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.

Traveling Therapist Q&A: Considering Travel

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


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

Housing/Insurance

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

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

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

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

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

Taxes/Reimbursement

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

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

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

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

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

Cancelled Contract

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

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

Recruiters

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

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

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

Overtime

Can you sign up for overtime?

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

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

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

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

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

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.

Working 40 hours is Overrated

I’ve come to believe that 40 hours per work week is just too many to be working. There’s so much going on in the world, so much more I could be doing than hanging out indoors for 40 hours each week. Who came up with 40 hours being the magical working amount anyways? On one tougher-than-average day at work, I once asked this question out-loud, more to myself than to anyone else, but someone within earshot replied, “Henry Ford”. I’ve never fact-checked this answer, but I was told with such confidence that Henry Ford had set the standard of the 40 hour work week for his workers, that I have accepted this as cold, hard fact. Despite my distaste for a full 40 hours at work each week, I have been finding myself accruing overtime more and more frequently.

Here I am complaining about how hard I worked this winter. This is one of the views from the PT gym at work, it could be much, much worse.

I used to insist on having a 40 hour guarantee on my travel contracts, meaning that even if there weren’t enough patients, I was contractually allowed to spend 40 hours at work each week and get paid for it. Of course, if you find yourself in the cooshy position of having more guaranteed hours than actual work, it behooves you to keep busy however you can – cleaning the hydroculator, scrubbing a whirlpool, updating facility rehab protocols, etc. Sitting around at work reading a book or surfing Facebook is not a good look on anybody, no matter what your contract says. When I reflect on the last few years, I don’t ever remember sitting, twiddling my thumbs. I remember working for hospital departments that would unload their fulltime employees schedules and pack mine – it’s part of the gig as a traveler, you are a grunt-worker hired for the purpose of easing the load on the facility. None-the-less, having that 40 hour guarantee is a concrete way to make sure you’ll be gainfully employed during your contract. It’d be a shame to show up to your job in a far-off town expecting and needing 40 hours worth of pay and coming up short, so I still recommend securing a 40 hour guarantee in your contract whenever you can.

The job that I work every winter in Colorado (7 years running), has never offered 40 hours guaranteed. They used to guarantee nothing, but somewhere along the line adopted a 24 hour/week guarantee – the truth of it is, if therapists are consistently getting anywhere in the neighborhood of 24 hours, someone’s contract is getting canceled, because the department is overstaffed. It’s a unique situation there. The hospital has a view of 3 of the 4 ski mountains in town. If a lot of people are getting injured on the mountains, we’re busy; if tourism is down, or the ski conditions are forgiving to injuries, we can have our slow months. In past years I’ve frequently come in around 36 hours per week with a few weeks significantly higher and a few weeks lower. This year I worked my tail off. I worked a lot of 42-45 hour weeks this winter. That probably doesn’t sound like a lot to many people, especially anyone working in a field where there’s a machismo about hard work at the office – long hours, late nights, early mornings, and postural dysfunction are signs of dedication to the company! For me, 45 hours is my hell-on-earth. A standard week consists of 168 hours – 40 to work, 8 hours of sleep per night gives you another 56 hours gone – we’re already down to well less than half of our living, breathing hours after only work and sleep (I do appreciate my 8-hours-square per night). These calculations don’t even take into consideration the hours spent getting ready for work, the time commuting, and the time when you’re too pooped to do anything else because you’ve been working so damn hard. We’re in a work-centric society and I don’t care for our society’s priorities one bit. Take a hike, Henry Ford.

Traded in my winter view for a summery one. This is from the parking at lot at my current assignment - working a few too many hours... #HawaiiProbs

Traded in my winter view for a summery one in Hawaii. This is from the parking at lot at my current assignment where I’m not in the ocean nearly as much as I’d like… #HawaiiProbs

I have been looking forward to  coming back to my island oasis here on Molokai in Hawaii to have some good time to relax and get away from the fast pace of a >40 hour work week. My wife, Kate, had been guaranteed the 40 hour position out here, and I took the second-position at only 20 hours guaranteed per week. There were some other PT opportunities that I looked into, but nothing panned out. I was kind of looking forward to filling some of my spare hours working at the bike shop, or on a boat somehow, or as a pool cabana boy, or just having time to do more with this website. This week was my second week of work and I worked 6 days for about 45 hours. So much for relaxing. The island around me is most definitely running on serious Aloha-time while I’m busting my rump during the vast majority of the sun-filled hours. Last time I worked on the Big Island, 2 years ago, we ran into a similar situation – Kate had a 40 hour contract and I had set up an independent contract with no guaranteed hours. On that job, I had a full schedule with a couple weeks. …a developing pattern? As the summer moves along, I hope my work hours come back to earth and that Kate and I can each work 36 or 38 hours, not over the dreaded 40.

I’m going to continue asking for 40 hours guaranteed in my future contracts, but have grown more open to accepting contracts with less certain work hours. I’m beginning to wonder whether this pattern of always being busy at work is just something I’m experiencing, or is it a symptom in a larger, growing healthcare trend as the baby boomers age and as healthcare professions fail to keep up with the growing demand. I guess time will tell as we all slowly, but surely, burn out from long hours of high productivity.That’s kind of a bummer of a thought, and I hope it’s not the direction we’re headed. But the numbers don’t lie, everyone in rehab is going to be pretty busy for longer than the next 15 to 20 years. This means one thing for sure – travel therapy and temp employment will be an option for therapists for quite a while. So, if you’re looking at traveling, but not quite there yet, take your time, it’ll be here when you’re ready and you’ll have a blast when the time is right.

Well after all of that, I don’t want to sign off on any sort of sour note. I’m in Hawaii, making a fruitful living and very happy for it. A couple extra hours of work each week isn’t really what I want, but doing physical therapy in Hawaii is a fine way to spend 40-something hours each week – there are far less meaningful and satisfying things to be doing with my day, so I’m thankful for that.

More blogs to come soon. I plan to write lots. See you on the open road!

A Tale of Contract Negotiation

travel PT contract negotiationAfter a few hours of skiing this morning, I had one heck of a day wheeling-and-dealing a travel contract. I ended up with a couple extra hours and thought I would quickly share the experience.

Kate and I are trying to return to a small, remote community hospital that we worked at a couple years ago. We absolutely loved the community and would love to return this summer for 3 or 6 months. We’ve been speaking with the rehab director over a few weeks and have established that there are 1.5 jobs (60 hours/week) available for the two us this summer. We’ve just been waiting, and waiting, for some details and pay numbers to come through. We had previously worked for this hospital through an agency, but the hospital requested we do an independent contract if we could. Finally, this past week, the ball got rolling, we filled out applications with the hospital and a proposed pay package came to us. I was pleasantly surprised with what the package offered – a rental car and housing included but a little too modest hourly pay. I sat down to crunch some numbers and with my estimates of housing cost, rental car, etc, the package fell well short of what we would be making at the same facility through an agency. I figured there was some wiggle room and while a rental car was a nice perk, we don’t really need a rental car and could perhaps negotiate it into a higher hourly pay. When I got on the phone with HR this morning, I was briskly informed that there was no room for negotiation – the offer we received was the final offer. Could we remove the rental car and turn that cost into hourly pay? No. Could any of the money be offered as tax-free per diem? No. How much are they paying for the condo? …a lot more than we would pay for a condo on our own. Bottom line, there was no wiggle in the pay package and I had to insist that we figure out a deal through a staffing agency because we would make a lot more moolah working the same exact job. But, the insanity wasn’t finished yet – just inform our recruiter to work with the hospital to set up the gig, right? No, the hospital has a policy that travel jobs must be posted publicly through a “vendor management system” (more on this later).

That’s the story on how this contract has come to be, but there’s a lot of nuance to break down and comment on that I believe offers some insight into the travel industry. First, non-negotiable!? Why wouldn’t we be able to negotiate a different pay package? While I did enjoy what was offered to us directly by the hospital, a lot of the value of the total compensation was spent on things I don’t need. Also, the tax free benefits available through an agency give them an edge on what the hospital could offer me. Here’s the factors that I believe led to the breakdown in the hospital’s ability to offer Kate and I jobs directly:

  1. A rental car. This is a huge cost. When going to remote areas, we tend to buy a Craigslist car and sell it at the end for minimal loss. If the money the hospital was pouring into renting us a car was converted into hourly pay, we  would have completed a deal directly with the hospital.
  2. Housing – When working for an agency, we typically take the housing stipend and find our own housing rather than taking housing offered through the agency. We do this, because with a little footwork, we can find housing that is better suited to our needs and costs less than the generic, supplied housing. This is exactly what happened with the hospital’s offer – we had budgeted $1200/mo for housing, and they were estimating $2000/mo. Sure it’s convenient to have housing set up for us, but not at a total of $2400 above our budget over the course of a 3 month assignment. (post-script update: We secured housing for $1100/mo – in the same exact condo complex the hospital was offering us housing in. This works out to $2700 more dollars in our pocket versus our initial  contract offer from the hospital.)
  3. Tax advantage – The hospital told me they had looked into their ability to do tax free payments (like per diem) and that they had chosen not to take it on for the tax difficulties it presented. When a portion of your pay is tax free, it really ads up. That was one reason I initially liked them supplying the housing. When they rent it for us, it’s like getting money before it is taxed. A great benefit!
  4. The nail in the coffin: HR literally told me, “We only pay a few more dollars per hour when we work with an agency, so we’re fine with that option.” A few dollars per hour!? That really ads up. Offer ME that money, man! Come on.
Kate and I enjoying the waning moments of our spring-time skiing before jetting off to the next contract in a couple weeks.

Kate and I enjoying the waning moments of our spring-time skiing before jetting off to the next contract in a couple weeks.

While I believe those are the main factors that ultimately led to the breakdown in our ability to work out an independent contract, the insanity was not finished. I mentioned that they had to use a vendor management system (VMS). There are several big VMSs and our contract was posted through the one I am most familiar with – if you have traveled for a while, you have probably had a job that was posted with this system. What exactly is a VMS, you ask? It’s the 4th party in a 3 party contract. VMSs collect job postings from facilities by handling a large portion of the foot work for the facility. These VMSs blast those jobs out to a bunch of different staffing agencies who subscribe to be a part of their listings. Have you ever had multiple agencies post the same job at the same time? If so, that job is posted through a VMS. Some larger companies that own multiple staffing agencies also own a VMS so that they can collect exclusive postings from facilities and post them solely through the staffing agencies that they own – big, shady business. The VMS that this job was posted through (where the facility, the clinician, and the recruiting agency were all known entities) charges a price of 4% of the total contract. So, again, rather than just paying the therapists, more money is being thrown at paying another company a good chunk of the available pay.

Lunacy, complete lunacy. But, you know what? Kate and I are returning to the jobs we want this summer. The contract eventually worked out through a staffing agency and we’re happy with the deal. It’s too bad that when you have a facility and a clinician that want to work together, it takes two other private companies to organize the employment. But, as long as facilities refuse to pay clinicians the money they are willing to pay to outside companies, traveling therapy will remain a strong industry and a great career choice for therapists all across the country.

There might be a second chapter to this story. We only have 60 hours of work between the two of us this summer. I’m currently working on establishing a contract with the state to do some part-time work in a very cool, very unique consulting situation. They are a little concerned with my temporary status, but I think I could do some great work for them in the time that I do have. I know, I have given you no details here …top secret… for now. Hopefully this part-time job will work out and I’ll have some very cool, very unique stories to share with you all. See you out there on the open road!

The New Grad Dilemma

new grad therapist travelNote: I have included a lot of links in this piece and there is a ton of information beyond this article through those links. If you are a new grad therapist looking into travel, take the time to explore these links. Some are other pieces about new grads traveling, some are about professional development, and some are conversations on the discussion board that are pertinent. Note 2: I’m going to write this post using “Physical Therapist” language, but I believe this topic applies to speech and occupational therapists as well. I feel passionately about this particular post and found myself getting bogged down in language trying to be more inclusive of all therapists – so, forgive me, I really mean all therapists, but as a PT, I just write more gooder when I can write in the terms most familiar to me.

In the last couple months, I have written and spoken with quite a few new grad physical therapists who are going straight to traveling after graduation. With several of these new grads, I have had the opportunity to give my typical schpeel:

I do not believe you should travel as an immediate new grad therapist. I believe you need at least a brief experience as a PT with your own patients and own license alongside other experienced therapists to get to know yourself as a clinician and what life as a professional in a good clinical setting is like. That way, when you run into employment, management, or ethical red flags on assignment, you can recognize them and react appropriately. As a student PT, you have gained great knowledge that is more up to date and in depth than many currently practicing clinicians. You have also likely managed your own patient case load and treated a wide variety of cases. But, you have never done this without a safety net – with everyone expecting you to be the person with the answers. Do you need to be an expert clinician to be a successful traveler? Absolutely not, but I recommend you have some sort of professional experience, because there is frequently less support around you as a traveler than there would be in a more stable environment. I do not think you should travel right out of school, but if you are determined to, I would like to help you down the path to a better traveling experience.

So, in summary: Don’t travel immediately out of school, but if you do, I’d like to help you along the way.

What has my experience with giving this advice been? Failure. Despite my advice, just about every new grad physical therapist I talked to this summer is already working in a travel job or currently traveling to their first assignment. I have lost them to the awesome, kick-ass world of traveling therapy. Can I really blame them? No, being a traveling PT has a lot of benefits and upside, but I hope I can still save a few of you who haven’t signed travel contracts yet. I plead with you, just get a brief stretch of experience as a therapist before you travel.

I’ve written a lot on this topic in years past. I’ll try not to be redundant and instead, as mentioned above, link out to the things I have written in the past. If you are a new grad considering travel PT, earnestly consider whether traveling therapy is the best thing for you right now. Maybe it is, life changes fast and your window to travel may be closing soon, but if you can delay travel for 6 to 12 months, it will improve your experience. What follows is a mixture of “why you shouldn’t” and “if you do” advice.

With the new grad therapists I have been talking to, the most prevalent challenge I have been finding is predatory recruiters who don’t care who you are and who you want to be as a professional. These recruiters are only motivated by the fact that they get paid if they place you in a job. I’m generalizing, but the more predatory recruiters tend to be in the really big recruiting agencies that are staffing-factories. Finding a recruiter as your “employer” is the same as if you were looking for a permanent employer. You would want a clinical employer that allows you to spend solid one-on-one time with each of your patients. Likewise, you want to find a recruiter who has the time to get to know you and give you some personal attention. When working with a recruiter (and I recommend you work with 2 or 3), ask yourself these questions:

1. Does this recruiter know or remember anything about me personally or professionally?
2. Does this recruiter care if I get placed in a good job?
3. Am I steering the conversation of where I am going to work? (or is the recruiter?)

If the answer to any 1 of these 3 questions is “No,” find another recruiter. Don’t worry, there are over 300 Joint Commission accredited recruiting agencies, you’ll find another recruiter. Your recruiter should be WORKING FOR YOU to put you in a situation that best fits your needs and sets you up to grow as a professional. The predictable next-step with any predatory recruiter is a low-ball offer to work at a facility with no other PTs but likely an ungodly number of support staff for you to supervise. In this conversation going on at the discussion board (which I highly recommend you read), one new grad mentions a job offer where he would be the only PT at the facility with 3 PTAs. Which brings another three questions to my mind:

1. If the facility needs a traveler, who is supervising the PTAs now?
2. Does a therapist supervising 3 assistants actually get to treat any patients of their own?
3. How unbelievably bad is this facility that they are willing to hire a new grad they have never met in person to be their only therapist?

Forgive me, I’m just a worried big-brother-PT trying to keep his siblings out of trouble. I know you guys are all (mostly) super-intelligent people and see the red lights flashing on this job offer, but I want to assure you that you have choices and should never-ever under any circumstances work for a recruiter who offers you a job like the one described above – pass on it, this job can be somebody else’s nightmare. I got really lucky with my first assignment, but took time looking for a recruiter that was willing to hold my hand throughout the process. Because I was working at a permanent job, I had the luxury of taking my time to research staffing agencies and search for a job. When I found the recruiter I would eventually take my first assignment with, we searched together for a job that would allow me to work in outpatient and would have other PTs around for my mentoring and growth. It took a few weeks of patience, but that assignment eventually came up. I interviewed and accepted the job, and I extended my contract there twice to ultimately stay 10 months because it was such a great fit for me and satisfied my need for growth as a new therapist – this, ideally, is what your experience should be as a new grad exploring travel therapy. Your recruiter should be some sort of a cross between a teacher and companion who can appreciate what you need in a job and what strengths you have to offer a potential employer. Here’s an older discussion board thread discussing travel as a new grad and selecting your first job.

Let’s talk about why a facility needs to hire a traveler, because I think it is central to why some travel assignments are better than others and why you should have some experience before you travel. A facility hires travelers because they are understaffed. A facility can be understaffed for a number of very benign reasons – an employee is out temporarily for illness or maternity leave, the geographic location is difficult to attract highly educated professionals to, the business has recently expanded or gone through a structural change and is spread thin on staffing, or the area doesn’t have any PT programs nearby so there is a chronic shortage. If you’re discerning, patient, and lucky enough, these are the jobs you will take consistently as a traveler. These facilities generally care about their patients, and, because they care, they will be expecting you to bring a certain established skill-set with you to hit the floor running and start treating patients confidently soon after you start. If you approach the job selection process with little care of where you work and no experience to demonstrate any specific skill set, you’re more likely to find yourself in the facilities that have staffing issues for the other, more sinister reasons – these places are willing to hire any warm body with a license. Facilities can have staffing issues because management is awful, productivity expectations are too high, or the business is unethical. The therapists that put themselves in the situation of working for the clinics with the worse kind of staffing issues are not going to have a good professional life. They will experience stress and burnout, and these are the people you will meet who are cynical about therapy and healthcare business in general. With a little bit of effort and patience, you can dodge lousy assignments – when the red flags go up, pay attention to your gut. If it sounds like a lousy situation, it is. If you can get yourself a year or even just a few months of experience before traveling, your marketability improves dramatically and the quality of jobs available to you will grow.

The reason I feel the need to warn you all about the dark side of traveling as a new grad is because I care greatly about our profession. We are uniquely situated to do great things in healthcare. We are primed to heal patients conservatively without medication or surgery, to heal and promote health in many different venues, and to prevent pain and disease in the first place. All of these things save patients and insurance companies a great deal of money versus other treatment options and will ultimately be our golden ticket as everyone continues to age. In order for our profession to best seize these opportunities, we need to cultivate the best clinicians, and I don’t think starting out as a traveler with zero professional experience will make you the best clinician and ambassador of our profession that you have the potential to be. Just a little time before you travel will get you grounded and set a baseline for your future experiences. There are great advantages professionally and clinically to being a traveler – if you travel for multiple years, you will eventually work in more settings than you ever dreamed of. You will treat patients of more different backgrounds and cultures than you could never imagine, and you will be one of the most well-rounded clinicians with more diverse clinical and world experiences than any of your non-traveler colleagues. Without experience in the setting you would ultimately like to work in, you are more likely to aimless drift from lousy assignment to lousy assignment without gaining a good foothold on who you are as a clinician when you are at your best. As a traveler, professional growth is a solitary experience, you really need to be on the right path when you start. Please, I beg you, travel, it is a fantastic experience, but get just a tiny bit of professional experience first – in the long run, you will be more successful in your travels and you will be a better representative of our profession to your patients and co-workers.

Locum Motion

This website is about being a traveling therapist, right? Then, why so often, do I get myself off-topic blogging and twittering about issues in PT and healthcare? Answer: Because I like it. Only once in a long while do the stars of the interweb align so that I can write about travel therapy and healthcare issues at the same time.

We call ourselves travelers. Traveling therapists, traveling nurses, travel PT or OT assistants – we are all “travelers”. But not MD’s, they, call themselves locum tenens, or just locum for short. Locum!? What the heck does that mean? locum tenens; locum – place, tenens – to hold; all together now, “Place holder”. Turns out locum tenens is actually a Medicare term that applies to someone temporarily filling in for another provider. When someone qualifies to work as a locum, they are able to skip a lengthy credentialing process to be able to bill Medicare patients. The list of providers that are currently eligible for locum status during temporary employment include Physicians, Dentists, Certified Registered Nurse Anesthetists (CRNAs), Nurse Practitioners (NPs) and Physician Assistants (PAs).

There is a Medicare bill currently working its way through congress that would extend locum tenens status to Physical Therapists in certain situations. Currently, in PT private practices, if a temporary therapist is brought in, it can take 3 months to be able to bill to Medicare under their own NPI. Most private practices doing their billing above board and truly the “right” way avoid travelers for this reason. I’m not sure what happens when a private practice hires a therapist through an agency – what I believe happens, is that the private practice bills under one therapist’s NPI. The practice of billing for an entire practice under one NPI, as far as I am aware, is frowned upon, but not illegal. I have done a couple independent contracts with private practices who have made me become in-network at their facility with Medicare, it’s a long process (2-3 months), mostly paperwork, and discourages a lot of employers from getting involved with short-term staff. This bill could change the whole arrangement.

bill

Forget how this whole bill to law thing works? Click above and return to being as smart as you were in middle school.

This new Medicare/locum tenens bill, titled the Prevent Interruptions in Physical Therapy Act (House bill: H.R. 556 and Senate bill: S. 313) would create some exceptions for certain PT private practices. The bill, if passed, would decrease interruptions in patient care that may occur through a PT’s temporary absence due to illness, pregnancy, vacation, or for continuing ed by allowing practices to hire PTs on a locum tenens basis. That would cut out the whole Medicare credentialing process that currently takes place when hiring a temporary PT. While this bill is certainly patient-centric, I do see a secondary opportunity here for travelers. If there’s a current process that inhibits some clinics from taking on travelers (Medicare credentialing), and that process is eased, there’s a lot of opportunity for an increase in the number of available travel assignments. As this bill stands in the Senate, locum tenens status would only be allowed in areas designated as non-Metropolitan Statistical Areas, or areas designated as Medically Underserved Areas (MUAs) and/or Health Professions Shortage Areas (HPSAs) – that’s a lot of private practice clinics that could soon hire temporary employees with less fuss when billing through Medicare. Ideally, the bill would be amended to include ALL areas in the country, not just those of special designation – that would be pretty sick. (it’s a Medical pun, get it?) Be sure to let your Senators know that ALL Medicare beneficiaries deserve uninterrupted access to PT, not just those in underserved areas.

All traveling PTs, everyone in private practice, and all recruiters should be pretty psyched about this bill and should definitely be contacting their Congress Men and Women today. Jump over to APTA’s website to get more information on the bill. From there, you can link straight on over to contact your Senators and Representatives. Get on it now!

SLPs and OTs, don’t worry, I haven’t forgotten about you. If the legislative bug gets you revved up, you have good resources to contact the people who represent you in congress. For OTs: http://capwiz.com/aota/home/ and for SLPs: http://takeaction.asha.org/

I do get fired up about issues, and this one is more special to travelers than most issues are. It was too good not to write about, but I realize healthcare politics can get a little dry. I promise more excitement in my next post!

Your First Travel Gig

first traveling PT assignmentAfter being a traveling PT for 8 years, I sometimes forget that what now seems like a pretty routine process was very intimidating and complicated at first. This post describes what you can expect in the process of getting your first traveling therapy job. I have another page that you can link to under the “Getting Started” tab. There’s some similar information there, but with a slightly different focus. Here I have tried to focus on the details of your interaction with your recruiters and the order of how this should all happen to get your first job in traveling therapy. Here we go!

Get a License

Do this first. Start working on a license for the state you want to go to as soon as you decide you want to travel. You can start this process after you start looking for jobs if you are still trying to figure out if you want to be a traveler (trust me, you do). But, if you wait too long, waiting on a license can delay the start of a job or prevent you from getting a particular job all together.

Contact a Couple Recruiters

This section was the impetus for this whole blog. I have heard more and more from people that their recruiters are telling them, “If I’m not your only recruiter, then I can’t give you my full effort.” If a recruiter ever says something like this to you, my suggestion is to hang-up and never talk to that recruiter ever again. Of course the recruiter wants you to work solely with them! It takes any competition or reason to hustle for you out of the picture. A good recruiter will understand that you are working with some other recruiters and will work harder to be the one to get you the assignment you want. Recruiters usually work on commission and get their pay from getting you a job. YOU, the therapist, are the commodity, without YOU, nobody gets paid. Seriously, if a recruiter says you have to work with them exclusively, they are playing you – ditch ’em!

Here are the reasons for working with multiple recruiters: First and foremost, talking with a few different recruiters should give you an idea of the going pay rate in a particular area which can vary wildly place-to-place. While different recruiters will have many of the same jobs available, there will be some jobs that are different between companies. Some companies have exclusive contracts with certain hospital systems – it all gets very complicated when you get into the details of how temporary jobs are posted and who they are posted with, but the bottom line is that having multiple recruiters working for you increases the number of potential jobs available to you. Also, when you do get ready to accept a job, having several irons in the fire will give you more leverage in negotiating better pay.

Get Submitted

When you are “submitted” for a travel assignment, it means that you have heard of a job from a recruiter, and you want your resume to be put in the applicant pool for the job. Some jobs will have dozens of applicants, while for others, you might be the only applicant. The number of applicants for an assignment has very little to do with the job itself and likely has more to do with the location of the job and how the facility chooses to post their available position with agencies.

Once submitted for a job, you cannot be submitted for the same job by a different agency – this is where having more than just a couple agencies working for you can trip you up. Early in our traveling, my wife, Kate, and I had 6 different companies we were working with, it got complicated. We had multiple agencies submitting us to the same jobs and arguing with the facility that that each had submitted us first. It was embarrassing – don’t let it happen to you.

Different agencies will vary in how they handle the process of submitting you. Some agencies will want all your information right away, I prefer not to give them my info (references, resume, etc.) until they have found me a job to be submitted for. So, if you can, delay giving a company all your details until it’s time to be submitted – but, some companies just won’t have it and want your info before they do anything for you. Some recruiters may ask if they can submit you for jobs without contacting you first – basically, they find a job that meets your criteria of location and setting, and they will submit you without hopping on the phone to notify you first. If you are working with just one recruiter that you trust, this is fine. Also, if you are searching in an area where there are many people looking, like Hawaii, and want to be one of the first people to apply, then this can be a good strategy. But other than those two situations, I have a hard time justifying giving my recruiter a “green light” to submit me for whatever, whenever. By having the recruiter check in with you, you are keeping control of what jobs you are applying to and where your resume is being pumped out to.

Interview

If a facility you have been submitted to is interested in you, your recruiter will arrange a phone interview for you with the facility. Simply remember that this is your chance to interview the facility as much as it is their chance to interview you. Ask questions, but come into the interview knowing some stuff about the place you are interviewing with. Usually, at the end of the interview, you and the interviewer will report back to the recruiter separately to let them know how the interview went.

The Job Offer

If the interview has gone well, you will receive a job offer. If your recruiter does this verbally, ask that it be sent by email also so that you have it in writing and can crunch some numbers. Swiftly move along to the next step.

Negotiate!

Therapists. We are really bad at this step. But, if the pay seems low compared to what you’ve been hearing through other recruiters, or if there is a benefit that you want that isn’t included in your package, ASK! It never hurts to ask. Don’t underestimate your ability to name a price and see if it can be matched. Remember, YOU are the commodity!

Accept

Don’t get so wrapped up in your negotiating and getting every little bit out of your contract that another therapist signs their contract first and takes the job. Sure, negotiate, but do it swiftly.

 

That’s probably more details than you really need, so I’ll stop here. I’ll again refer you to the “Getting Started” page that is somewhat redundant to this post, but offers some other details including a link to what benefits you should expect or ask for. Happy job searching, I’ll say something here that I don’t say nearly often enough: I love being a traveling PT. If you have the itch to get out there on the open road, you should do it now, because life is a funny thing, and you don’t know how long this opportunity to travel will last. Happy travels!

Preview of Coming Attractions

Matha's Vineyahd

The Cape and Islands

So much to talk about. There is a lot going on in our world right now. The normal hecticness of finishing up the assignment and end of ski season parties has been compounded by actually knowing where we are going in May. Usually at this time of year, as the winter season wraps up in Colorado, we’re discussing where we would like to go for the spring and just starting to get some leads from our recruiters. But, this year, we locked down our May to November assignment in March, a true luxury. Normally, 2-4 weeks ahead of an assignment is good lead time to get everything set for the next assignment, but we have been graced with a full 2 months to get ready for our summer doing home care on Martha’s Vineyard. There seems to be a lot of confusion about exactly what and where Martha’s Vineyard is.

I grew up nearby around the Boston area, so I do know that Martha’s Vineyard is an island off the coast of Cape Cod – Nantucket’s next door neighbor. There once was a man from Nantucket…. um, nevermind. Anyways, Martha’s Vineyard is an island, there is no actual vineyard that I am aware of. I’ve only ever been there for one day as a kid – I seem to remember it being a fall day with pretty lousy weather – Kate has never been there. An unknown adventure awaits!

Housing is coming together pretty well for us despite running into a few challenges along the way. We originally were looking into houseboats for the summer, but there’s a lot of logistical challenges to how long you can stay in one harbor, what to do when a storm comes, and whether you are actually allowed to live on your boat at all in certain places. Basically, if you plan on working a 5-day-per-week job on land, it gets really challenging logistically to live on a boat. So, we shifted our focus to finding an apartment. At first glance on Craigslist, apartments looked very reasonable for rent – unfortunately, all the rent rates I was seeing were weekly rates. It quickly became clear that finding a reasonable place to live without having half a dozen other roommates was going to be a real challenge.

Dear Champ, Hey there Champ, Kate and I need to talk to you about something. We had some great times out there on the road - some of our more memorable times in all our years of traveling. But, well, it's time for us to move on and get another camper - something newer, something sleeker, something a little more "liveable." I know you'll understand, we'll think of you often. - James

Hey there Champ, Kate and I need to talk to you about something. We had some great times with you out there on the open road – some of our more memorable times in all our years of traveling. But, well, it’s time for us to move on and get another camper – something newer, something sleeker, something a little more “liveable.” I know you’ll understand, we’ll think of you often. – James

Kate and I have long dreamed about living in a camper since riding around in our old RV “Champ” every weekend during our assignment several years back in Anchorage, AK. It turns out that Martha’s Vineyard has one campground and we have locked down a campsite for the summer. The only problem is, we don’t own a camper yet. Our main logistical problems will be 1. Finding a camper small enough for our SUV to tow, but big enough to live in for 6 months. 2. Reserving a spot on the ferry to the island not knowing the exact size of our camper yet. 3. Figuring out how to watch as many Red Sox games as possible without cable!

I’m really looking forward to the adventure of living in a camper this summer. At some point we’ll have to make a decision whether to sell the camper at the end of the summer or keep the adventure going. I guess whether we keep or sell the camper depends on how much we like it. In the meantime, the end-of-season parties are wrapping up here in Colorado. Work parties, ski mountain parties, and just party parties will keep us busy over the next 3 weeks before starting the road trip back “home” to New England. The first leg of the trip going back East will be to head West for a dry needling course in Salt Lake City! After that, I hope to grab a couple baseball games in random stadiums along to route and couch-surf with a few old friends from the road.

Stay tuned! Lots of adventure and fun ahead!

Places in Time

I was listening to NPR on the way home from work today and heard a segment that caught my ear. I grew envious of the author in the piece who had lived on a remote Alaskan island for two months to study the island’s history and write a book about it. I thought, “Man, I wish I had a job I could just take around to a cool places like that.” I then laughed hysterically at myself, because I do have a job that I can take where ever I want – if that remote Alaskan island ever needs a PT, I’m there.

I hear about peoples’ travels to far out and cool places and immediately want to be there. The only problem is that I can only be in one place at one time. Working typical 13 week travel contracts, a person can only see four different places in one year max. When I first started out traveling eight years ago, I had a short list of places I absolutely had to live in – Hawaii, Alaska, and a ski town. Three assignments, you figure you can chisel that out in nine months, right? Wrong. It took me six years to get to those three places.

We took 4 weeks off for our wedding and honeymoon including this zip-lining in the Dominican Republic. You're absolutely free to take whatever time off you want between assignments, but no PTO.

We took 4 weeks off for our wedding and honeymoon including this zip-lining in the Dominican Republic. You’re absolutely free to take whatever time off you want between assignments, but no PTO.

There’s so much time in travel PT that people don’t account for. If a three month contract is going well, it’s not unusual to negotiate a contract extension (typically another 13 weeks at a time*). Sometimes, particularly in home care or far-off places, the facility will request that the contract be six months instead of three. Usually a contract is longer when there are anticipated costs to the facility like an extended training process or extra relocation expenses. Living life 13 weeks at a time can get really manic, so most of the travelers I know who have traveled for a while have found a way to slow the pace of the constant 13 week shuffle. For instance, those of you who read often know that my wife and I spend half our year returning to the same seasonal jobs in Colorado. Returning to the same jobs provides us a little stability  while leaving 7 months each year to be true traveling therapists. Other travelers I know make a habit of extending their contracts whenever they can – their typical contract is not three months, but more like six or nine after extending their contract a time or two. One thing to know about extending contracts is that you do have a year cap on how long you can work somewhere before giving up your “traveler” status. I’m honestly not sure what determines this, but I do think it has to do with the IRS, tax home, and not being able to continue to receive tax-free per diem and housing.

*If you do negotiate a contract extension, always ask for a raise, even if it’s a small one.

In addition to extended contracts, the other place I’ve lost a lot of time over the years is between assignments. When I say I’ve “lost time,” I only mean that I’ve completed fewer traveling assignments because of all my time off. Most agencies don’t offer paid time off (PTO) unless you’ve done a few consecutive assignments with them. The bad news is you likely won’t get paid for your time off. The good news is that nobody else has a stake in your time off, and you can take as much time as your bank account can tolerate. I spend a lot of my time between assignments visiting family and friends back home, but I also use the time between assignments for some of my best adventuring. There were a couple years where I was ending up with 10+ weeks off per year! Luckily I’ve reeled that in a bit and tend to only have a week or two between assignments.

So far, I’ve talked about two positive things that can account for unanticipated time – prolonged assignments and vacation time. The third way your next travel assignment can be delayed is because you can’t find a job. I’ve written recently on the discussion board about staying flexible as a traveler. The more flexible you are, the less likely you are to remain unemployed. The only times I have ended up unemployed are few and far between – and I’ve never been more than a week without a job. Should you ever find yourself in a position where the job you want is just not popping up in time, re-evaluate and see what your other options are – other adventures await! There are great opportunities available in travel rehab, the only reason you would ever remain unemployed for a sustained period of time would be your own stubborn solidarity to a particular city or a particular practice setting.

Arriving in Juneau on our boat/roadtrip back from Alaska in 2012. One of the coolest uses ever of two free weeks between assignments.

Arriving in Juneau on our boat/roadtrip back from Alaska in 2012. One of the coolest uses ever of two free weeks between assignments.

As you plan to take on traveling as a career, or even for just one year, there will be many places you’ll want to see. You can’t see them all at once, so allow time to get to where you want to be. There will be positive experiences that keep you in areas longer than you intended, and there will be obstacles to getting exactly where you want to go. But, with a little patience, you can turn  traveling therapy into one of the greatest life opportunities ever.

When my wife and I started traveling, we thought we’d travel for two years. We eventually saw everywhere on the original list of places we wanted to see, but haven’t shaken the travel bug yet. Eight years later, we still think two more years will do the trick. Yeah right! Maybe we’ll find our way to that remote Alaskan island someday.