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!

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!

What’s Next?

If you’ve read this blog over any sort of extended time, you should notice a pattern: May to November, really good at writing frequently; December to April, really infrequent writing. I came into the winter this year with a head full of steam and several partially-written blogs. I had desires to reach out to more Occupational and Speech Therapists, and I also had the intention of voicing my strong opinions of PT-specific topics. But, as usually happens in December and January, I’ve had too much damn fun in Aspen and haven’t written a damn thing.

The mountains of Aspen have kept me aptly distracted from writing this blog.

The mountains of Aspen have kept me aptly distracted from writing this blog.

So, it hasn’t snowed a meaningful amount in several weeks, I got a quick ski session in this morning that was reminiscent of my days back skiing on the blue ice of the Northeast, and I’m left with a full afternoon to produce something meaningful for you. After procrastinating a couple hours by clearing a couple items out of my Netflix queue, I’ve sat down at the computer to write. In my mind, I’ve abandoned the two possible topics I had intended to write about and have forgotten what my partially-written blogs from November are even about. This will be stream of thought entry, proof-reading may be marginal, and I’d like to just get some of my current thoughts out to you. In these ramblings, I hope there’s something useful about being a traveling therapist that can be a take-away for you. If not, I’m sorry – at least my blogs are short.

The football playoffs started out with a lot of different potential outcomes for me. As a Native New Englandah and now as a Colorado Resident, the prospect of a strong Broncos’ team scares the heck out of me. It seems that in most of recent history, the Pats inevitably meet the Broncos in the playoffs – rivalries are fun, until it pits you against everyone around you. This year, we snuck by, the Broncos were eliminated early and my friends and co-workers (sorry, guys) were silenced. Crisis avoided. Then, two weeks ago, I realized my Pats were up against the Indianapolis Colts – Indy is also the home of this year’s CSM conference which is to be held 3 days after the Superbowl. If the Colts got past the Pats and went on to win the Superbowl, I would be in Indy for the victory parade…. Not a pleasant thought. Luckily, the Pats have prevailed beyond the Broncos, beyond the Colts, and are on to play in the Superbowl against the defending champions, the Seattle Seahawks. The NFL has once again stirred up controversy to make a good-guy/bad-guy scenario: Last year, the terrible Richard Sherman was portrayed as an out of control brute who can’t control his emotions, this year he is the intelligent tough-guy who will be playing through injury to take on the New England cheaters. I imagine by the time most of you read this, the NFL will have cleared the Pats of any wrong doing – it was trumped up controversy, folks, the NFL choreographed the whole thing to make you care about the Superbowl, just saying.

::segue coming::

The current center piece for our living room. A Hawaiian coconut painted with the Patriots logo. Below that, a series of books from Colorado, Hawaii, and Alaska.

The current center piece for our living room. A Hawaiian coconut painted with the Patriots logo. Below that, a series of books from Colorado, Hawaii, and Alaska.

Anyhow, let’s move along to the topic of therapy and travel. Did I mention I would be in Indianapolis for a conference next week? For those of you who may not be in Physical Therapy and may not know, CSM is our biggest conference each year, it moves from city-to-city each February, and over 10,000 PTs, PTAs, and students attend. Everytime I attend a conference, I come away incredibly motivated and excited for the future of our profession. I’ve written in the past about the need to gain knowledge and continuing ed while traveling (Traveling Doesn’t Have to Mean Professional Sacrifice – 4/11/11). Attending this conference accomplishes learning at a very high level and so much more – hanging out with old friends, meeting new colleagues/friends, discussing the future of our profession, meeting other travelers, and having a good time.

In the past, I have felt like the opportunity of being a traveling Physical Therapist may be some sort of compromise. Traveling frequently from place-to-place has limited me in creating real traction to move forward to the next stage of life (whatever the hell that is)! The approaching of CSM and some recent conversations with friends has brought this thought of the balance between travel-life and being established to the front of my mind again. This thought apparently comes to mind frequently around this time of year (Community Chest – 3/1/14). I was speaking with a co-worker, who is also a travel PT, and she was wondering what is “next” for herself. For me, “next” usually comes in the form of a 3-month plan that my wife and I spontaneously put together over a couple beers in mid-February. (Perhaps back home to New England for a few months? (and maybe catch some Red Sox games?)) (Who uses parentheses within parentheses? (Weird.)) But, this traveler I speaking with was asking the bigger question, “What’s next in her CAREER?”

Oh man, the “C”-word for travelers: “CAREER”. This word is only surpassed by the “S”-word: “Settledown”.

The life chosen as a traveler is unconventional. Kate and I, my wife, have chosen to roam fancy-free and mostly without any agenda other than to see as many different, awesome things as we can. We’ve been at this for 8 years and aren’t done yet, but it seems that through our meanderings, some sort of career-traction is being established. 1. I have had several requests for meetings at CSM this year, mostly about and due to travel (the total of all requests for meetings in previous years is zero). 2. I’ve inserted myself into conversations legislatively about licensure issues which has opened some big doors in the last couple of months. 3. Traveling just feels good to keep doing – after all, it’s what everybody does once they are retired and no longer hindered by their work schedule. Could it be possible that a career could be made traveling? Just writing down the words makes me feel uneasy, you’d think there would be some stop to this crazy travel-life. Who knows. For now, I’m excited for the Superbowl, CSM, and the next three months – but I should come up with a solid plan for the following three months soon. The three months after that? Not important, I’m doing jobs that I like, where like, with people I like.

Whoa, well I certainly got on a roll there. Hope it wasn’t too manic for you and sorry for blabbering about the Superbowl, be thankful I didn’t go on-and-on about the Rob Gronkowski dream I had this week. I’m just glad I finally got around to the topic of travel therapy. Have a wonderful winter and I promise I have more poignant topics soon.

White Christmas

This quick entry is specifically inspired by my friend Ry. He has requested I send him a picture of myself at work some day, because he doesn’t believe that I actually work. I can’t blame him, I really try not to work, but it is a necessity.

If I have to work, I like to have a view of a ski area. :-) Loving it.

If I have to work, I like to have a direct view of a ski area.  Loving it.

As a traveler, you sometimes have to do the grunt work. You might work weekends, you’re likely going to be working hard during the hours you are at work, you might even work Christmas, but hopefully you’re doing it in an awesome place.

Here in Aspen, the place Kate and I return to every winter for work, I know the drill. I’m going to work Saturdays, I’m going to work Christmas and New Years. I have come to grips with this schedule and actually have come to like it. Someone suggested a possibility of no working Saturdays, and I realized I actually like working Saturdays because it’s low-key and I get to be off an extra weekday off.

If I have to work (and I do have to work), I’m going to do it in a place I love and that will make my hours outside of work so very much better. Living here in a touristy paradise there are many, many benefits. Working Christmas Day is a small sacrifice. It’s a White Christmas today, which means it’s a powder day tomorrow (when I’m off) 🙂

Christmas Day, at work. Merry Christmas all!

Christmas Day, at work. Merry Christmas all! It’s not so bad.

When I’m off work in a few hours, Kate and I will host our annual Christmas Party for many of our co-workers and few of the new travelers here who don’t know many people yet. If you’re in the Aspen area, drop on by. We’ve come to celebrate our Christmas in an unorthodox way, but it’s one part of great life through being traveling therapists.

Happy Holidays, Happy New Year, See you on the slopes. See, Ry, I do work…. sometimes. 🙂

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.

The Downside

I have written many uncompleted drafts of this post over the years. For about 4 years, it sat uncompleted in my drafts folder titled “Trouble in Paradise.” I deleted everything I had written and started over – like a waste bin full of crumpled papers by a typewriter. I have a hard time expressing the cons of traveling PT because I do really enjoy it and can’t even seriously consider how different my life would be working the last decade in one place, doing the 9 to 5 grind. Uhg, the thought disgusts me. 🙂

But here it is, my attempt at talking frankly about the downside to travel PT. I’d also like to hear from other travelers about what they think the downside is. Here we go, back to rainbows and unicorns next week.

——

There’s not much to gripe about with traveling physical therapy. After almost 8 years of travel, I’m beginning to think that the nightmare-assignment barely exists. In about 20 assignments, there is only one I’ve had to terminate the contract on early. If I had asked the right questions during the interview, I don’t know that I ever would have worked that assignment. Over time, I realized my boss was a unlicensed foreign chiropractor. I also realized that I was a PT giving massages, not a PT doing PT. After a couple agonizing weeks and all of the full-time staff quit, I managed to get that contract terminated. From that experience, I believe two things about bad assignments: 1. Awful assignments are pretty rare; 2. If you perform your due diligence in researching your assignments, you can easily avoid disaster;

Therapists that repeatedly finds themselves in difficult situations or putting out fires with their bosses needs to take a deep look internally and know their roll. As a traveler, you are frequently not treated as a full team-member; you are a temp filling a spot and may be a bit of an outsider from the other staff.  Even with facilities that are very welcoming, you may find yourself the work-horse while other overworked staff gets their long-needed rests. If you eventually accept more permanent employment from a facility, then, your role may change, but until that time, do not tell your boss how you think the facility could improve. I did this on assignment back in 2010 at a home care company – I was told, “We welcome your feedback, we want to know what could be done better.” Even if you are begged for feedback, you are a temp, do not tell your boss how the facility could improve. I have learned this lesson, don’t repeat my mistakes. The last day of that assignment came with one of the most unfriendly goodbyes I have ever experienced. That home care company has since closed their doors. OK, so maybe 2 assignments out of 20 didn’t go as smoothly as they could have for me. That’s a 90% success rate, I still believe really bad assignments are a rarity.

The only thing in travel PT that gets me riled up on a regular basis is the licensure juggling act. I think I have ranted about licensure in the past. After a period of time, Kate and I had let all our unused licenses lapse. We found ourselves in a jam last spring and started re-upping many of our licenses. We decided at that time that we would maintain all our current licenses as long as we traveled, because it’s too much of a pain to renew a license you have let expire. That strategy went to junk last week.

All Alaska PT licenses expired on June 30th. Can you imagine what this month is like in the Alaska licensure office!? Holy Cow, just hope you don’t have to contact them to get anything done in the next couple weeks. Anyways, Kate and I set into filling out the paperwork for licensure renewal which included a 20 question juris prudence exam heavily focused on the new continuing education regulations – also, you had to write down the statute number that contained the answer to each question. Over the last two years, I’ve attended several multi-day national meetings to discuss PT issues and practices, but this is not considered continuing education by Alaska. So, I set off on the internet to find a cheap courses that would provide the CEU’s I needed. Two hours into this process, we had the applications in the envelope (no email or faxing allowed), $240 checks written each for renewal, and I was about to order a lousy $300 online course for my CEU’s when we finally decided to pull the plug on staying licensed in Alaska. Kate and I may renew in the future, but the prospect of shelling out $800 to keep a license we might not use seems a bit ridiculous. I did end up ordering a much higher quality, online course from APTA that I’ve been wanting to take, so the 2 hours spent not-renewing wasn’t a total loss.

The licensure process stinks, it’s an antiquated process that bears no real function in the modern world, other than to satisfy the outdated rule books. I will soon write ANOTHER letter to FSBPT expressing my displeasure, but in the meantime, I just take it as the way things have to be done to continue traveling.

Licensure is the thing that bothers me most about traveling, but it’s a relatively small inconvenience. I think people’s primary fear about traveling is getting stuck in a nightmare assignment. As I’ve expressed, the really bad assignments are rare. If you find yourself in a bad assignment it will only last 13 weeks, and it will probably take you half of the 13 weeks to even realize you have accepted a bad assignment.  If it’s exceptionally bad, there are ways out, and a good staffing agency will have your back. Other than what I’ve already talked about, there is very little downside traveling physical therapy. The frequent moving can get a little old at times, but that process streamlines itself with practice. Who am I kidding, packing and cleaning will always be the worst – just awful.

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Stay tuned, lots of excitement happening in the initial stages of searching for an autumn assignment. I’ll keep you posted. And please do share your gripes about traveling PT… a one time chance. I will not write another negative blog for a long time.

How Should I be Paid?

With any job, there are a number of different ways you can be paid. There’s straight-forward salary, hourly, or some sort of productivity-based pay. Of course, when considering pay for a typical job, there are things to consider besides just the money – health care, retirement, life insurance, employment-related discounts, and the list goes on. In traveling physical therapy, the list gets a little bit longer and more complicated. A traveling therapist has more say in how he or she would like to be paid and needs to determine how much he would like to weight his taxed versus untaxed wages. There are IRS limits on how much you can take tax free in each zip code, but I have been told that taking those upper limits with low taxed pay can be a red-flag for an audit. So, I typically take $20-$30 hourly (taxed) and get the rest of the pay as stipends/reimbursements. I know a lot of travelers think hourly should be near the normal hourly amount a perm PT makes with the reimbursements being in addition to normal pay, but that’s just not the way it works. A more adventurous travel assignment can have some perks that can make the math of take home pay a bit more complicated: a loaner car from a boss, employee housing, a coworker’s mother-in-law apartment, or other non-monetary compensations.
Productivity arrangements in healthcare can get iffy real fast, think anti-kickback laws. I am not a fan of pay-per-code or percentage of billing situations. These can quickly turn an honest therapist nasty. It’s just too tempting to bill an extra modality or therex that may not be necessary when you know your own bottom line is linked to it – I don’t like it one bit. I’ve seen a number of positions, particularly for therapists in management, where bonuses (boni?) are paid for meeting certain productivity thresholds – number of patient visits or units billed. I occasionally see pay-per-visit systems go awry with a therapist seeing many patients at once, episodes of care dragging on, care extenders over-reaching their scopes of practice, patients getting less attention, and therapists getting burnt out. But, I can’t speak too harshly about pay-per-visit, since it is how I’m getting paid right now. Luckily I’m in a practice where all treatments are provided by PTs 1-on-1 for an hour. With the focus of 1-on-1 patient care, I find the arrangement ethically acceptable, but it’s definitely got its pros and cons. I’m well paid for my hour with a patient, but there is nothing worse than an initial evaluation that no-shows and leaves me unpaid with nothing to do for a full hour. I would encourage anyone considering a pay-per-visit position to first strongly scrutinize the care patients are receiving, and secondly, to ask for a little more money than you normally would, because the chances of batting 1.000 for attendance in any given week are slim.

Advance Healthcare Network

From Advance – Click to access their full report

New travelers are always asking me what they should get paid – I don’t know. Pay varies so much regionally and even town to town. It can be real tough to know if you’re making all you can of if a recruiter is taking you to the cleaner’s. Just find a recruiter you trust and get as much as you can out of each contract. I may try to establish a database where travelers can anonymously input how much they got paid on assignment. It would likely be a small sample size, but may provide all of us some information about what other traveling PTs are getting paid in each state. As I mull over that idea, here’s a nice piece that Advance puts out each year based on their survey results of PT pay. I just stumbled across the APTA Workforce Data page, not as sexy or user friendly as the Advance survey, but lots of good info in there if you click around (APTA Members only).

Some advice for the new traveler: Remember that your recruiter is working on commission and doesn’t get paid if you don’t get hired- it is in their best interest to get you on board even if it lowers their own bottom line. You are a temporary worker for a facility that needs help immediately, you are willing to pick up your life and move to that job to fill a position they desperately need filled – this has big value to it. With all these things working in your favor for higher pay, the costs of travel, furnished apartments, and miscellaneous other will likely cancel out a big chunk of the extra moolah. But, traveling PT can be an exceptional lifestyle that is worth so much in personal experience and growth – so get what you can financially out of a contract, but more importantly, just get out and see some more of this world.

In other news, a series of conversations this week have lead me to believe that the travel PT market is rebounding from a couple of more difficult years, I’m finishing up my SCUBA certification with four dives off the coast of the Big Island this weekend, and (in a crazy out of this world experience that only traveling PT could provide) a hospital has bought Kate and I plane tickets to fly out to interview for a possible once-in-a-lifetime travel assignment this fall – we shall see and more on this later.

Keep living the dream 13 weeks at a time!

Wiki Wiki

The increasing infrequency of my posts is a clear sign that my work hours panned out. Just a wiki wiki (quick) update on the travel and jobs in Kona.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back - interesting history everywhere you look.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back – interesting history everywhere you look.

The hospital gig, which was a wishy-washy thing from the get-go did not work out. I had tried to get something going at the hospital through one of my go-to recruiters. When he wasn’t able to come to an agreement, my recruiter gave me his blessing to try to establish a contract with the hospital on my own. So I tried. I spoke with the rehab director and later on the contract manager (the fact that they have a full-time position dedicated to manage contracts should have been a dead giveaway to steer clear). They were very encouraging that something would work out for me to be at the hospital. As they requested, I sent them a written proposal of what I would expect in my contract – 2 weeks went by and they requested I establish a contract through one of the recruiters I had used previously. The situation started to feel a little icky since my original recruiter had found the job, and working with another recruiter on the same job can start to cross travel PT ethical borders quickly.  Hesitantly, I went along with it. As everyone who has been doing travel health care for any period of time knows, credentialing for a job can take up a fair amount of time. So, I got underway on getting my paperwork and vaccinations all set for the staffing agency; I did the tedious skills checks online, I requested old varicella titre reports from my alma mater, I took a drug test at one facility, and I went and got my TB test up to date at another facility – all to find out just a couple days later that the contract wasn’t happening. Bummah. At least I got a free TB test out of it…. silver lining? Whatever, ainokea (“I no care”).

Waipio Valley - "Valley of the Kings" - We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

Waipio Valley – “Valley of the Kings” – We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

BUT, I got lucky, again, and landed on my feet. Everything is coming up James! The private practice prn job now has me booked 40 hours/wk and would gladly book me 50 hours if I let them. That job is doing just fine. And the kicker is that some of the staff at the clinic also work for a local coffee shop up the street, so I have found my Kona Coffee hook-up!

I have to get going, time to get to work. Upcoming island excitement includes a state holiday tomorrow, Kamehameha Day, celebrating King Kamehameha “the great” who united the Hawaiian islands which has previously each been under separate rule. He united the islands primarily through war and execution, and he also ended human sacrifice in the Hawaiian Islands right around the year 1800… different stories for a different day.

We will start SCUBA training this weekend, so that should lend itself to some good stories and pictures.

Aloha!