Physical Therapist Pay – Then, Now, and the Future

I have had a lot of conversations around pay in Physical Therapy over the past couple of years. A pattern has developed that leads me to believe we have been approaching pay the wrong way. We have failed at improving PT insurance pay, but not for any lack of effort. Suddenly, there may be a new opportunity for systemic change that I believe we must take full advantage of. In the last few months, we have seen the COVID pandemic set the stage for large changes in just about every aspect of life – especially in the provision of healthcare.

In physical therapy, we have taken the stance that our services save the system money. When people interact with us, there is less medication use, less imaging, and less surgeries – usually with comparable results. Every time research is conducted on the most common musculoskeletal conditions – i.e. back pain, neck pain, meniscus tear, rotator cuff tears – we get the same results: purely anatomical findings are not as predictive of dysfunction as the medical model thinks. Physical Therapists often get superior results for exponentially less cost. This is the truth, and this has been our consistent talking point to insurers, regulators, and legislators.

Last year, I went to a conference put on by the American Chiropractic Association in conjunction with Physical Therapist and Osteopathic professional groups. One speaker, who was formally trained as a Chiropractor, but working as a higher-up in United Health Care spoke bluntly on the topic of increased insurance payment. He said, plainly, bluntly, and quite rudely, that insurance companies do not care who saves the system money. That is not what they are looking at. He does not care about our value proposition.

That was the first time I considered that our kumbaya approach to saving health care makes a lot of sense to us, but may only be valuable through a therapist’s eyes – not the view of others. This insurance exec went on to say that what UHC is looking for in a valuable professional encounter is one in which the patient doesn’t return. Meaning, they are cured and the insurance company is no longer on the hook for the bill. I’ve been turning this over in my head for more than half a year now, and I still can’t make sense of it. My best guess is people change insurance plans so often that the insurance companies want a short, finite episodes of care that ends in a tangible result (good or bad). They do not want the prolonged liability of someone who may be getting gradually better over several months of rehab, even if waiting to see the outcome of rehab would save billions of dollars over the entire population. It seems like bad math to me, but I digress.

Within a few weeks of the ACA conference, all the PTs, OTs, and SLPs I work with had a meeting with HR at our community hospital. There were some changes being announced in the pay structure at work and HR wanted to present it to us with an opportunity for questions – I assume we were given extra attention because we are notorious for complaining about being underpaid.

The hospital was switching to a market-based pay system. Meaning, our pay would be established by the pay of other hospitals around us. The HR employee told me, point blank, that the money our department brings in has no influence on what our pay is.

After hearing HR tell me the money I make for the hospital has no influence on the money I make for myself, and the insurance executive telling me that my saving him money doesn’t mean I’ll get paid more – I was starting to have doubts about our whole profession’s approach to increasing our insurance payments and overall pay. It seems the factors that we think impact our pay do not. Saving insurers money doesn’t get us paid more. Making our employers money doesn’t get us paid more. We need a new playbook.

At the end of last year, a large group of leaders in the Academy of Orthopaedic Physical Therapy (AOPT – formerly the Ortho Section of APTA) got together to make the strategic plan for the next 6 years. A part of that process was surveying the nearly 20,000 members about their priorities for the Academy’s work – about 300 people replied with information that would ultimately help guide our work.

The survey, though poorly responded, had clear results. Members of AOPT and APTA want leadership working on increasing insurance payment and the value of PT. This was made central to the strategic plan which I encourage you to take a very quick look at:

Increasing pay from insurers is work APTA has advocated for daily for years. That Members want increased pay is not new information to anyone. There are annual conferences focusing on payment, groups from all over APTA work constantly in many ways to increase payment, but what do we see? Decreasing reimbursements. Which brings me back to what I have expressed above – what we think should work, does not. Throw. Out. The Playbook.

AOPT will be addressing payment in a more direct way than previously. I hope novel approaches are researched, the who’s-who of payment in rehab are gathered, and the dissenting insurance executives are consulted. There has to be something we can do to increase our insurance payment for our valuable services that cure patients for far less cost than the other more invasive alternatives.

I had one more very recent conversation. I have this patient I’ve seen off-and-on for a couple years. He is a bonafide titan of industry – the real deal. He has held very big positions in businesses you know. The other day, he comes into his appointment talking to me as he often does about whats going on in the world and what might be the next big money-maker/world-changer. But this time, he is suddenly talking my language.

He says there are several major revolutions that will be coming from the COVID-19 pandemic and one of them will be in healthcare. He says we have long assumed that what the DOCTOR (Physician) says is right. That we rely on very tangible procedures for well defined problems to get tangible results – simply, surgery for broken and torn stuff, but that time and conservative measures can get a lot of the same results for far less money. He says people who delayed surgeries during COVID shutdowns are seeing good results in their recoveries without having had the surgeries they previously planned on having. He suggests that part of the revolution will be an investment in value-based treatments that save the system money. He stresses preventative medicine over interventional medicine. This guy isn’t saying the words “Physical Therapy,” but those are the words my ears are hearing.

So what do I think now? Is our old mantra, our kumbaya-ing, on the brink of finally paying off in our society’s most desperate time? Or is it time to move on and see what our new approach should be? I’m really not sure, but if you’re not a payment expert and you’re not working directly in the insurance industry, there is one way for you to directly contribute to and be a part of the effort that finally gets Physical Therapists the financial respect we damn-well deserve. Become a Member of APTA and AOPT – the work is being done at the highest level and may be on the edge of the breakthrough we have all been waiting for. This is your chance to contribute to the cause, and you might be jumping on the bandwagon at exactly the right moment.

Health Insurance As a Traveling Therapist

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

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

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

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

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

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

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

Short-term Insurance

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

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

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

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

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

The Open Market

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

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

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

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

Recycled Emails

I’m always looking for content to put on the page and recently realized that the emails I receive are probably better travel information than the stories I try to tell. So, without further adieu, the second installment of our Q&A.

I like the question that this email asks, The new traveler asked about the finances of travel, and whether there’s really all that much to gain when the expense of travel, furnished apartments, and moving several times per year are all added up. You’ll see my response below, but I’m afraid I downplayed an important point. For me, the extra pay with traveling PT is just a bonus. I do traveling for the adventure, locations, change of pace, and fun of it. Just wanted to be clear. 🙂


Thanks for your last email. I wanted to ask, since you use more than one company for jobs, how do you handle benefits e.g. health insurance, time off etc. I wonder if the higher pay of travel just gets eaten up by not getting a paid vacation, health insurance etc.

Although I am interested in seeing other places, what I most want is to make money to pay off my student loans!




I do carry my own health insurance. From a lot of companies I’m able to get another $1/hr for not needing their insurance. My wife got short-term insurance for a while. At you can get insured 6 months at a time. The way to combat having to get your own insurance is to stick with one company – some of them are real sticklers about being back working for them within 14 days between contracts. If you are jumping around between companies like I do and you have a major health issue between assignments, I believe you can retroactively enact COBRA for up to 60 days, so there is that safety net.

You’re right that there are costs to travel – no PTO, moving expenses, etc. I think my wife and I break even compared to working a full-time perm job. But, on the other hand, we take a lot of time off each year. In the last two years I’ve probably taken 15 weeks off. If you are diligent about getting right into a new assignment following the assignment before, there’s a potential to get quite a ways ahead financially…. Another way you can maximize your pay is by actively seeking out the higher paying assignments which are typically in more rural areas and less desirable settings. If you’re a new PT, I’d probably skip seeking out these assignments at first, but later on they can be a great way to make some cash, see some different social/cultural situations, and expand your comfort level on a wider scope of practice.

Hope this helps!!!


Note: I originally had responded in this email saying COBRA could be enacted 90 days after losing employer sponsored health coverage, the limit is actually 60 days as corrected above. Here is the department of labor’s website of FAQ’s on COBRA. If you jump from recruiter to recruiter without your own insurance, it’s probably really good information for you to know.