Experience Before Travel PT vs. New Grad Travel PT

new grad traveling therapy

James of HoboHealth worked in private practice before going into traveling PT and believes gaining professional experience is the right move to make before traveling.  April of The Vagabonding DPT has had professional success and happiness through becoming a traveler immediately as a new grad. These two traveling Doctors of Physical Therapy from different personal and professional backgrounds have connected to provide you diverse perspectives on travel PT.  This is their first blog post together of a series of topics.

What are the advantages of being a New Grad PT vs. being an Experienced PT then going into Travel PT?

 

headshot-square-finalHoboHealth:
Professional Experience – I only worked for six months between graduation and starting as a traveling PT. The brief time I worked in private practice before traveling did a lot to shape who I am as a clinician today. Getting just a little bit of experience as a clinician allowed me to become grounded in a healthy work environment before setting out into the less predictable and less stable world of traveling.

Personal Marketability – I believe the little bit of experience I had in private practice prior to traveling gave me a leg-up on other candidates looking at the same jobs. My first traveling job was (primarily) outpatient in a community hospital outside of Boston with other therapists around to help continue my mentorship and growth. Without a little experience, I don’t believe they would have taken on the risk of hiring a near-new grad. Six months in private practice, followed by 10 months at my first travel assignment with strong mentorship set me up for 10 years of positive traveling assignments. Bottomline, if you get a little experience before travel, better employment opportunities are available to you as a traveler.

Vagabonding DPT:april-fajardo-headshot
My life was as compact as possible.  I already had sold all my furniture and everything I owned fit into my Honda Civic. I was as mobile as I ever would be.  If there was any opportunity to travel and explore, now was my moment. I had just spent my 3rd year completing my clinical rotations in Oklahoma City, OK; Salt Lake City, UT; Springfield, MO; and Dallas, TX. I was moving about every couple of months.  In essence, my clinical internships provided me the opportunity to live the life of a travel DPT as a student.  I was used to learning at a rapid rate and had to learn to adjust to a new city and clinic every few months. Because of this, It was quite an easy transition to go from a DPT student on clinical rotations to a DPT on the road for work.

You have “less” responsibility. As one begins to settle into their career and life (in general), the natural progression is to get settled into a specific location, get married, buy a house, have children or furry kids, and/or take care of ill, elderly parents.  Although I think it is absolutely possible to travel with all the aforementioned circumstances, these factors require far more extensive benefit/cost analysis. For myself, I wasn’t married, I didn’t have a house, nor did I have children.  So I made the personal decision to take the plunge straight into travel PT for further domestic exploration and adventures!

Money
Although I believe that this shouldn’t be your primary reason for going into traveling therapy.  It definitely doesn’t hurt. Students are coming out with a tremendous amount of debt and this is definitely a great way to pay down those student loans.

What are the disadvantages of being a New Grad PT vs. being an Experienced PT then going into Travel PT?

 

HoboHealth:
When I first thought about this question, my gut reaction was, “There’s no disadvantage! What could be wrong with having more experience going into a job?” …but then I thought of the hardest day of my PT career – the day I had to quit my first job. The day I told my mentor and friend that I wouldn’t be able to work for him anymore was a really stressful day. Quitting a job, especially one that you like, is hard. I can see how someone with the intention to travel could go get a steady job and never end up leaving it. While I do believe strongly in getting experience before traveling, I can see how you risk getting “stuck” in a permanent job. I remember the phrase one of my professors told me to make quitting professional and simple, “It’s an opportunity I can’t pass up.” Remember that phrase, it’s a good one.

Also, the traveling lifestyle is only available to those in the right life situations to have the flexibility to take short-term contracts. Sometimes you have to strike while the iron is hot – waiting to take a permanent job, get several months of experience, and then quitting can shift you into a phase of life where the idea of travel isn’t as easy as it once was. New family obligations, meeting a significant other, and simple logistics like year-long rental leases can obstruct your path to the open road.

Vagabonding DPT:
Mentorship:
Off the bat, one’s initial thought may be the lack of mentorship.  There are some travel companies that may market mentorship opportunities.  I challenge you to ask them what exactly this looks like.  Just being in the same clinic as other physical therapists does not constitute as mentorship.  This can be countered by building an army of mentors while being a student.  Based on my interests, I’ve inadvertently built an army of specialists from Neurologic PT to Global Health to Nonprofit Leadership.

Mentorship does not have to be limited to our profession. There is something to learn from everyone.  Quite frankly, our patients become our first mentors.  If you learn to listen intently, they will lead you to the answer.  In addition, a firm understanding of other disciplines such as occupational therapy and speech & language pathology can help us maximize our role with a focus on patient-centered rehabilitative care.

Lack of Experience:
James touched upon this and it is true.  There will be some jobs that will require that you have more experience than what you have had. However, I secured my second job assignment by highlighting my strengths and experiences in that setting.  I applied for a position in inpatient rehabilitation that required 5 years of experience.  So during my phone interview, I discussed my experience.  I worked for two years as a PT aide in outpatient PT, then did an additional two years as a rehab aide prior to even applying for physical therapy. I also completed two clinical rotations in inpatient rehabilitation. I felt I was more than qualified for the position at hand.   I’m glad that the rehabilitation manager was pleased with my response as well because she essentially hired me for the position. I’ve extended my contract since then.

Being a traveler can isolate you from the typical learning and professional development paths that may be available in more traditional PT careers. What have you done or do you plan to do to continue your professional development?

 

HoboHealth:
Board Specialty
Shortly after completing my transitional-DPT, I soon felt ready to pursue my Orthopaedic Clinical Specialty (OCS). I spent more than a year reading every piece of ortho research I could get my hands on and reading a couple comprehensive ortho books cover-to-cover. The constant studying kept me focused on a fixed goal for quite some time. Specialties through ABPTS are available in variety of practice areas. A couple supervisors on travel assignments have told me they hired me specifically because of my board specialist certification. In total, my tDPT and OCS combined filled the first  4 years of my professional life with a structured, focused learning path.

Some universities are offering post-doctoral learning paths that culminate in sitting for (and hopefully passing) the specialist exams. My alma mater, Northeastern University, offers a Certificate of Advanced Study in Orthopedics. Essentially, you take 5 online classes focused on advanced orthopedic practice, earn college credits, and become more prepared for the OCS exam. Programs like this can help you keep a structured learning schedule that can otherwise so easily fall out of priority while working as a travel PT.

Certifications
Generally, I am skeptical of programs focused on one clinical belief system and the alphabet soup that comes along with them. Courses that all come from a single guru will help you dive deeply into a treatment strategy, but are typically lacking in variety outside of that one strategy. However, as a way to provide a structure for learning towards a final goal, they can be very useful. I currently am about to set out on earning my certification in Dry Needling. Over the next year, I have my learning laid out for me and a fixed goal to be certified in Dry Needling and Cupping by the end of 2017. There are some other great programs available that offer several courses on different topics culminating in a single certification – do be discerning, not all certs are created equal.

Vagabonding DPT:
With the constant change, rapid rate of learning, and high productive expectations expected as a Travel PT, you can get burnt out and/or apathetic as a PT.  It is pivotal that you “Be fearless in the pursuit of what sets your soul on fire.”  Since graduation, I have done exactly that through social media, leadership positions, national PT conferences, and continuing education courses.

Social Media
I didn’t understand Twitter.  I didn’t get the point.  However, a few years ago, I ran for the position of APTA Student Assembly Director of Communications and thought that I should get one in the event I got elected and had to manage one. I’ll be honest.  I had no idea what I was doing.  With the Twitter mentorship of Matt Debole, PT, DPT, OCS and Stephanie Weyrauch, PT, DPT, they opened up a world of passionate students and clinicians from all over the country and the world.  I started utilizing pound signs…I mean hashtags and twitter handles in my tweets.  A few years later, I had the pleasure of engaging with these professionals virtually and in person.

If you don’t have a twitter account, get one.  The best way is to just dive in and follow a few hashtags such as #ChoosePT, #DPTstudent, #SolvePT, #FreshPT, #PTFam and/or #TravelPT, just to name a few.

Still don’t get it? Start one, follow me, then tag me @AprilFajardoPT in your first tweet! Be part of the conversation.

PT Conferences
National Conferences: Have you ever been to National Student Conclave, Combined Sections Meeting (CSM), or NEXT?  It’s how the kids say, “lit?”  Yesss, LIT!!!! Everyone comes to this conference to learn, but one of the most important aspects of these conferences is the opportunity to formulate connections.  If you’ve been active on social media, meet some of those you follow on Twitter at one of these conferences.  You get to attend a multitude of receptions based on your interests and involvement from Alumni events to Section events.  The exhibit hall is equipped with the latest physical therapy gadgets and with recruiters from every corner of the US.  The

International PT Conference: This coming year, I plan on attending the World Congress of Physical Therapy on July 2nd-4th in Capetown, South Africa.  I look forward to the opportunity to learn from and engage with physiotherapists around the world.  Sounds enticing, doesn’t it?  Well, the early registration deadline is November 30th.  Join me and check out their website at http://www.wcpt.org/congress.

Professional Leadership
I’ve been on the go as a traveler; however, I’ve stayed engaged through the pursuit of my passions in professional development, engagement, APTA membership, global health, and service.  I currently serve as The Academy of Neurologic PT’s membership and public relations committee member, an Early Career Team committee member, and the PT Day of Service’s Global Affairs Chair.  My role in all these leadership positions has been location independent.  If I can do it, you can too!  Not sure where to start?  Fill out the APTA Volunteer Interest Pool at http://www.apta.org/VolunteerGroups/ or email the APTA Executive Director of the Section you want to get involved in at http://www.apta.org/Sections/.

Continuing Education Courses
Every state has a different set of requirements for continuing education courses.  However, I’ve found that the most helpful courses have been those developed by a specific section of the APTA.  I’ve taken a continuing education course on Parkinson’s Disease developed by the Academy of the Neurologic PT.  Terry Ellis, PhD, PT, NCS of Boston University  and Lee Dibble, PhD, PT of University of Utah taught the course through the integration of the evidence and its clinical application.  So if there’s a specific topic you want to learn about, check out what courses are provided by the appropriate APTA section.

Last Day of a Travel Assignment

I just came in from fishing on my kayak on the eve of my last day of this travel PT assignment. As usual, I caught nothing, but got a killer view of the sunset. Tomorrow, my wife Kate and I will work the last day of our contract on the island of Molokai in Hawaii before heading back to our winter home in Aspen, Colorado. This transition seems a little more subdued than usual – maybe it’s that we have some time between assignments and aren’t in a rush to get on the road. I used to lose all motivation to do paperwork during the last 2 to 3 weeks of any assignment – of course the paperwork eventually had to get done, but it wasn’t pleasant. As time goes on, the switch has become a bit more mundane for me – one job ends, another begins… just like they always do. But I’m better at keeping my nose to the grindstone until the very last days.

Here I am fishing out front of our apartment on a similar evening where similarly, I caught nothing.

Here I am paddling out to fish in front of our apartment on a similar evening where similarly, I caught nothing.

With ending a job, there’s all the finals steps that need tending to: cleaning out/off your desk, finishing all notes, tying up the loose ends on the cases of any patients who may have gone missing, and preparing for the other therapists to take your patients. Bottomline is: you don’t want the last memory of you to be all of your unfinished work left behind for the other therapists to handle. There’s typically some pageantry as a traveler gets ready to leave an assignment. I try to avoid too much fanfare, it feels awkward to me – I’m very used to coming and going. If it were up to me, I’d leave the office on Friday with the typical wave of my hand and a “have a good weekend!” …and never come back. In the PT Department earlier this week, we had a nice, simple ice cream bar with just the 5 of us in our department. It was nice, simple, perfect – it was a wonderful, delicious gesture, but not over the top. This location has trouble finding a permanent PT because of its isolation, so they are used to a revolving door of travelers. Perhaps that explains why my style of a “goodbye” matches with theirs. Someone, Vikki, will come in on Monday and take my place. She seems nice, and I hope she is – I’ve been telling all the patients she seems good, and I bet she’ll take all the placebo effect she can get. The patients definitely don’t like it when a traveler leaves, but I still laugh when an unassuming grandma threatens to come to Colorado for PT this winter.

The greatest challenge that comes with moving along to the next job is the process of getting the next job arranged. After traveling for 10 years, and returning to the same seasonal job every winter, finding the next job isn’t usually too much of a process anymore, but it used to be! Figuring out where to go is the first major hurdle, and it needs to happen well before the last days of the job. If you’re on a 13 week contract, you should have a pretty good idea of where you’d like to go very early on in the contract – especially if you need to get a new license to go there. When it’s time to find the next job, it’s not uncommon to find me in little corners of a hospital, between appointments, making calls to recruiters for quick updates on potential jobs. There’s a lot that goes into getting the next assignment, and it can, and usually does, happen at a pretty fast pace in the middle of a busy work week.

I just read a couple articles in a ski magazine and it got me pumped to be headed back to Colorado for the winter. I cannot wait to get my skis out of storage and onto the mountain (it’s snowing there right now as I write). Kate and I have ordered a fair amount of ski gear on sale over this summer while we’ve been here in Hawaii, so we’ll have to box all that junk up and ship it ahead. We have almost two weeks of hanging out in Hawaii before we have to leave – I really think this is the ultimate traveler’s hack. I haven’t had to pack a thing while I’ve been working. It is so refreshing to not have a car full of stuff before my last day of work tomorrow.

Here's the Shasta camper we bought. I can't wait to get to work sprucing her up!

Here’s the Shasta camper we bought. I can’t wait to get to work making her shine again!

When we do leave for Colorado in 2 weeks, we’re going to swing through Oregon and visit some friends in Bend before flying into Denver where we’ll be buying two cars. The original plan was to have one car when we returned to Colorado and have some time to find a second car, but while we’ve been away, the Colorado car’s engine stopped working. I’m not very mechanically-inclined, but my understanding is that the engine is a fairly essential part. So, we’ll buy at least one, maybe two cars in Denver – one has to be able to pull the 1970 Shasta Camper we bought from a friend sight-unseen (more on this in the future). After we’re done visiting Oregon and vehicle shopping in Denver, I have a dry needling course in Colorado Springs to attend for 3 days. So excited to finally be a needler (but not excited to be needled for 3 days straight)! The course ends Sunday, and work will start Monday – guess I won’t be starting this assignment well rested regardless of my 3 weeks off.

Despite all the excitement that lies between today and work starting 3 weeks from now in Colorado, I’m bummed to be done here. It’s a community I have grown to know and love and the bitter is mixed a little more heavily with the sweet this time. I guess I’ve got a pretty good thing going here, I could keep working here for another couple months, but it’s that time of year to move on. This is our second time doing a contract on Molokai. When Kate and I came over from the Big Island 2 years ago for an interview, we thought it might be a once-in-a-lifetime visit to Molokai. Three contracts later, Molokai is a part of our life. We’ll be back. I don’t know in what capacity we’ll return, but we will return.

Hawaii, it’s been a blast and I shall return. Oregon, let’s see what you’ve got (I hear you’ve got mountains, ocean, and beer – I like those things). Colorado, I can’t wait to hit the slopes and reconnect with all the friends back there. Nose to the grindstone, one more day of work.

Where Should I Work This Winter?

As pumpkins take over the world, traveling therapists begin to think about their next assignment that will last a good portion of this winter. Where do you want to be this winter?

Ocean, check. Mountains, check. Yeah, I could do San Diego. Does anybody know what San Diago means?

Ocean, check. Mountains, check. Yeah, I could do San Diego. Does anybody know what San Diago means?

On the beach? On top of a snowy mountain? Somewhere exotic and outlandish? Are you going to hibernate, or are you going to thrive? I’ve got you covered, here are some of the best places I’ve been in the winter and other places I would love to go in the future.

Southern California

I always wanted to do an assignment in San Diego, but somewhere along the way it fell off my list. It seems like it would be a great place to get a January tan. I know lots of people who have taken assignments throughout Southern California and absolutely love it there. Home care offers really good pay rates in SoCal if you’re willing to try out that setting. The only hitch to working in California is that getting a license can take 4 to 6 months, so get started now if it’s on your list.

Ski Country

Pop Quiz: Question: How does a snowboarder order a meal? Answer: "Hey Bro, you gonna finish that?" Question: 2 Snowboarders are in a car, who's driving? Answer: The cops.

Pop Quiz:
Question: How does a snowboarder order a meal?
Answer: “Hey Bro, you gonna finish that?”

I love skiing, so I do the opposite of the snow birds. I love living in the mountains with skiing right outside my front door in the winter. There’s a lot of places to find jobs near skiing, but to actually live and work in a ski town is an experience that every avid skier (or snowboarder) should have.  most hospitals in the Colorado Rockies hire directly (without staffing agencies) and you’ll need to pick up the phone and call or go check the hospital’s website for employment opportunities. You might have more luck around Salt Lake City which has more employment opportunities and all the world-class skiing you could dream of within a 30 minute drive. Wyoming and Montana offer more rural settings with great back country access and beautiful, pristine landscapes. New Hampshire, Vermont, and Maine all have quick access to big mountain skiing – some of the best skiers (and snowboarders) in the world come from New England – Bode Miller, Ted Ligety, Simon Dumont, Jeremy Jones. If you’ve wanted to see the Northeast and you’re a fan of winter sports, winter can be a great time with a lot of job opportunities and decent access even as far south as Boston.

Hawaii

Hawaii, idyllic for any traveller anytime of year. Plan ahead, lots of people want to go to Hawaii and jobs are competitive.

Hawaii, idyllic for any traveller anytime of year. Plan ahead, lots of people want to go to Hawaii and jobs are competitive.

I love my time in Hawaii, but I am never here in the winter time due to my aforementioned affection for skiing. Although, the summit of Mauna Kea at over 13,000 ft does offer enough snow to ski on in depths of winter – so there’s that option. During the Hawaiian summer, the surf is more calm and better for swimming – the summer brings less rain too. But the winter is when Hawaii really displays its beauty. Migrating whales visit Hawaii by the thousands in the winter. The increased rain brings deep green colors to the hillsides that are brown and parched during the summer. And the surfing world gets together on Oahu’s North Shore to hold competitions on the best waves in the world during the winter months. If you want to go to Hawaii, you have to be flexible – a lot of people want to go there, so finding an assignment or getting your resume in ahead of other people can be hit or miss. I normally recommend making sure your recruiter presents jobs to you before letting them submit you. But Hawaii can be competitive enough that getting your name in first can be a real advantage – when it comes to Hawaii, you may consider giving your most trusted recruiter the green light to submit you to any job that fits your criteria.

Antarctica

Huh? Antarctica. Hang with me here for a minute. Our winter is the southern hemisphere’s summer. The University of Texas Medical Branch staffs the 3 US research stations in Antarctica with contract workers. Each year they look for, “Licensed Physical Therapists who have a strong clinical background and a taste for adventure.” I think both of those qualifications need to be strongly met. In a position where you may end up being a fairly solitary clinician with limited resources, you must know your stuff, and you have to be able to improvise with whatever is available to you. A “taste for adventure” states it lightly. I have heard this job is essentially like working on a submarine except that you get to go outside occasionally. My understanding is that you rarely get off base, and when you do, there is NOTHING (except hungry polar bears)… but, you’re in Antarctica and that is pretty cool. I have also heard about the “Race Around the World” – A 5K race in a loop around the South Pole – that’s just hilarious and awesome.

US Virgin Islands

Did you know the US Virgin Islands are a part of FSBPT, the same body that all US states belong to for PT licensure? Oh yes. It is as easy to transfer your license to the Virgin Islands as it is to any other US state. There are jobs available in the Virgin Islands, it’s easy to transfer your license, and they are a short flight from anywhere east of the Mississippi. I’ve talked with a couple people who have worked there, and they’ve loved it.

On a side note, while FSBPT is in the conversation – if you are a traveling Physical Therapist or recruiter and you are unaware of the Physical Therapist Licensure Compact, educate yourself now. PT licenses between certain states will be reciprocal within the next two years – very exciting, make sure your state is included!

Choose Your Own Adventure

Don’t be limited by these 5 options. Choosing where to go as a traveling therapist is as personal choice as you could make. There’s all kinds of opportunities available in the Southeast and the Southwest – great, warm places in the winter. I’ve seen and heard wonderful things about Lake Havasu in Arizona and San Padre Island in Texas – I just know nothing about them, so they aren’t mentioned here. Why not make an adventure. Try finding an assignment in the Florida Keys. Don’t let any list limit you, go out and find the place YOU love, that’s what traveling therapy is all about.

Celebrating and Promoting Physical Therapy

“What can I do this month to help celebrate and promote Physical Therapy?” I imagine a lot of other travelers ask themselves the same thing and come to the same usual outcome as me during National Physical Therapy Month – you do nothing. This year my job has been made easier by PTDayofService.com. #PTDOS aims to bring PTs together on October 15th to serve their communities locally and around the globe. While many will be participating in activities that are specific to PT, others will be grouping local PTs together to serve in food banks, homeless shelters, and a great variety of other community programs that need some hands to help. I don’t think that it’s necessary to find something PT-specific to do this month, just get out and serve in any way that appeals to you in the name of the Physical Therapy profession. If you happen to read this before the weekend of October 15th, you can hop on PTdayofservice.com and contact an ambassador in your area who may have a project you can join.

Traveling PT Hawaii

The fish pond we will work on is in the dead center of the picture. There’s another, bigger one off to the right with a thinner wall. There’s a lot of mangroves filling in the ponds in this picture, which is one of the things we will be working to remove. I know scale doesn’t do justice here, but the fish ponds are HUGE.

Here in a rural community in Hawaii, we only have 4 PTs locally. The 4 of us, with our families and staff, will be joining a local non-profit to help restore an ancient Hawaiian fish pond. The fish ponds were unique to Hawaii compared with other Pacific cultures. The fish ponds are lava rock walls built in shallow water forming a large contained semi-circle of ocean. As the tide comes in, water and small fish pour in through the rocks, but the fish are trapped inside, creating a high density area for fishing as they grow bigger. Some of the best fish ponds, like the one we will be working on, were reserved specifically for Hawaiian Royalty to eat from. Should be a great morning of hard work (at least as hard as it gets on a beach in Hawaii), followed by a potluck meal to reflect on our experience.

I’d like to take my usual October question and flip it on its head: Rather than asking what can I do this month to celebrate and promote my profession, I’d like to pose a question that I think any traveler can ask him or herself: “What can I do on each travel assignment to celebrate and promote my profession locally?”Here’s a few ideas, some I have done in the past, some I would like to do in the future. Some are specific to National Physical Therapy Month, but others can be done on any travel assignment, anytime.

Change Your Work Desktop

APTA has resources on their website which include PT Month Logos, links to PT Day of Service, ideas to promote #choosePT, and templates to send to local legislators to legally pronounce October National Physical Therapy Month. Find APTA’s resources at www.APTA.org/NPTM. Changing your desktop is one simple way to get the word out to co-workers and patients that October is PT Month.

PTDOS - Fish Pond Clean up in Hawaii

The fish pond restoration is a monthly project, Here I am with a bag of gorilla ogo, an invasive seaweed that we are working to remove. In the background, you can see the wall of the fish pond stretching out in the distance just below the horizon.

If #choosePT is a new phrase to you, let me do my PT month work right now and let you know about it. There is an ongoing epidemic in America of opioid abuse. There is a clearly documented path from the abuse of prescription opioids to using other illegal hard drugs. While there are people whose pain is being appropriately managed by prescription opioids, many others are being inappropriately prescribed these drugs. We in Physical Therapy are uniquely situated to educated and treat people with acute and chronic pain who otherwise would need opioids to manage their pain. The CDC has named Physical Therapy one of the main alternatives to opioids for pain management. This is the #choosePT campaign – choose Physical Therapy to manage pain rather than entering the potentially harmful cycle of longterm opioid use.

Health Fairs

Many communities have health fairs on a regular basis. It’s easy to show up, take some blood pressures, screen people for falls, or do a postural analysis – but are those typical heath fair activities too easy? I challenge you to get creative and take it to the next level. As a PT, you could offer free bike fits, set up a mock-office and do ergonomic education, or do functional movement screens – all are quick, offer valuable information to the attendees, and demonstrate a meaningful PT skill.

Write A Letter

Write a letter to the local paper about whatever hot topic is in the air and in your arena. There are always new bills running through congress that affect the care patients will receive in the future. These are great topics to sound off on. Write in and let people know why they should be excited about possible changes in law that could improve their personal healthcare experience – urge them to contact their congressional representatives. Sometimes you get lucky and topics come up locally that beg public input from working healthcare professionals – local partnerships aimed at driving down the cost of healthcare, efforts to stem prescription drug abuse (#choosePT), or discussions in a community about the need for improved elder services. If you keep your eyes and ears open, you’ll find all kinds of topics you can meaningfully contribute to by writing a letter to the editor in the local paper.

Make An Appearance on Public Access Cable

Physical Therapy on TV - ski injury prevention

The best screen shot I have of myself on “The Lift” – the daily morning program on channel 82 in Aspen, CO. Me and Tory had a great chat about ski injuries while atop Aspen Mountain. Also, our jacket colors were complementary.

Whatever your role in healthcare, there is some topic that you know forwards and backwards and you love talking about it. Other people find this topic hugely interesting and would love to hear about it. For me, my topic is ski injuries. When I’m working in Colorado in the winter I talk ski injuries constantly for 40 hours a week. Sitting down with the local cable host and talking about this topic for 3 minutes was easy and fun. Pick a topic that’s in your wheelhouse, something you know so well that you don’t even have to think about it. The right local cable show would die to interview someone who is living locally for a short while and has something interesting to offer on a health and wellness topic – give them a call!

Community Classes

There are classes going on every day in every community. The class might be yoga, tai chi, aging gracefully, CrossFit, a community speakers series, self defense, a workplace safety meeting, or any number of other things – as a health professional, you have knowledge to contribute.
My wife Kate, also a PT, somehow found herself giving injury prevention talks to pregnant women. First, here in Hawaii one summer, she filled in for the regular PT to give the usual talk about potential orthopedic issues encountered during pregnancy. When we returned to Colorado, the local community center got word of her pregnancy talk through a friend, and she did a presentation there as well. So random, especially considering she had no specific experience or expertise in the topic, but I think this is a great example of things we quickly write off common knowledge that is not known at all! People do not know where the ACL is, they do not know to stay relatively active following a run-of-mill back injury or ankle sprain, and they don’t know about the orthopedic changes that can occur when pregnant. There are so many people out there who want a little piece of your knowledge in their brain – go find those people!

Volunteer at a Road Race or Triathlon

National Physical Therapy Month 2016…but mark my words, DO NOT give massages.  Soft tissue mobilization is only one small intervention in the broad scope of PT. There’s so much more we have to offer at these races than sports massages – set up a quick footwear consultation booth, offer mini-consults to give home exercise programs for minor aches and pains, or offer a brief injury prevention program. Whatever you choose to do, show off the skills we have as PTs. For a traveler, this particular suggestion might be more along the lines of things to suggest to the owner of the clinic you are working for.

Dust Off Your Elevator Speech

You have a few seconds and one sentence to describe what a Physical Therapist does. Ready. Set. GO! This is the classic elevator speech. I think most PTs do a great job serving their clients in the clinic, but do a poor job of describing exactly what it is we do. In your one sentence, did you mention we are the experts in human movement, did you mention we are the primary non-surgical option for musculoskeletal injuries, did you mention that PTs are educated at the Doctorate level? Probably not – but take some time to think about how you would like to concisely present to a stranger what it is a PT does on a daily basis. It’s the least you can do this October.

Happy Physical Therapy Month everyone! Get out there and represent our profession well wherever you are. If we all give one day to PT Month with half of the enthusiasm we greet our patients with each morning, I know we’ll accomplish a lot.

Originally Written in Collaboration with Fusion Medical Staffing to celebrate and promote physical therapy during National Physical Therapy Month.

Choosing the Right Camper to Live In

As we have done our traveling in the last year, we have slowly but surely made some changes. One of those changes that we came to was the decision to buy a trailer and live out of it full time. Our journey to the trailer probably took way longer than necessary because Kelsey was very particular about what she did and did not want our trailer to look like. Phil was more concerned about the inside, which is more important in the end. When we actually looked at all the possible options we each wanted in a trailer we knew we had our work cut out for us.

Here are some things Kelsey wanted/needed in the trailer:

Phil and Kelsey normally blog on their website at minimalistlifemaximumresults.com

Phil and Kelsey normally blog on their website at minimalistlifemaximumresults.com

1. NO STRIPES – Kelsey likes to be unique and she did not want her trailer to look like the other trailers we often see on the road, this means no stripes decorating the sides. If you like the look of the trailer or RV with stripes that’s fine, but you see those trailers everywhere. It is kind of hard to find a trailer or RV without stripes nowadays. We want to be unique and that’s what we were looking for.
2. Solar energy – This wasn’t exactly a deal breaker like some of the other items on this list. It is relatively easy to put solar power into an already existing home, whether it’s a standalone home or a mobile home. It makes it much easier when it is already installed for you. If we were going to pay big money for our new home, we preferred it already done for us.
3. No shower – This was kind of a weird one since most people think of a shower as a necessity. Kelsey did not want to deal with the hassle of the shower and fell in love with the idea of having to join a gym in order to shower. That little incentive to shower can be a huge motivator to go to the gym and get in better shape. This is a tip not just for people on the road but for all you home dwellers out there too! Another benefit of not having a shower is reducing the amount of water used. The average American shower uses 17.2 gallons of water. That can equal out to over 6000 gallons of water used per year, per person. Just on showers!
4. Small in size – We like downsizing and quickly realized we tend to have more space than we could ever need. We also like getting rid of stuff and living as minimalist as we can (hence the title of the blog). By doing this and going as small as we can, we are forcing our hand even more. Sometimes a big (or small) change can do a world of good in your life if you feel stuck.
5. Enough room to change comfortably – We looked into the van life a little bit, but we are still working professionals. That means we have to dress business casual – so looking presentable in a van would be tough. Not impossible but definitely becomes more difficult if you have only a small van’s amount of space.

Phil’s lists of wants:

1. Towable by a small SUV or crossover – Phil has never wanted a truck and has always wanted a vehicle that optimized gas mileage. Anything bigger than an SUV or crossover would really impact this ability to stay eco friendly in the car department.
2. Decent amount of windows to give open and outdoor appearance – The draw of the trailer is that you’re outdoors, you can walk outside at a moments notice. If your trailer is stuffy with no windows, it makes it feel like you live in a small box, not a tiny home.
Camperlife3. Kitchen of some kind – Phil isn’t really big on cooking but we have made healthier food choices in the last 12 months. Cutting out Cheetos, pop tarts, potato chips, chicken, beef, etc has been great for us. By making a big life change for the better, we didn’t want to make a big life change for the worse. Our kitchen is only an induction (energy saving) stove top and a mini fridge, but we are able to use that efficiently to keep up our healthy lifestyle.
4. Toilet – This one is kind of important to Phil as he goes roughly 20 times a day. Technically, he also wanted a shower but after some negotiating the no shower lifestyle ended up winning out. And the toilet in this place is composting! So less water and even better for the environment!

It turns out finding a trailer that meets all of these needs is way more difficult than it sounds. By way of luck (or more just constant searching) Phil came across an all wooden solar paneled travel trailer that actually fit all of our wants. The company is Homegrown Trailers, and they are amazing. Not only did the company already meet the needs we had laid out on paper but when we went to look at the trailer they came up with ideas to customize the trailer even more to fit our needs. It was perfect timing since the company has only been running since early 2016.

We do have to give some honorable mention to Air Stream as that was our top choice until we found out perfect match with Homegrown Trailers.

Suggestions to finding the trailer for you:

philkelseybeds1. Make a list of what you want and categorize by what is and what is not negotiable.
2. Set a budget – Don’t go over your comfortable amount to spend just to find the perfect trailer. If it’s perfect and you still want it, it will always be there later. We ordered ours back in July and are happy to make money and get ready to pick up in December.
3. Do research – And a lot of it!
4. Don’t settle – wait until it is exactly what you want. Kind of going along with the budget point above. If the trailer doesn’t have what you want, it’s not the trailer for you – unless you are very interested in the DIY trailer, which some people are.
5. Make time to call the company and see what other types of options or customizing is available.

Everyone is different and that’s perfectly fine. If you want to live on the open road go check out some awesome vans, trailers, RVs and mobile homes. There is no wrong choice as long as it fits your needs and is what you want! Thanks James for the awesome opportunity to write about our beginning of nomadic, eco-friendly travel trailer PT and thanks to everyone for following along with our journey!

Home Health as a Travel PT

home-health-travel-pt-hobohealthI never considered working in home health when I was a new grad fixated on my career as a sports PT. But, when I started traveling, I quickly noticed there were a lot of home health gigs available. As I began yet another home care assignment a few weeks ago, I realized I was starting my 5th contract working in home care. When did this happen? How did this happen? How have I allowed this to happen!?

Turns out, home health is a pretty good shtick for traveling therapists. As I launch into this blog about “home health,” I’ll make a clarification up front: I’m going to use “home health” and “home care” interchangeably – I feel like most people prefer “home health,” I personally prefer “home care.” Whatever, it’s semantics, don’t worry about it.

I think of home care as more of a lifestyle than a job. With the right employer, home care can offer a flexible schedule that is great for people in a variety of stages of life. Flexible schedules typically bring to mind new parents or late-career therapists looking for per diem, but, for me, in 2010 in Hawaii, flexibility meant completing all my patient visits by 3 PM, then surfing for a couple hours before going home to finish paperwork with a cocktail in the evening. The right employer will allow you to control your own schedule – this can be a great way to get more out of the daylight hours in a work week. Paperwork and case management (calling doctors, other clinicians, and patients) do account for significant time during your work day – the good news is that you can do paper work and case management at a coffee shop, outdoors on a sunny afternoon, at home, or where ever you feel like it.

Productivity

The flexibility does not come with every home health job, it is essential to ask about productivity expectations during the interview.

The two major factors that will affect how busy you will be are: a. how many visits you are expected to make weekly and; b. whether more complex visits are weighted to be worth more than one normal follow-up visit.

Basically, without getting into the nitty-gritty jargon of home health, an evaluation visit may be worth more than 1 regular visit (ideally 1.5), but an admission, which can easily take 3 hours of your time, should definitely be worth 1.5 to 2 visits. This is called weighting – where a visit that requires more work counts more on your total productivity. A job with a company that doesn’t weight any visits, is a job worth walking away from.

Number of visits: 5 daily is perfect, 6 is usually fine, 7 is just too many – think about the weighting of eval and admission visits when you think of these numbers (i.e. 7 with heavy weighting may be OK, 6 without any weighting could be a lot of work, 5 with weighting is a great job to have).

The distance and amount of time you’ll be driving plays heavily into the pseudo-equation as well, so ask about your territory during the interview. Also consider looking at a Google Maps of the area you could be working in during rush hour to get an idea of traffic.

Home Health Lifestyle

I got to do some visits inside the famous gingerbread houses of Oaks Bluff (Martha's Vineyard) in the summer of 2015. Strange sitting in my patients' living rooms with tourists going by the windows taking pictures of the houses... neat, strange houses with a fascinating history, but try gait training someone on narrow, steep stairs built in the 1800s' version of tiny homes.

I did some home health visits inside the famous gingerbread houses of Oaks Bluff (Martha’s Vineyard). Strange sitting in my patients’ living rooms with tourists going by the windows taking pictures of the houses… Fascinating history of how these houses came to be, but try gait training someone on narrow, steep stairs built in the 1800s Victorian version of tiny homes. The challenge and adventure of home care was very apparent.

Enough of the boring logistics of home care. It is full of action. You will go into people’s homes and see how they truly live. Truthfully, you will be completely appalled at how these people live. Hoarders, live chickens in houses, 8 people sleeping in a room with one bed, beautiful mansions, family situations that are wonderful, and family situations that are incredibly ugly – I will NEVER say I’ve seen it all, because in home care, you see stuff you would never ever see anywhere else. It’s a crazy adventure going into people’s houses. It’s also really educational. Home care will forever change your perception of what kinds of living situations hospital patients are being discharged to. It is wild out there… usually in a really fascinating way.

Professional Challenge

Clinically, home care can offer a stimulating challenge. Frequently, you may be the only clinician visiting a patient’s house, and you will have to make important decisions like whether to call 9-1-1 or not. I have called 9-1-1 from patients’ houses a number of times. Typically, it’s a pretty low-drama experience, but you might be the first to come upon a patient whose blood pressure is too low to ignore, or whose blood glucose is too high to wait it out, or who is just too medically complicated to be left at home alone. Home care does make you use a lot of clinical skills and judgments to make decisions that matter, and that’s one of the coolest things about it. It’s worth mentioning, that because of the judgement calls you will have to make, it is worth getting a year or two of experience as a therapist before venturing into home care.

A Setting You Might Consider

So, think about it. Consider home care even if it seems far from what you normally enjoy. It has aspects that will challenge your clinical skills, and it will most definitely change your outlook on how people actually live on a day-to-day basis. Not to mention, there’s a ton of available jobs in home health, and it pays well.

This is 100% true about today: For me, it was a pretty cool day at work. I worked in the mansion of a business man and sat across a very important-looking wooden desk from my patient discussing his mobility and what he wanted out of therapy (business meeting style, he wasn’t coming out from behind that desk unless he had to). I went to a small shed in a backyard to treat another patient, while she is actively in the process of being evicted from the shed… by her mother. In between, I enjoyed some moments outdoors during the work day and even paused for a moment beside the road to soak in a view of the ocean. I took an afternoon bike ride before finishing paperwork, which I wrapped up just before sunset. To summarize my work day, I went into a mansion, positively affected the life of someone near-homeless, and drove around an island …Not a bad way to make a living.

This piece was originally published in the summer of 2015 through thegypsynurse.com

Time Away – The Traveling PT Lifestyle

As I write this piece, I’m on a plane flying back to Hawaii from a couple weeks off work visiting with friends and family in New England. This flight is non-stop from JFK airport to Honolulu. While it is highly convenient to not have to make a connection on the West Coast, 11 hours in one seat is incredibly uncomfortably, and the lady in front of me is driving me nuts. The trip away from Hawaii was planned this winter while working in Aspen at my annual winter job there. My wife and I knew we were going to Hawaii for the original 13 week assignment, but weren’t sure if we would be extending our contracts for the fall. All the right things fell into place and we’ll be working in Hawaii until Thanksgiving. The break from work was a great 2 weeks away and got me reflecting about the traveling physical therapist lifestyle. As we fly back to Hawaii, the reality is setting in that we have another 3 months ahead of exploring some beautiful islands. I’ve been flipping through the pictures on my phone, looking at the last 3 months in Hawaii, and I feel fortunate to be getting back to a more peaceful and simple lifestyle than the last few busier (but awesome) days we just spent hanging out with friends in Boston, my home town.

DSC_5966-2

The front yard at the cabin in Maine. (Or “Upta Camp” as any Mainer worth his salt would describe it.) Mountain, water, and a lack of people – what more could I possibly want!?

I don’t know when I really began to like a slower pace of life, but I’ve definitely grown away from being a “city guy”. The highlight of the vacation I’m currently returning from was a week up at my wife’s family cabin in the Northern Woods of Maine. Time spent just beyond where the paved road ends and out of reach of cell signal was a nice re-set to return to work feeling refreshed and ready to push through the next 13 weeks. The relaxation centered around daily dips in the lake and a few steep hikes in the surrounding mountains which I’ve become more-and-more familiar with over the years. Sure, I’m returning to work in a beautiful, peaceful place, but it’s still work and I believe strongly in regular time away to refresh the mind and stave off burn-out.

On the seat-back display here on the plane, I can see that we are cutting a South Westerly line across the country and that we are passing right over Aspen, the place I now consider home because of our yearly return there for work each winter. If I could get to a right hand window seat, I think I could look down and see town or some of the familiar valleys, or at least I-70. While skiing in the winter, I have frequently wondered where those high up planes might be going as they pass over the mountains, and now I wonder if anyone I know might be out hiking today looking up wondering where this plane is going. Strange to be so close, but so separated – if I could, I’d hop on the phone and call a couple people to let them know I’m waving down at them. Weird feeling.

Enjoying the Aspen back country with friends. "Traveling Physical Therapist" is really just a euphemism for glorified ski bum.

Enjoying the Aspen back country with friends. “Traveling Physical Therapist” is really just a euphemism for glorified ski bum. (Aspen Mountain in the background)

The Aspen connection was indirectly made through another “get away”. Growing up, my family would  travel in the summer to a rugged family cabin in the mountains outside of Colorado Springs. This cabin, also, is beyond the end of paved roads. It was my favorite place growing up and has been joined on my “favorite places list” in recent years by the cabin in Maine – along with handful of other special places. Visiting in the summer as a kid was my introduction to Colorado, and it is what eventually led me back to the mountains and to Aspen. I initially enjoyed Aspen primarily for the great access to culture without living in a city. While I still enjoy the concerts, the culture, and all the action Aspen has to offer, I now appreciate it more for the great access to extreme wilderness. Within a couple miles of walking out my front door, I can be deep in the mountains, away from much of the busy nonsense of life in the 21st century.

Another one of my more recently acquired favorite places is the island of Molokai where I will return to work tomorrow morning. Hawaii is the most geographically isolated place in the world, so it’s only natural that you can get off the grid pretty fast in many parts of the islands, but Molokai is even more isolated than most of the other islands. It offers a rural life that doesn’t have the conveniences of box stores or instant gratification through being able to get exactly what you want right when you want it, but I’ve learned to embrace that – sometimes it’s an easier life when you have to get by with what you have. I don’t know what the future holds for my relationship with Molokai (work? vacation?), but I believe it’s a place that will be a part of my life in the future. I often joke that I can’t stay in Molokai because the snow skiing is awful – I don’t think this joke ever goes over that well, but it’s the truth. I do need a healthy dose of slippery hills in my life. Skiing is my favorite mode of exercise and my favorite way to get my adrenaline fix. I don’t ever hoot and holler doing anything the way I do skiing on a great day.

We got invited back to camp in one of the valley's that Audrey Sutherland swam to in her book Paddling My Own Canoe. Unforgiving ocean, rugged land, beautiful place.

We got invited back to camp in one of the valley’s that Audrey Sutherland swam to in her book Paddling My Own Canoe (great book about getting away from it all). Unforgiving ocean, rugged land, beautiful place.

While visiting the Maine woods last week, I was reading a book by a woman,Audrey Sutherland, who had swum and paddled to many of the most remote valleys in Hawaii and later to many remote islands in Alaska. While she lived and worked on the more-busy island of Oahu where Honolulu is located, the book was mostly about her time away and the quiet and loneliness she needed to reset. I don’t necessarily crave loneliness like she did, but at times, I need the quiet for sure. When I read the book up in Maine in a quiet and peaceful place, I couldn’t help but think how connected these isolated places can be. That connection seems to be amplified as I fly from Maine to Hawaii while passing directly over my winter home in Aspen. For a small island with a population of only 8,000, I find it bizarre that I know at least 3 or 4 people on Molokai with a connection to the small town of Aspen, Colorado (also <8,000 residents).

I got to visit another one of my favorite places on this vacation. But this belongs in a different blog...

I got to visit another one of my favorite places on this vacation.

Sorry for the long blog, but I have nothing but time today – just about 3 hours until we land in Honolulu. I’ll run out of computer battery before I run out of words. I’ve taken the long way around on this story, but this is a blog about why I am a traveling Physical Therapist. I am not OK living a life built around working a job that keeps me from the places I love for all but a few days of the year. I want to constantly be surrounded by the places I love and to have easy access to the wilderness and quiet time that I am craving more and more often. The flexibility offered by the traveling-lifestyle and the opportunity to intimately discover and explore places that Kate and I love is the greatest reason to travel. I hope if you are considering traveling therapy that you too will seek out the places you really want to be. If there are great cities you want to experience, landscapes you want to explore, or beaches you want to lay on, go work there!

It has been a wonderful vacation. I saw a lot of people and places that were great to visit with. Time to get back to work this week, but I know when the work week is done, next weekend holds another adventure in the mountains and ocean right outside my door. For me, that’s what it’s all about, working where I want to live and not the other way around.

DPT and Physical Therapy’s So-Called Identity Crisis

DPT identityI have recently heard a lot about “physical therapy’s identity crisis”. That phrase, “identity crisis,” is uttered by those I know personally, by other leaders in the profession, and by PTs across the interweb. Collectively, we have labelled ourselves as having no consensus on what our role in health, wellness, and prevention. There’s in-fighting about the superiority of treatments centering on pain theory, manual therapy, movement science, and other guru-isms that insist, of course, their way is the best way. But, I don’t think we have an identity crisis. We firmly know who we are and what we do – we may have varied methods of treating our clients, but we do have a central, shared focus. I personally believe our percieved identity crisis has everything to do with a large part of our profession not owning their level of expertise, being shy to demonstrate their full expertise to patients and colleagues, and as cliche as it is, not “being the change”.

10 years ago, we were a profession in flux. I was graduating with my Master’s degree from Northeastern University and almost immediately re-enrolled for my transitional Doctorate, because that’s where the profession was headed. Since the 90’s, things have moved very quickly for our profession from a role as a technician, carrying out Doctor’s orders, to an autonomous profession evaluating patients and safely dictating our own treatments.  In a span of about 20 years, universities have propelled us from a 4 year undergrad education to a point where all PT students are trained as DPTs. This relatively quick transition from a 4 year education to a 7 year education did leave us poorly defined for a period, because our knowledge and role did change over that time. Now, it’s about time we get over it. As a profession, we are not at all confused about who we are anymore. APTA’s branding project has been proclaiming since 2009 that we are the human movement experts. The Guide and Vision 2020 had earlier defined what it is we do on a daily basis with our patients and clients. No matter your practice setting or population, human movement is central to your practice – occupational health, sports medicine, acute rehab – even in the realm of cardiopulm, the human body’s ability to move blood and air are central to care. There are some specializations and niches in PT that start to stray from the precise phrase “human movement” – i.e. wound care or veterinary care – but human movement is truly at the core of what the vast majority of Physical Therapists do at work on a daily basis.

So we have had a defined identity for the better part of a decade, why do patients continue to come into the clinic surprised at our education level? Because as individuals, not as a profession, we have refused to embrace the DPT and everything it stands for. I know that somewhere, right now, there’s a private practice owner griping about a patient who has come in expecting to get a massage. This weekend, that same private practice owner will go to a 5K race and give simple, boring, unskilled massages! This is the kind of thing that kills us. Stop giving massages at road races – why not offer gait analyses instead? Or offer mini-consults for ongoing injuries, which there are plenty of in the 5K community. Injury prevention, nutrition, running gear, pain – these are all topics we can consult on with authority. If you give massages at a race, then that is the snapshot of your practice that you are displaying to your community, and people will continue showing up at your door expecting nothing more than a massage. I’m sure you can get more creative with what your practice can do to engage your own community than I can, but please, stop giving massages at races – that’s not Physical Therapy!

We need to be shouting our knowledge from the mountain tops in all of our own communities. Get interviewed on local access cable about injury prevention, write letters to your local and not-so-local papers every chance you get, throw a fit every time physical therapy is forgotten on a TV show, radio program, or news article when we are the experts that should be leading the conversations on musculoskeletal health, not an afterthought. Get verbal, show off your knowledge. Participate in community planning to advocate for healthy and accessible community planning. Even as a traveling PT who is only in communities for a short time, I have hopped on local cable, written letters to local papers, and encouraged others in the community to contact their congressional representatives on topics that matter. It doesn’t take a whole lot of effort to positively and productively promote PT in your community.

Why are we so scared to call ourselves Doctors? I don’t know, but I’m as guilty as anyone else of shying away from routinely using my earned title. We really, really need to embrace “Doctor”, we have each earned it. The Chiro’s sure don’t shy away from the term, and we’re a lot more qualified in providung safe musculoskeletal care than they are. Ever thought twice before calling your Psychologist, Optometrist, or Dentist “Doctor”? These are all non-MD clinical Doctorates – the same as the DPT. In education, even High School, teachers with a Doctoral degree are called Doctor. I really don’t know what our problem is, but we each individually, and collectively, need to get over our phobia and embrace our advanced level of education that matches and surpasses plenty of other professionals who have no qualms with being called Doctor.

Stop looking to leadership for answers on what our role is. Stop looking to APTA to make that one Suberbowl ad that will change the world’s knowledge of PT – that’s not how this works. It’s time more individual clinicians embrace the unique and unmatched work they do in the clinic everyday and demonstrate it to their external community. There are many communities across the country where people do think of their Physical Therapist first when they have an injury. If you think we have an identity crisis, it’s time you changed your identity in your own community. That’s how this works.

Health Insurance As a Traveling Therapist

As a traveling therapist, there are all sorts of things you can, and should, insure. This may end up becoming a multi-part blog, but for now, I want to focus on health insurance and the options you have available. Getting and maintaining steady health insurance can be a challenge when you change jobs, and possibly employers, every few months. Other than going uninsured (awful idea), there are three potential options to keep yourself insured.

traveling therapist health insuranceEmployer Sponsored Health Insurance
If you are working steadily for a single travel therapy staffing agency or for a combination of agencies, taking your employer sponsored program is clearly the way to go. All the agencies I have worked for factor your health program into your pay package. So, if for any reason you are not taking your employer’s insurance, ask if you can get more hourly – I typically get a dollar per hour extra for carrying my own insurance… more on why I carry my own insurance later.

Typically, what agencies have available for choices are good plans that cover you with providers nationally. When you accept a plan from your employer, you are not subject to pre-existing conditions or other demographic categories that might cause your rate to be higher – you pay into the group price that the insurance has contracted with your employer, simple and right to the point.

A staffing agency that I worked for when I first started traveling physical therapy would drop you from their insurance if you weren’t actively working for them for 14 consecutive days. This used to scare the heck out of me and force me to get right back to work quickly. If a job wasn’t coming together within 2 weeks of the last assignment, I felt the pressure to take anything that was available so I wouldn’t lose my insurance. The truth is, it doesn’t matter if they drop you from their insurance, COBRA (federal gap insurance) covers you. What COBRA does is extend your employer sponsored program when your employment ends. You have up to 60 days to accept COBRA coverage and it works retroactively. This means, if you are taking anything less than 60 days off between assignments, you can go without insurance and if something happens, you can adopt COBRA after-the-fact and you will be covered under your previous plan. The catch is that COBRA is not cheap – unless you need it, then it is a great deal cheaper versus the medical bills you would otherwise incur. Once you have adopted COBRA, you can keep it active for up to 18 months, but in most cases, if you need insurance for more than a couple months, it will be much cheaper to go get a plan on the open market.

I’ve said it before, I’ll say it again: Always look for jobs with 2 or 3 agencies, it helps you get a handle on the local markets and gives you more options for assignments that could be a better fit to your needs. One of the big downsides to jumping between companies is all the “new hire” paperwork – which includes a few healthcare enrollment forms. Don’t worry about the paperwork, the benefits of searching with a few companies outweighs the burden of a couple hours of paperwork every few months. Paper work, JCO quizzes, and constant TB tests are a part of being a traveling therapist, deal with it.

Pros: Everything. Take this option if you are consistently working through agencies. You pay the employer rate and are not subject to rate increases for pre-existing conditions.

Cons: Becomes expensive and complicated if you take more than 60 days off between assignments or do independent contracts. You may have to take short-term insurance to fill these gaps.

Short-term Insurance

Doing a single independent contract? Taking a few months off from therapy to just travel? Unexpected circumstances keeping you out of work for >60 days? This might be the option for you.

The job I work every winter in a Colorado ski town is arranged directly with the hospital and does not offer health insurance for my seasonal position. This can be more common that you would think, especially with seasonal positions in resort towns. Frequently these facilities will not hire through agencies and rely on independent contacts for their seasonal hiring. The first couple of years I worked in Colorado, I got temporary insurance plans, and they were the perfect fit for my needs.

These plans last up to 6 months, are cheap, and are available through most insurance brokers. I got mine through eHealth.com, but I really have no allegiance to them and you should be able to get a temporary health plan through any insurance broker. The downside to these plans are that they only cover conditions that happen during the 6 months you have the plan. Any pre-existing conditions are not covered. If you have an injury or illness that extends beyond the 6 month period that is insured, payment will stop after the last day your plan covers. Also, there is no gap coverage, like COBRA, that would help you if you ended up with no insurance and an injury immediately following the completion of your temporary plan.

Pros: Cheap. Keeps you are covered for any 6 month period where you don’t have other insurance.

Cons: Covers only that 6 months period. Nothing that started before that 6 months, nothing that extends beyond that 6 months. No preventative care coverage.

The Open Market

If you find yourself, like myself, doing frequent independent contracts or in a repetitive rotation to a facility that doesn’t provide health insurance, then the open market might be your only choice. The open market can be unforgiving in its cost. I choose to find insurance through a broker who can compare rates and plans of multiple companies, or you can just go online and start searching rates by individual companies. You’ll find different insurance companies available in different states, and even certain companies are conspicuously absent from specific zip codes due to local laws or other factors. You should always apply for health insurance in your home state and at your home address. It may be tempting to get insurance in a state you are working in if they have lower rates than your home state, but by getting insurance at your home address, you are ensuring the insurer (pun intended) will cover you when you travel temporarily for work. Also, having your insurance based at your home address is one more feather in your cap if you ever have to defend the location of your tax home. It’s worth mentioning that when buying an insurance plan in the open market, there are some plans that only have in-network providers locally. You should make sure that the plan will cover you and has providers nationally – especially when buying from a state’s healthcare exchange marketplace (state Affordable Care Act plans). If you do end up with a plan that has providers nationally, but you happen to be in an area isolated from those providers, there are typically ways of getting your care covered in-network  by contacting your health insurance company – I have had success getting in-network coverage with United Healthcare when working in “far out” places.

State healthcare exchanges offer a good place for you to go and find a plan – so whether you are looking for a subsidy or not, you may want to start there and see what’s available. I almost hate to even mention the subsidies available through the ACA. I don’t think traveling therapists are who the subsidies are intended for, but at the same time, buying your own insurance can be expensive, so you might as well get as much help as you can. I know, with my half year working fully-taxed in my home state of Colorado, that my taxed income is too much for me to qualify for a health insurance subsidy. However, those of you working the entire year in situations that are heavily tax-free and for therapists that are recently graduated from school, I bet you’ll qualify for a subsidy to help with your health insurance plan. The one catch with the subsidy is that even though it’s called a subsidy, it’s really a tax credit that you’ll receive when you do your federal tax return, and if your income is more than expected through the year, your actual subsidy can be decreased. Proceed with caution. Here’s a link that provides good, easily understandable information about the health insurance subsidies: http://obamacarefacts.com/obamacare-subsidies/

Pros: It might be your only choice. It will travel with you where ever you go.

Cons: Can be expensive, rates are even higher if you have pre-existing conditions. You must make sure your plan covers you nationally.