A Year of Firsts

2018 was my first full year living a settled life – not as a travel PT.

It has definitely been a transition – a transition that I might not be fully appreciating until now. Friends often ask, “Do you miss traveling?” I answer quickly, “Yes”. But, as I reflect, I realize all the things that have gone on in the last year. A lot of the things that I accomplished could only happen once I was done with the travel lifestyle. I loved my life traveling for work between ski slopes and beaches, but this year has been pretty special.

Violet charging around in the backyard of our family cabin in the foothills of Pikes Peak

This is the first year since 2004 that I have lived in one domicile for an entire year. Kate and I bought a house out here in Colorado almost two years ago. After months of DIY jobs and decorating, we are finally feeling a sense of home. Previous to this, we had briefly worked as permanent PTs before our 10-year stint as travelers. Before that, we had each traveled state-to-state for clinicals our final 6 months of PT school. …and prior to that, lived in a potpourri of apartments scattered across the segment of Boston inhabited by Northeastern University students.

I finally lived in Colorado long enough to get acclimated to the altitude. Many say it takes 2 weeks to get acclimated, I insist it takes more like 6 months to truly feel strong. I had grown up outside of Boston, but visited a family cabin in Colorado at 8,000 ft for just a week or two most summers. On most trips, someone got altitude sickness. Whether it be me, a family member, or a friend I had brought along, someone would puke intensely for about 24 hours, and then be fine for the rest of the trip. Now knowing what I know about altitude sickness, we might have approached acclimation a little more seriously.

This sign put up near an aid station about halfway up Pikes Peak made me laugh out loud. A bunch of rescue workers and volunteers were camping out around that part of the mountain… with a helicopter, just in case.

When I was a kid, my family trips to the cabin were usually during the last couple weeks of summer before heading back to school. We were often at the cabin during my birthday which is the same week as the running of the Pikes Peak Marathon. On most trips to the cabin, my family would drive up the “Pikes Peak Highway” to the 14,110 ft summit of “America’s Mountain”. On more than one occasion, we were at the top during the marathon to watch runners tag the 13 mile mark of the race, barely pause, and head back down. We all thought those guys were a bunch a psychos – who would want to do that? At some point along the way, I decided that I too was a psycho who wanted to do it – probably intense nostalgia and just a bit of hypoxia influencing that desire.

This year, I got to check the Pikes Peak Marathon off my bucket list. I was extremely excited and motivated during the whole process of training and through the marathon’s completion. The race went great! I took a relaxed approach and spent time getting food and water at each checkpoint. After resting a few minutes at the top to shoot some pictures, take in fuel, and have a small internal celebration, I soon realized many people were blowing past me to head back down to the finish line. I quickly rejoined the psychos for the 13 mile plunge back to the bottom. I am so happy to have had that experience. I don’t think I’ll do it again… but who knows.

Half way done. Feeling great taking pictures at 14,110 ft while this guy in the purple shirt and lady in the blue jacket both casually pass me and head back down.

I feel like staying in one place and stopping traveling finally let me make some headway professionally. I knew this would be a part of stopping travel, and it’s one small solace in losing several months near the coast each year. When I left my patients every 3-6 months, it was hard to find any sense of professional momentum. Now, working in one place for almost 2 years, I finally feel like I have some personal connection with my patients. I have people who come back every time they have an injury. I have malingerers who are constantly hurt and seem to never leave. I have doctors who expect me to be there for their patients. Most importantly, there is continuity – I get to see all patient cases to their end, and that has helped me grow tremendously as a clinician.

I still frequently joke about going back to travel, if only to make my co-workers uncomfortable, but let’s be honest, I have a house, I have a life here, and I have a kid – I am stuck!

Which brings about the greatest and best addition to my life – this has been my first full year with a kid. I can’t describe the happiness our daughter has brought. It’s a wild experience. At 1.5 years old, I’ve already been strapping her into skis in the backyard. She enjoys it for about 2 minutes, which is probably enough skiing when you’re one year old. People around here typically get their kids on the mountain in this first year – but I’m not so sure we need to be so aggressive about it. It will probably happen just before her 2nd Birthday, but only if the timing is right, and if it’s fun.

The whole fam damily.

I just remembered one other great thing from this year: my Boston Red Sox winning the World Series…. again! The Red Sox winning the World Series this year was the cherry on top of an already incredible year. Just had to mention that. GO SOX!

That’s it for now, but another year of adventures and firsts is just beginning. The whole family will head to CSM in Washington DC to kick off the year, and we’ve been brainstorming other potential air and road trips for the summer. Other APTA conferences have me busy zipping out of Colorado for 2-3 days at a time throughout the year. Hang on, it’s going to be a wild ride, and I’ll keep you updated as we go. Happy New Year!

Travels Well With Others

Physical therapists find ways to live this crazy travel-life in a bunch of different ways and have to overcome a variety of obstacles to find the flexibility in their lives that can allow them to up-and-go to different jobs at any time. People travel with their friends, with their spouses, with their pets, and with their families. Any of these obstacles adds a little complication to travel, but by no means should these be reasons not to travel.

Traveling in an RV has always seemed to me to be the best way to overcome housing struggles. Having your own, mobile space solves many of the difficulties of shuttling kids around from state-to-state or finding a short-term apartment that will allow pets. In 2014, we lived in a camper on Martha’s Vineyard to solve the issue of not being able to find affordable housing. The camper was a major part of what made that one of my all-time favorite travel assignments. There are pieces of our lifestyle that summer that I wish I could make more consistent staples of my everyday life. If Kate and I ever did continue to travel with our daughter, it would be in a camper again – like the Partridge Family of Physical Therapy.

Travel PT Camper Martha's Vineyard
Our pretty sweet set-up on Martha’s Vineyard.

A couple resources:

  • I have been enjoying reading PT Adventures and some of their recent posts on traveling with a baby – some on traveling with a dog too.
  • Highway Hypodermics is a facebook page for healthcare travelers living in RVs. The page has over 5,000 members and is definitely the best resource if you have any questions about living the travel life in a camper.

Travel PT With a Significant Other

If I know anything, I know how to find two travel PT jobs at once, because Kate and I were travel PTs together for about 10 years. I can’t think of a time that we weren’t able to travel to where ever we wanted because we couldn’t find two jobs – though, we did have to be flexible and inventive at times.

Travel PT Kona Waipio Valley Hawaii
One independent contract I worked was in Kona, Hawaii. This is from a day trip out to Waipio Valley. That was a great summer.

Normally, our first line of attack would be to find two jobs close to one central town. This approach would typically work. We never put any effort towards trying to work in the same clinic, but often a recruiter would find us two jobs at the same workplace. The agency would present us as a “travel team” which is advantageous for a facility trying to fill multiple positions – one stop shopping for multiple therapists. This easy solution was sometimes nearby where we wanted to be and not necessarily exactly where we wanted to be (i.e. commuting to work in communities just outside a major city we wanted to live in).  The most frequent settings we would find work together in was in smaller community hospitals (CAH) or working for a home care agency.

Even if you’re not romantically involved with another traveler, you might consider traveling with a friend. Two travelers working contracts together can be a great way to get ahead financially – getting two housing stipends and having only one rent is a great way to keep some more cashola in your pocket.

In the rare occasions that we couldn’t find two jobs in the same area, we would start calling around the area to private practices looking for independent contracts. One of us would have the “official” travel job with benefits, and the other would find an independent contract. Here’s a more detailed post on the process for finding an independent travel PT contract.

Living with a significant other who isn’t a Physical Therapist should not be the lone reason not to travel. I have met many couples along the way who have figured out how to make travel therapy work for them. One good friend (PT) met a Speech Therapist while traveling. They eventually got married, settled down, had kids, the whole nine yards. But, for a while, they took year-long travel assignments – her as an SLP in schools, him in a variety of settings as a PT. Additionally, I know several PT/OT couples who have had the same positive experiences we did – there’s a lot of facilities out there looking for PT/OT teams. I’ve also met many couples traveling as a PT with a non-healthcare worker (even one PT/recruiter couple!). If the non-therapist doesn’t have an easily portable job, he typically has to be more flexible in his work – odd jobs, seasonal work, Ridesharing driver, Amazon delivery, etc. With a little determination to get on the road, it’s easy to work odd-jobs for a few months at a time in many regions of the country.

Traveling when you have add-ons (family, pets, etc.) ultimately comes down to the final conclusion that so many things in travel therapy do – flexibility helps! The more flexible you can be with where you’re willing to travel, what setting you’re willing to work in, or what you’re willing to live in, the more opportunities you’ll have. A little flexibility goes a long way in finding happiness through traveling therapy.

THE BEST Travel PT Job

I get questions like this all the time: Where should I go on a travel PT assignment? How do I find a good travel PT assignment? Is working in this particular health care setting the best I can do?

The answer: I don’t know what is best for you!!!! These are personal decisions that rely on the balance of many different factors. The right assignment for you may be very different than what somebody else wants. To be successful in travel therapy, you need to be flexible where you can, but you also need to know what is important to you and pursue it. I’d like to explore a few of the factors that will play into you choosing the assignment that is (hopefully) the best one for you.

Location

Location has ALWAYS been my top priority traveling. Where you should go as a traveling therapist is a very personal decision. For instance, in the winter, I want to be where it is cold, snowing, and I can ski. I recognize that many other people want to be somewhere warm in the winter instead – our wants and preferences will vary wildly. If you have a very specific city or town in mind to travel to, you might need to be much more flexible in other details of your job search. If you don’t have any specific places in mind at all when you start to travel then you already have some good flexibility to your options.

…or mountains AND ocean… jobs available now in Sitka, AK. Click the picture for more info.

If you’re unsure where to go I recommend thinking about the types of things you would like to have around you when you arrive at your assignment:

  • Coast, Mountains, or Open Spaces
  • Hot or Cold
  • Rural or Urban

If you can easily pick a favorite in each of those categories, you are well on your way to finding a location that will make you happy. Some logistical issues that may help you further narrow down where to look for a job are the speed of a certain state for getting a license (perhaps fastest through the PT compact) and availability of travel jobs in a given area – your recruiter can help guide you in either of these criteria.

Traveling as a couple, my wife and I typically picked a city we wanted to live in and would give our recruiters an amount of time we were willing to commute to find two jobs within a reasonable radius of our homebase. More often than not a community hospital or home care agency would have two travel PT jobs available at the same time, but that’s something that can be very dependent on the region.

Clinical Setting

This is another very personal decision, but the more flexible you can be on setting, the better chances you’ll have of checking the boxes on all of your other priorities…. but is there such thing as being too flexible?

So often, I talk to new grads who have leapt straight into traveling. Many of these new grads are looking for outpatient jobs, but often told that SNF jobs are their only option. If you have no experience as a therapist, then you have very little bargaining power to explore anything but the options that are first presented to you. So, I advocate for two things – get at least a little experience before you travel and put up a bit of  fight before accepting a setting you absolutely do not want to work in – hold out, be patient, and be flexible about where you might travel to to get a setting you desire.

On the other hand, one of the things I love most about traveling is the variety of practice settings I have been exposed to. There is so much in PT that I never would have experienced if I hadn’t gone into travel. There is a balance to be reached between pursuing the setting you want and being open to other settings that you are willing to work in. Yes, please strive to be in the setting you most want to be in, but also work to acquire the experience and expertise you need to pursue those jobs. Also, be open to accepting jobs in other settings that might expand your clinical experience and allow you to grow with more diverse clinical skills.

Pay

Last, and least, pay. Yes, you can make lots of money in traveling therapy. But if you go into traveling for only the pay, you won’t last very long. I’m not saying to cast aside all thoughts of pay. It is very important that you are paid well for being highly educated and having the flexibility in your life to pick up and move for work. If two otherwise equal options present themselves, by all means, take the one that pays more! But don’t set pay ahead of all other factors, I believe you’ll eventually come to regret chasing the money in the absence of person and professional satisfaction.

You have to find that balance between your pay and the other factors that can make or break an assignment. If you’re not happy, you won’t last long in travel – the best travelers go into traveling therapy to live a better life. If you are doing it only to pay off loans or make as much of you can, you will burn out quickly and head back to a settled life in order to gain satisfaction in other life-areas you have neglected.

Finding both happiness and success in traveling requires a balance of several factors. Sit down, write down your priorities, and figure out where you are willing to be more flexible. Finding the balance that uniquely suits you is what will help you succeed, find joy in your work, and allow you to continue traveling.

International Crimes Against Physical Therapy

Stick with me, this isn’t your average tale of of international crimes committed in clandestine night clubs or amongst thugs with weapons. This is far more nerdy. Far less violent. But, it’s real, it’s effective, and it’s highly destructive. I think it’s super interesting – why would international crime choose physical therapy?

Traveling Physical Therapist

Looking for info on International Travel PT? Click here.

In 2006, I was a new grad serving on a committee within FSBPT (Federation of State Boards of Physical Therapy). The committee dealt with the administration of the PT liscensure exam. While we didn’t deal directly with the security of the exam, I got to be front row for some high drama taking place across the Pacific Ocean.

As I remember it:
Some test takers in the US territory of Guam had higher scores than they should have. Guam is a convenient location to take the test for foreign-trained PTs coming from across the Pacific. After statistical analysis of test results, a cluster of test takers originating in the Philippines was identified as having abnormally high scores. Upon further investigation by US and Philippines law enforcement, these abnormally high scores all seemed to be coming from people who had taken one specific test-prep course. This test review course had sent employees to take the NPTE and steal questions by a variety of methods – small cameras, writing down questions, memory, etc. Unsuspecting test-preppers had taken the review course with stolen questions and were unknowingly exposed to hundreds of actual test questions. These course participants then went and did REALLY well on the test… so well that the statistical anomalies drew some attention. Law enforcement bodies from both countries investigated and prosecuted those who had stolen test materials. FSBPT stopped offering the test in US territories and increased security to the test. In addition, the test was limited to several specific dates as it is administered now, rather than being offered throughout a portion of the year as it had been previously – making it harder to steal and re-use test questions. With heightened security of the test and scrutiny of specific testing centers, the test is again being offered in specific test centers in US territories including Guam.


Guam is is a location very far from the US – about 5,500 miles off the coast of California, almost 4,000 miles from Honolulu, but only about 1,300 miles from the Philippines.

 

From a 2011 FSBPT report¹:

In response to compelling evidence gathered by the Federation reflecting systematic and methodical sharing and distribution of recalled questions by significant numbers of graduates of physical therapy schools in Egypt, India, Pakistan, and the Philippines, as well as several examination preparation companies specifically targeted to these graduates, the Federation in 2010 temporarily suspended NPTE testing for all graduates of schools located in those countries, pending the development of a separate, secure examination. This evidence was obtained through extensive forensic analyses of NPTE performances, as well as a variety of legal actions brought by the Federation in the United States and abroad.

That’s crazy stuff, right? Who knew why security around the NPTE was so tight – there’s reasons, the incident I described is only one reason. People domestic and abroad make attempts to steal test data  more frequently than you would think. The test materials are held under very tight security and the cost of protecting the test questions is very high – a major reason why the test cost hundreds of dollars to take.

I only share the above story to add some plausibility to what I am about to describe has happened on HoboHealth. Foreign entities have attacked the profession of physical therapy previously – and they’re at it again.

At this point, we’re all aware of the desire of foreign powers to sow discord through our society. “Foreign Bad Actors” as they are now frequently called are known to have participated in our online discussions, pretending to be normal, fed-up Americans. There are known warehouses of people in Russia and other countries sitting at computers where their only job is to interfere in American online discussion² ³. These paid trolls place misinformation all across social media and try to start arguments where ever they can. The ultimate goal is to make conversations within the US divisive – to pit us against each other and prevent us from being able to come together and do anything productive. It seems this strategy has been very effective within the realm of politics, but never did I think HoboHealth would be a target. Frankly, it’s flattering.

In July, two separate comments came through on HoboHealth blogs. My first reaction  anytime I get an email notifying me of a comment on my blog is cautious excitement. It’s wonderful to have a conversation happening on my site, but more often than not, it’s spam – these comments stood out as a very different kind of spam. The two comments came through the same day (July 4th none-the-less) and each were well written but very aggressive. On closer inspection, it turns out each came from foreign email addresses – Canadian, I don’t know what to make of that.

Here are what the posts said:

“Manual therapists who self identify as such should spend time actually reading the current research and sober up. Those who refuse to do so will be marginalized as a fringe group, further eroding the credibility of the profession, something it can hardly afford. Unless you have super powers, maybe stop pretending you deserve superhero status. The legend is in your own mind, but only.”

“The DPT is a ginormous waste of money and its [sic] starting to look like the profession is willing to eat its young just to survive. Stuck in the past, too rigid and clinging to orthodoxy of the past to demonstrate the flexibility needed for change that they tell clients they need. Welcome to the slow swirl.”

These fake comments reflect real sentiments spread by a loud, but minority few who have blogs and participate extensively on Twitter. I have previously railed against similar real voices who preach anti-manual therapy (Why I AM a Manual Therapist). But the truth is these are fake posts, by people or computer algorithms that likely have nothing to do with physical therapy. It is wild to me that the body or government behind these posts is so desperate to create arguments that they would go after physical therapists. It makes me wonder, is it just another part of a foreign government’s efforts to sow discord in our culture where ever they can? Or has a competing profession gotten in the business of starting a troll farm? The topics they went after, Doctoral degrees and manual therapy, do seem like the type of thing a very specific profession we often compete with would want to have us divided on…

Don’t get carried away with anything you might read from any commenter on the internet. I have heard it estimated that only 10% of the physical therapy profession actively participates on the internet. Meaning, if you read a minority opinion on the internet (say from the anti-manual therapy camp), that opinion may be held by only a small portion of the 10% participating on the internet – a VERY small minority of the whole profession. It turns out, that some of the voices chiming in to support those minority, extremist opinions may not even be real – just paid trolls, specifically participating to create conflict.

I’ll never know the source of these posts, but I believe the moral is this – If fake accounts are being made to post on lil’ ol’ HoboHealth, then they are posting EVERYWHERE. Be very, very wary of where you get your information, who you debate with, and when you allow yourself to believe that a real, genuine person is on the other side of the computer screen. Paid trolls are intervening in every little innocuous conversation we have on any public platform.

A final tangential topic just came to mind: Fake research. I only recently heard about fake research, but I believe we’ll all be hearing about it much more in the near future. I first heard about fake research publications a few weeks ago on this short episode of PT Pintcast featuring Chad Cook. I have since heard about it on NPR in different arenas outside of PT. There are journals that are publishing completely unreviewed, unmonitored research – I find the phenomena totally mind-blowing. We need, in all aspects of our lives, to use reliable resources. Whether in research or news, there is too much information available for the average individual to vet it all. We need to insist our research comes from research journals with highest impact factors and news that comes from similarly reliable resources.

That’s my take. Be careful what you read. Treat each other kindly in person and on the internet.

 

  1. https://www.fsbpt.org/download/2011DH_ExamDevelopmentCommitteeReport.pdf
  2. https://www.nytimes.com/2018/02/18/world/europe/russia-troll-factory.html
  3. https://www.foxnews.com/tech/insiders-russia-troll-farm-even-zanier-than-indictment-says

Careers in Travel PT with Regis University DPT Students

I had the opportunity to talk with Regis University DPT students. We covered a whole lot of topics in just 30 minutes – housing, tax home, finding a recruiter, searching for assignments, independent contracts, PT compact and licensure, health insurance…. and a lot more.

The presentation and Q&A were video recorded and are here for your enjoyment!

Travel PT Assignment Red Flags – With the Vagabonding DPT

In this piece, The Vagabonding DPT and HoboHealth are teaming up for the 3rd time to present to you the major red flags we look for when choosing a staffing agency or when choosing to accept a specific travel assignment. These red flags shouldn’t be treated as absolute no-no’s for taking an assignment or using specific recruiters, but they should make you pause and think, “Is this what I want in an assignment?” If you run across these red flags, your antenna should perk up and you should be asking yourself if it is the right situation for you.

Red Flags for Recruiters

We may use recruiter and agency interchangeably. The recruiter is your main point of contact who also represents the agency. So, if you are working with a recruiter that starts checking the boxes on several of these red flags, move along. There is enough options for agencies that you shouldn’t be working for one that employs any recruiters with shady practices.

  • One of the most egregious red flags is if your recruiter ever tells you that you can only work with them and not for any other agency. “If you don’t commit to me, I can’t give you my full attention either,” is usually how this is presented. The thing is, that is EXACTLY the role of a recruiter: To give you their full attention, to work as hard as they can to find the best job for you. If a recruiter can’t find you a job, they don’t make money. A good recruiter should be going above and beyond to win you over. YOU, the therapist, are the commodity. YOU hold the power, not the recruiter.
  • When searching for a job, your recruiter should stay in touch with you often and actively search for jobs. Many agencies are passive in their job searches – they sit and wait for jobs to be posted to them through subscriptions to staffing databases. If your recruiter isn’t in touch with you often and communicative about the process of finding you a job, they may be solely relying on these databases. There are recruiters and agencies out there who will do the footwork of getting on a phone and calling around to clinics to look for jobs that match your priorities. You should feel like your recruiter wants to find you a job that meets your needs.
  • As we’ve mentioned, constant communication with your recruiter is essential for your success as a traveling therapist. An excellent recruiter will disclose all aspects of your contract including the cancellation clause.  All contracts include a cancellation clause in which the facility reserves the right to cancel your contract in the event that they hire a full-time therapist or therapist assistant to take over your position. This clause will typically give the traveling therapist either a 2 or 4-week notice prior to terminating the contract.  Many new travelers may not even know about this until their contract gets cancelled. If it isn’t obvious in the contract, ask questions of your recruiter. While having a contract cancelled isn’t extraordinarily common, it does occasionally happen and you should know what the process is in case it happens to you.
  • Some red flags may take a couple assignments with an agency to reveal themselves. If you find yourself in a situation where a company is refusing to pay referral bonuses you earned by referring colleagues, or if situations develop where previous pay is being reclaimed for questionable reasons – it’s probably time to start looking for a new agency. When things of a financial nature begin to creep up that don’t seem completely above-board, it is usually a good indicator of where the agency’s priorities are – in their own bottom-line, not the wellbeing of their travelers.

Red Flags for Facilities

The phone interview is typically your only chance to interview a facility. These red flags below come from questions you can ask on the interview to reveal what you really want to know about a facility. The interview isn’t just your chance to convince a facility that you are right for them, it’s also your chance to learn if the clinic is right for you! Ask the right questions on your interview, search for these red flags, and you may never have a bad assignment.

  • During your interview with the facility, you must ask about productivity expectations.  Skilled Nursing Facilities are notorious for unrealistic productivity expectations of 95%.  This means that they expect you to have direct patient care for 7 hours and 55 minutes leaving you less than 5 minutes each day for chart review, documentation, team meetings, progress notes, re-certifications, discharge summaries, etc. Home care companies can also vary wildly in their expectations, it makes a huge difference whether you are expected to see 5 or 7 patients daily and whether different types of visits (i.e. Start of Care visits that can take multiple hours) are credited on your productivity as more than one visit.
  • Ask the facility if they’re caught up on documentation.  At times, SNF’s with staffing issues may have PTAs or COTAs running the facility and have a PT or OT off-site, which means that they may be behind in clinical documentation.  If they are behind, you may be placed in a position in which they will ask you to update documentation for a time period before you were hired. This is a RED flag. Don’t ever risk your license.
  • Listen intently to the flow of your conversation with the person interviewing you. Is it curt? Do they ask you about your experience, skills, or interests? We’ve both had interviews, which were brief with little insight to the work culture and dynamic. Our patients thrive when we are immersed in a collaborative environment that supports us as clinicians. Don’t be afraid to directly ask, “what is the work culture like?”
  • If you’re interviewed by a regional director who does not work onsite, ask to speak with someone who does. If they say no or try to dodge this, then that should be a red flag.  You want to speak to someone who can attest to the daily challenges of that facility. A regional manager, who lives in a different state, will not be able to provide you a realistic picture of those challenges. You will have a direct clinical manager, this person should be available for a conversation.
  • Ask why the facility is short-staffed. Is it location? Is a therapist on sick leave or maternity leave? Have they recently expanded? It’s important to know what kind of staffing need you are filling for a couple reasons. If you would like the potential to extend your contract longer than the initial 3 months, it’s more likely to happen if the staffing need is ongoing rather than only for an employee’s temporary leave of absence. Chronic staffing needs occur for a variety of reasons. Some reasons for long-term staffing needs are completely reasonable, like being in a location far from any PT schools – these clinics often have staffing needs. Another reason that a clinic may have ongoing staffing needs is because they are, frankly, a lousy place to work. Asking more questions about the clinic’s staffing needs may help you discern between clinics with staffing needs for good reasons and clinics with staffing needs for bad reasons.
  • If you are working in a stand alone clinic, ask who the owner is. In all other situations, it’s at least practical to know who your direct supervisor is. This seems like an innocuous question until it isn’t. James once didn’t ask this question and the owner and clinic supervisor was an unlicensed Chiropractor from South Africa. Ask this question, if the answers get weird, it is worth asking more questions.
  • Find out who you’ll be working with. How many therapists and of what type? How many therapist assistants? How many other kinds of care extenders (ATCs, Massage Therapists, Techs/Aides)? An abundance of Assistants is a big red flag and a good indicator that as the therapist you will be spending more time doing evals and discharges than actually carrying out treatment. These questions can also help paint a picture in your mind of what a day in this facility looks like.

If you try to suss-out these red flags with your recruiters and during interviews, and if you are willing to walk away when the red flags stack up, you are likely to have a successful, enjoyable travel career. Failing to ask the right questions and have a meaningful dialogue on the interview can set you up for a frustrating time as a clinician and traveler. Good luck out there!   

If you’re a traveling therapist and have any additional advice feel free to comment below.  

April Fajardo, The Vagabonding DPT can be found on her blog at https://thevagabondingdpt.org/

4 Island Travel PT Assignments

As winter comes to a close, you might be wishing you were on an island somewhere…. if you’re a travel PT, you may have that option on your next assignment. Here’s (more than) 4 opportunities that could have you living on an island soon. Lots of links included to articles from when I worked on and visited several of these islands.

Kate hiking down from the 10,000 ft summit of Haleakala on Maui to camp in the base of the volcanic crater many hours and miles later that night in 2014.

Hawaii

Let’s not bury the lead. Hawaii is a tropical paradise within the borders of United States. All the advantages of really getting off-the-grid without any of the hassles or insecurities of international travel. Within Hawaii, there is a wide spectrum of opportunities – from uber-urban living to the very rural – a little different flavor for whatever your taste is.

Oahu is the main island and generally a good place for anyone unfamiliar with Hawaii to start. Oahu is home to about 1 million people, many of whom live and work in Honolulu, a major city and international hub. Honolulu offers all the perks and culture of a big city with the world famous surf beaches of the North Shore a short 30 minute drive away. Traffic can be brutal on Oahu, so plan commute between home and a potential job appropriately

Maui and Kauai each have occasional assignments available and tend to be a happy-medium for the traveler seeking a mix of social life and rural island-living. Both islands have thriving communities and also places you can quickly get off the beaten path. Each island has grown a bit in recent years, but also have huge swaths of land preserved for their beauty and recreation. On Maui, much of that land is within Haleakala National Park. Haleakala is a 10,000 ft volcano with astronomy observatories on top and it’s flanks running straight into the ocean. On Kauai, few views on Earth rival those of the Napali Coastline – a stretch of steep cliffs and secluded beaches spanning the coastline between where the two ends of the road circling the island end. I really believe you can’t go wrong with any opportunities that arise on Maui or Kauai.

Mother nature hard at work creating more land on the Big Island through the eruption of Kilauea volcano and lava running into the ocean in 2016.

The Big Island, which is actually named “Hawaii”, has it all. The Big Island is about 70 miles across and boasts 13,000 foot peaks, an active volcano, some of the best scuba diving in the world, and a thriving biking/running/swimming community that hosts the Ironman World Championships each year in October. Kona on the dry West coast of the island, and Hilo on the Eastern wet side of the island are the two major towns – each have a pretty steady stream of revolving travel assignments available.

When finding a travel PT assignment in Hawaii, luck and timing play big roles. Sometimes, very few jobs are posted, while at other times, you’ll find many jobs. Waiting just a few weeks typically resolves any drought of jobs, but be cautioned that Hawaii assignments draw a lot of applicants, so bring your A-game to the interview. Also worth noting that pay in Hawaii can be low… but you’re working in Hawaii, so….

Martha’s Vineyard

On the beach below the Gay Head cliffs on Martha’s Vineyard in 2015.

Martha’s Vineyard, off the coast of Cape Cod in Massachusetts offers the true island-living experience. In the summertime, people are intent on fishing, beaching, and… outdoor showers? I believe that nowhere in the world is as passionate about outdoor showers than the people of Martha’s Vineyard. When assessing function and patient goals on my home health assignment on Martha’s Vineyard, it was not rare to have a primary goal for a patient to return to their outdoor shower. When Kate and I lived in a camper there, we caught the fever – although we had a shower in our camper, the campground opened a row of 6 outdoor showers, and we indulged daily, rarely, if ever, using the indoor shower.

Martha’s Vineyard Hospital and the Martha’s Vineyard office of VNA of Cape Cod often have openings because affordable housing is near-impossible on the Vineyard. Many of their permanent employees travel 45 minutes by boat everyday from The Cape for work. If you can figure out housing on The Vineyahd, you’ll have a great time. Also worth mentioning, the Cottage Hospital on Nantucket, a couple hours by boat from Martha’s Vineyard, also regularly seeks travelers.

St. Thomas

The US Virgin Islands are part of FSBPT. Like any state, you can apply for a license in the Virgin Islands. St. Thomas is the main island and has historically had good availability for jobs. The Virgin Islands are definitely for the more adventurous traveler, or, perhaps, for the traveler who wants a tropical experience, but doesn’t care for the long distance to Hawaii. Most people on St. Thomas speak English, but Creole or Spanish may be primary language of some patients. I have read about concerns of safety, but travelers who have worked there tell me that if you are smart about your surroundings and company, then it is safe…. and highly enjoyable – basically like any major US city.

Hurricanes Irma and Maria may have changed the travel experience on St. Thomas. Largely overshadowed by the destruction in Puerto Rico, the Virgin Islands got hit hard as well – in fact, the roof ripped right off the hospital in St. Thomas during Irma. As best I can tell sitting at my computer in Colorado, it appears there is still an ongoing need for travel PTs in St. Thomas – it also appears there are many volunteer opportunities to continue helping with hurricane recovery. It’s worth mentioning that Puerto Rico is also under the umbrella of FSBPT, so you might consider volunteer work in Puerto Rico as well.

Alaskan Islands

With more coastline than the entire rest of the US, there are many way-off-the-grid island opportunities in Alaska, but here are a few standouts.

Looking across the town of Sitka at Mt Edgecumbe, a dormant volcano. Also, I remember Sitka having a great brewery!

Kodiak Island currently has travel PT needs. Kodiak is 100 miles long and has a population under 14,000 making it a true outdoorsman’s paradise. Kodiak is best known for the Kodiak Brown Bears, which alongside polar bears are the largest bears in the world. Kodiak has ample fishing, hiking, hunting, and anything else you can imagine outdoors. Though, it is not for the faint of heart – no one is around to bail you out if you get yourself in trouble out in the wilderness. But for the therapist looking for a truly rugged off-the-grid experience, Kodiak could be a dream assignment.

Sitka, on Baranof Island, was the capital of Alaska back when the state was a part of Russia. On our way back from working in Anchorage, Kate and I stopped off to visit a PT friend there and quickly fell in love with the community. Sitka is a vibrant town with architecture reminiscent of it’s Russian past. Our friend took us down to a park to watch for whales, and sure enough, we quickly saw a pod of Orcas swimming by in the bay. Sitka has excellent access to the outdoors both in the mountains and on the ocean. Compared to most of the rest of Alaska, Sitka is relatively Southern and therefor more temperate.

If you are willing to make a longer-term commitment (starting at 2 years) in Alaska, there are opportunities to make substantially more money in the form of student-loan repayment. These opportunities are available both in private and government facilities through a government program called SHARP. When working for large health systems in Alaska, there can also be opportunities to take small planes out to remote bush towns reachable only by sea and air. PTs fly in to provide rehab to the residents for a couple days at a time. While I don’t think a typical 13  traveler in Alaska is likely to be sent out to the bush, it might become more possible to make these trips after extending a contract for a longer period.

Mendenhall Glacier in Juneau Alaska, 2012…. not technically on an island, but you can only get there by boat or plane.

There are many more islands all over the country where you can find work as a traveling therapist. Jobs exist off of Texas, in the Northwest corner of Washington state, off the far Northeast coast of Maine, and down in the Florida Keys. If you look, you will find the island that suits you fancy. Happy travels, and good luck turning those island dreams into your real life.

 

When Will the PT Compact be Active?

A lot has been happening behind the scenes to bring the PT Compact to fruition. We have a lot of good news and things to look forward to in the near future, but also some restrictive rules that travel PTs need to be aware of.

Let’s start with a couple pieces of good news about the compact:

The Compact Commission and Colorado have come to an agreement that officially ends Colorado’s suspension from the compact. Colorado had previously been suspended from the compact because of the state’s “Michael Skolnik Medical Transparency Act” that requires all healthcare workers in Colorado create an online profile. Per the rules of the compact, the requirement for a profile is an additional burden on compact licensees that is not allowed. Other states have similar requirements, but their laws exclude professionals seeking a license through a compact. APTA has worked tirelessly with contacts in the Colorado legislature and with FSBPT to come to an agreement. Legislation has been drafted that if passed would remove the additional requirements for compact PTs and PTAs. Also, the state has assured the commission that it will not seek disciplinary action on individuals participating in the compact in relation to the Medical Transparency Act. Given the efforts made by Colorado, the commission lifted the state’s suspension this past Friday.

The compact was passed into law in the first 15 states last year, and the compact is set to be live in “the first half of 2018” (per PTcompact.org). At the rate most bureaucratic processes move, it is amazing that it is scheduled to take less than one full year from the inception of the compact commission to having actual reciprocity of PT licenses across state lines. To make things even sweeter, 8 other states are currently considering the compact in their legislature, and more states are expected soon. Achieving a compact between over 20 states in less than 2 years would a great feat! I’ve said it before, and I’ll say it again – states that are not in the compact are going to have a hard time filling their staffing needs. Many travel PTs will choose to travel only within the compact states for the increased ease of license transfers. This will greatly shrink the candidate pool in the non-compact states that are still relying on an antiquated, cumbersome license verification process.

FSBPT has also launched a new website for the compact PTcompact.org, click this map to visit.

…but here’s the catch that every traveler should know about. The current compact rules restrict compact privileges to only those PTs and PTAs with a permanent address in a compact state. To be clear: your tax home has to be in a compact state to participate in the compact, you cannot merely hold a license in a compact state to enjoy the reciprocity. The PT compact came into existence largely because of traveling PTs, and now, the current rules cut out a great number of travelers. The reason for this rule is the commission does not want PTs “license shopping” – meaning, if one state has lower standards, or lower fees, they do not want to flood that state with thousands of travelers who are trying to get in on the compact. Travelers who do not hold a home address in a compact state must continue with the same-old process, even if they are traveling within compact states. I, personally, see a simple solution – grandfather all PTs or PTAs currently holding a license in a compact state – boom, tons more well-vetted travelers admitted to the system with no shopping. But in the meantime, state licensure staff will continue to review hundreds of paper verifications from PTs already holding licenses in compact states, travelers will spend weeks completing the appropriate, pointless paperwork, and the inconveniences that the compact was designed to avoid will largely continue –  I digress.

So what can we all do to improve the system and allow more travel PTs into the compact?  I wrote a letter to the compact commission prior to their adopting these rules explaining my aggravation and the need to allow more travelers into the system.  I have since been in contact at length with APTA staff, Compact Commission Staff, and others. My concerns have definitely been heard, but it would helpful for the compact commission to hear that same concern from others.

There are 2 topics to take action on:

  1. Travelers need to be working to make non-compact states become compact states. APTA members should be contacting their state chapter to let them know adoption of the compact rules is a legislative priority. Colorado wouldn’t be a compact state if I hadn’t spoken up to make it happen – but once I had mentioned the idea, it was quickly taken up as a priority and set into motion.
  2. Travelers should be letting their licensure board, APTA representatives, and FSBPT know that the current compact rules that require residency in a compact state harm the efficiency of the compact. The purpose of the compact is to eliminate barriers to licensure between states for well qualified individuals. The current rules restricting compact privileges to permanent residents of compact states fail to optimize the potential of the compact to help travelers and the member states alike.

If you aren’t sure who to contact, your local APTA chapter is a good place to start. But, as the compact is an agreement among states, contacting your state board is an excellent next move after contacting your APTA chapter. The PT compact is moving forward, but it definitely needs the help of the travel PT community to move it in the right direction!

What’s Your Price?

If you went into rehab to get rich, you’ve made some questionable decisions.

Traveling Physical TherapistPhysical therapy students are coming out of school with 100K to 200K in student loan debt. Insurance payments for therapy tend to be decreasing rather than increasing. It’s understandable that therapists, especially new grads, would want to come out of school and immediately maximize their income, but I’m writing here to plead you to take your time, be patient – you’re going to do better in the long-run taking “stepping-stone” jobs than going for big money as quickly as you can.

I’ll be the first to admit that the primary reason I show up to work each day is because I’m getting paid. If I weren’t being paid, I would blow off work often (or at least show up late). The reason I am there so consistently and for so many hours is simple . . .   money. Don’t get me wrong, I like what I do. Being a Physical Therapist is a great way to spend many hours of my week directly helping people and doing something meaningful and good in this world. But, when it all boils down, we have jobs for one primary reason – money. If I won the lottery today – and not just a little, but let’s say a whopping retire-with-a-yacht-sized jackpot – I think I’d continue in therapy in some way, but it certainly wouldn’t be 40 hours per week, and it probably wouldn’t be before 10 AM.

My path as a PT, and specifically as a traveling PT, has not been a difficult one. Kate and I had a very reasonable amount of debt coming out of school and were able to eliminate it in just a few years through smart spending while working as travel PTs. I’ve written in the past about the financial advantages of travel PT over permanent work while I also maintain that new grads should not go straight into travel PT. This discussion I’m attempting to have here is much like my argument for new grads being patient, getting a little professional experience, and then going into travel therapy – a little patience greatly improves your ability as a traveler to pick the jobs you want and improve your overall experience traveling. This is the same mentality as having a little patience in your career, slowly gaining knowledge through your early experiences, and gradually transforming into an expert clinician that can confidently negotiate for top pay.

There are blogs and “gurus” out there that claim new grad Physical Therapists should be aiming to make upwards of 100K straight out of school. They purport that there are an abundance of jobs that any therapist with entry level skills could grab today and get rich quick. On the other side of this equation are new grads I talk to who are already burnt out. Recently, my lab partner at a course was 2 years into her career and already had classmates who had left the profession due to burn out. She, herself, was managing a clinic for a major national therapy chain seeing 4 patients an hour…. no other therapists in the clinic, just her, a new grad, pressured to see a patient every 15 minutes. Our entire profession should be appalled – even if she is a good clinician, this is a crap physical therapy model. The idea of seeing patients every 15 minutes should stun and sadden all of us.

High volume physical therapy clinics are giving us all a bad reputation. They should not be tolerated and we should insist that all of our friends and colleagues stop providing therapy in this manner. Superior patient care comes largely from increased 1:1 PT:patient time.

A close friend of mine has worked his way up in the ranks of the same national chain as the new grad I just mentioned. He has maintained a 1 to 1 PT-to-patient ratio in the clinics he manages, but he’s losing many of his therapists to another large chain opening in his area. He’s very willing to pay his therapist well, but the new chain infiltrating his area is paying relatively inexperienced therapists $90,000/yr. On the surface, that’s tough to compete with, but do you think these therapist see 1 patient every 45 minutes to an hour? They most certainly do not. These therapists leaving to make the much higher pay can kiss mentorship, paid professional growth, and anything that doesn’t contribute to the overall productivity of the clinic GOODBYE!

A lot of clinics and facilities bill poorly. I believe that’s where a lot of the perception of under-reimbursed PT clinics comes from. When employers put their efforts into billing properly and efficiently, clinics make reasonable money and therapists are paid adequately. I “grew up”as a PT in the Northeast where high-volume models are more the norm than in other areas of the country. I believed at that time that several patients arriving per hour being treated by a therapist and a number of PTAs, ATCs, and Massage Therapists was the  only way therapy could be delivered while still making a profit – just not true – and I thought this was the way the whole industry worked. Sadly, so many people are willing to apply their own, personal circumstances to an industry as a whole. i.e. “I worked as a PT for 4-years, but healthcare is factory. I WAS FORCED to see 4 patient an hour, that’s why I got out.” In my personal experience, after 10 years as a traveling Physical Therapist, I learned that there is a huge volume of jobs willing to hire well qualified therapists to work 1-on-1 with patients for an hour at a time. I have worked for clinics serving patients this way in 7 out of 7 states I have worked in. The mantra that reimbursements are too low to allow for hour treatments is a complete farce and a product of either sloppy billing or greed. But, then again, most clinics seeing patient 1 on 1 for an hour are not paying as high as the clinics seeing multiple patients per hour.

A culture of continuous learning at work should be a huge deal to you. Without research discussion, coworker inservices, and other educational opportunities built into the work-week, keeping up on your own professional growth can become an arduous task.

So, back to our gurus who tell thousands of student and new grad DPTs that they can go out a grab their $100,000 per year straight out of school. I do think these guys have some big parts of their message right: each therapist should be advocating for him or herself. Learn to negotiate, and get more than your boss would like to give you. I bet the articles out there advocating high pay for inexperienced therapists are actually driving up pay of all therapists, and hopefully, in turn, insurance payments as well. Therapists are frequently undervalued and need to put more time and effort into advocating for themselves and seeking out the better deal. But, the better deal is not just more money, it should also include weighing the value of a happier professional and personal life as well as being incentivized at work to provide BETTER patient care, not just MORE patient care. Do you see 10 patients each day, or do you see upwards of 40? How many support staff is each therapist supervising? Is it all evals and discharges while someone else carries out the “treatment”? Is work time and money allocated for learning – or are you doing all of your continuing ed on your own dime? Is work time allocated for documentation – or are you doing paperwork on the weekends from home? Most importantly – ask yourself if your job is setting you up to provide the best care you can to your patients. Therapists being set-up to provide great care is important to our patients, our profession, and to our own self-satisfaction.

If everything else about two jobs is equal, by all means, take the one offering more pay. But don’t forget all the other factors that play into choosing a job. For me, time with my patients is huge; I don’t want someone else carrying out the treatment, I want to get to know my patient and provide top-notch care on my own. I believe that most of the high-pay jobs you find also tend to be high-volume. What on Earth can you effectively do with a patient in 15 minutes? …30 seems like a rush-job to me as well. While the instinct seems to be to flock to more money, I believe the majority of these clinics are a pipeline to burnout after providing awful patient care to hundreds (thousands?) of people.

The whole purpose of our jobs in healthcare is to help people, to make them feel less pain as they complete the tasks of their day, and to help them move better. As a profession, we should wholly reject high-volume rehab-factories. These clinics provide inferior care to patients, wear-out young clinicians, and are a poor representation of the abilities of therapists. If you or your friends are seeing multiple patients every hour, look around your area and see what other opportunities might be available.

Take your time choosing the right job for you. When coming out of school with seemingly insurmountable debt, it seems that getting the highest paying job ASAP is the greatest priority, but getting that job and then burning out quickly does nothing to pay off your debt. The slow road is not sexy, but if you choose good professional situations where high-value patient care is a priority, you will gradually gain experience over time. Those high-value experiences will eventually lead you to higher paying jobs, financial freedom, and most importantly personal satisfaction. By all means, take the job that pays you best, but it must also maintain excellent patient care and provide you the tools to be happy and successful at work.