have tried to understand the suspension and am still left not understanding why Colorado would be suspended due to requiring additional consumer protections. I have read the compact commission statement posted on FSBPT many times and fail to see a comprehensive explanation or even an explanation that makes sense. It seems the stance of the commission is that Colorado should change its laws that govern all medical and health professions rather than the commission changing its rules to be more accepting of the variances in regulation it will undoubtedly run into as more jurisdictions become members. In my reading of the draft rules, I expected to find something that would resolve the Colorado suspension, but found nothing that would seem to indicate the commission is trying to reintegrate Colorado into the compact. In the past several months, I have been asked by many traveling PTs and Colorado PTs about the suspension, I have assured them that with time the commission will and must come to its senses and find a way to reintegrate Colorado into the compact. My faith that the commission would want to modify its rules to allow as many states into the compact as possible is being challenged now as months and months pass by. It seems that additional background check requirements would fall right in line with other variances that are explicitly allowed – differences in CEU requirements, differences in state fees, juris prudence exams – why not additional consumer protections? If the commission cannot resolve this small issue, then surely the dream of a majority of states being compact members will not become reality. Again, I have tried to access meaningful information regarding Colorado’s suspension, but it is simply not available – I would truly be happy with a more comprehensive and explanatory statement from the commission on Colorado’s suspension, provided that the rationale behind it actually makes sense.

2. In my reading of the draft rules, I came to a separate, but not unrelated concern regarding the definition of “home state”. As a long-term traveling PT, I may have a perspective that has not been adequately represented to the commission. Traveling PTs often do not have a permanent address, or they have an address that changes often. The definition of “home state” (Rule 1.1, I) and Rule 3.5, B, 2 seem to exclude any PT or PTA from the compact that does not have a permanent residence in a member state or does not have a permanent residence at all. It seems to me that this is EXACTLY the licensees you would want the compact to be open to. The traveling therapist community are the therapists who would most benefit from the compact. They also are undoubtedly the ones cluttering the desks of licensure staffs across the country. In my mind, “home state” should be defined by whichever state a licensee enters the compact through. To be clear, I should be able to live in a non-compact state, hold a valid license in any compact state, and have access to compact privileges. The current language does not allow this, I beg the commission to reconsider with my added view point – traveling PTs are exactly who would use the compact and exactly who clinics in member states want to be attracting to fill their needs. Just last week, while presenting at APTA’s National Student Conclave about careers in travel PT to several hundred students, I commented that compact states would become popular destinations for travelers and that there would high competition for the jobs in those states – with the currently proposed rules, this would not be the case. The current definition of home state means that only therapists originating from compact member states would be able to access compact privileges. Many of the member states that are largely rural will continue to experience difficulties in in filling open PT job positions, and all state licensure staffs will continue to be overburdened by the volume of work they are doing for travelers who could potentially have compact privileges if the “home state” definition were different.

3. Finally, my last point is a brief one, and perhaps one that just needs some clarification or explanation to me. Rule 5.1, C excludes anyone on the board of directors of APTA or any one of its sections, chapters, or councils to not be eligible to be a delegate to the commission. I’m frankly not sure what an APTA council is – is that any committee within APTA? It seems this rule excludes a large portion of Physical Therapists and Assistants who have any interest in policy making from participating in shaping and refining the commission. This is not a handful of PT leaders, but hundreds. Again, I may just need an explanation on this, but it is concerning to me that all leaders in our profession would be excluded from commission leadership.

There is one theme and commonality between each of my concerns, and it is about inclusion of as many therapists as possible in the compact system. So far, what I am seeing is a system that waits for states and individual therapists to comply with commission rules to be included in the compact, rather than a commission that seeks to include as many states and therapists as possible. For the compact to be a truly useful entity, it needs to be available to states to join and available to as many well qualified therapists as possible. I hope the commission will genuinely consider my view points and suggestions. And, again, I am happy to help and contribute to the process, I would love to offer more perspectives of the traveling therapist’s experience in licensure.

Sincerely and Respectfully,

Dr. James Spencer, PT, DPT
Orthopaedic Clinical Specialist
www.HoboHealth.com

Using Airbnb for Travel Therapy Housing

Through most of my career as a travel PT, I have used a couple simple ways to arrange my housing. Primarily I used Craigslist, but occasionally I would check the local paper classifieds. It seems weird in the digital age to be checking classifieds in the paper, but typically those listing are a different pool than the ones on Craigslist… definitely worth a shot.

This was the view behind the most recent Airbnb I stayed in… on a farm, in the back of a valley, in Iceland! Lot’s of cool options available on the airbnb.

I’ve written about using Craigslist in the past and it suddenly seems like Craigslist has become antiquated. With new technology and services, the coming-of-age of tiny homes, and people seemingly taking interest in paring-down their Earthly belongings to be able to get creative with their housing, it is time to update the way I think about temporary housing. I’ve often used Airbnb.com for weekends away. I have used it on trips between assignments. I have used it on the front-end of assignments to fill gaps while I look for longer-term housing. But I guess it’s time to start using Airbnb as a primary way to find housing on assignment.

Airbnb has changed the way we can all look for housing. People are building homes and apartments with areas specifically set aside for guests as an extra income stream. The variety in what you can find on Airbnb is endless. If you are into renting just a single room in someone’s house, they’ve got it. If you want a furnished place of your own, there are a lot of options. There are many houses and apartments on Airbnb that are set for 30 day minimum or longer which is perfect for travelers. It seems more and more travelers are depending on Airbnb as their primary go-to for lodging. With the ability to contact the owner ahead of booking, it also leaves open the option to make contact and create month-to-month arrangements – or arrange whatever works best for your travel schedule. People have also told me about their ability to negotiate down posted rates through contacting the owners – as a professional, don’t underestimate your value as a desirable tenant and your ability to drive down rent. Airbnb also has an option to search specifically for units that allow pets. FINALLY, a solid answer for all you people asking me about traveling with a dog.

Here’s the waterfall we hiked to behind the Airbnb we stayed in in Iceland. This waterfall is in the crevasse seen in the above picture. There are sheep roaming free all through the valleys and hills.

Tip: Actually read the reviews. These are a huge perk to Airbnb and can save you from committing to a less-than-desirable living situation. The reviews are one feature that makes Airbnb standout from options like Craigslist and the classifieds. Like your interview for any travel assignment, the reviews are your big chance to learn everything you can about where you are headed when you are likely going to have to commit sight-unseen.

The Downside: In the most expensive areas, Airbnb seems only to exacerbate the price rather than relieve it. I recently did searches in San Francisco, Boston, Honolulu, and Nashville for 3 month private housing (no bedrooms in someone else’s home). I found very few options less than $3,000/mo. In the majority of cities, you can find very reasonable options, but just be aware that Airbnb is only one way to find housing and you may have to consider other options if you aren’t finding what you need at the price you can afford. If you are willing to share with roommates, your affordable options open up considerably.

Alternatives: HomeAway.com is very similar to Airbnb, essentially offering the same service. It’s worth a look, but there tends to be less overall selection. I had hoped in expensive markets it would offer some more affordable options, but the prices seem to be on-par with Airbnb. The one great redeemer for HomeAway is the ability to search for more specific features and location of housing. You can even specifically search for properties like houseboats, cabins, castles, etc… it’s a pretty cool feature and the places are absolutely wild to browse through, but I don’t know how practical that is in reality for traveling therapist housing. Incidentally, I did come pretty close to living in a house boat on assignment once – I’ll just say that it has to be the right season in the right location at the right budget point for a houseboat to work out. You can probably rule a houseboat out as a reasonable option, but how cool would that be?

As a quick reminder, unless you are just getting into travel and want to keep it simple, take the housing stipend and find your own housing. With a little bit of footwork, you can save a ton of money finding your own housing and typically find it in an area more suitable to your own, unique taste. Airbnb is just one more tool for you to use in immersing yourself into the next community you work in!

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.