4 Island Travel PT Assignments

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

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

Hawaii

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

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

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

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

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

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

Martha’s Vineyard

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

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

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

St. Thomas

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

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

Alaskan Islands

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

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

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

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

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

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

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

 

Does Travel Therapy Really Pay Better?

People ask all the time if it’s really true that working as a traveling therapist pays better than working as a permanent employee. The easy answer is “yes,” as a traveler you make much more money hourly than as a permanent employee. But I have often wondered if the costs of moving frequently, unpaid time off, and more expensive temporary housing eat so far into the net gain that we come out about even. After additional costs, I think travel therapists likely end up taking home about the same as permanent therapists, but let’s do a little math and see if we can reach a semi-scientific answer. As I begin to write this blog, I have no idea what the answer is going to be – this will be fun.

We’re going to have to make some assumptions to get a rough estimate of what a traveling therapist takes home each year – there are a lot of factors that can drive the take-home up or down significantly. I will make assumptions based on what I would consider a typical year in a traveler’s life:

  • Let’s assume 3 contracts in one year. This allows for either one longer 6 month contract or one contract extension during the year. Also, most people can’t keep up consecutive 13-week contracts for more than a couple years, it gets tiring.
  • I know some people jump right from one assignment to the next with little, if any break. I tended to take 3 or 4 weeks between contracts to visit family, take road trips, or go on vacation – that’s probably more leisurely than most. If you have trouble finding a contract, you may find yourself out of work a little longer than expected. Let’s go with 2 weeks between contracts, this is more time than some will take, but it allows some wiggle room for travel and job-finding.
  • Let’s assume we’ll take the housing stipend and find housing for cheaper than the agency would give it to us – it’s the smart and frugal thing to do.
  • We’re going to have to agree on “typical” pay for a traveling therapist, this is tough because geography and setting cause great differences in pay everywhere. With pay in desirable destinations being as low as $1450/wk and a really good paying jobs being up around $1850 or higher, I think the middleground and a typical travel contract pays about $1650/week. This number is after taxes and with that housing stipend that we have decided to take.

So, at $1650/wk for 48 working weeks, that’s 79,200 after tax – or the equivalent of a $110,000 salary taxed at 28%. Whoa, that’s more than I thought it would work out to, an impressive salary for a staff PT. So these are the base numbers that makes travel look appealing compared to permanent work – now let’s do some subtraction and bring these numbers closer to reality:

  • As a traveler, you’re not going to get paid for sick days and there might be some holidays your facility takes that your agency doesn’t recognize (local, state, and other frivolous holidays). There’s also the common circumstance that your desired start date doesn’t quite line up with the facilities needs, or some extra work days are lost to travel. Maybe you miss a day or two at a continuing ed course or conference. Perhaps, you are waiting for your new state license to come through. Anyways, doing some rough math, let’s say there are 10 other work days in a year that you will miss – 2 weeks. -$3300
  • The actual transportation part of moving can vary wildly in cost. Road trip? Probably. Fly there? Depends. Ship a vehicle? Maybe. Will you need a couple nights in a hotel, or at least campground fees? Food on the road is not usually cheap. The saving grace is that as a traveler, you will get some sort of relocation reimbursement. It’s unlikely to cover all of your costs, but it will cover a good portion. Let’s say the average traveler on the average assignment will spend $250 of their own money on relocation if they travel wisely (getting to 3 assignments this year)  -$750
  • Also included in moving costs are all the things you need in a home when you move: TP, cleaning products, staple foods, condiments, etc. I typically spend about $500 at target at the start of every assignment stocking up on the things I’ll need to live comfortably. -$1500
  • In this scenario, we’re going to take the housing stipend so we can get furnished housing for less than the stipend and keep the extra tax free money. But, the furnished, short-term housing is going to cost us more than we would spend with a typical long-term lease in an unfurnished space. I believe it’s reasonable to say we will spend $400/mo more in short-term, furnished housing. -$4800

$10,350 less for our estimated traveling costs brings us down to $68,850 after taxes, or the equivalent of a $95,625 taxed salary.

I’m honestly surprised that the salary equivalent of what we’ve just calculated as a typical traveling job is so high. We can see from the pseudo-math above that the great boost in pay for travelers is the tax free money. To make the most of the tax free advantage, it is vital that you have an established tax home. Also, I believe this scenario represents someone who is being financially conscious and making attempts to get back to work in a timely manner, find inexpensive housing, and live within his or her means.

There is going to be a lot of variation to these numbers based on whether your assignment pays more or less and a number of personal factors.There are years I took 10 weeks off throughout the course of the year – that affects pay. I’ve heard of people renting cars on assignment, that’s a lot of money (comparable to a second housing rent). You can be frugal with your choice of housing, or you could be frivolous – you could even take the housing provided by the agency rather than the stipend. All of these choices greatly affect how much money you are left with at the end of the year.

Clearly, if you want to make more money through traveling PT, you could find the high paying assignments in the high paying states, live a frugal lifestyle, and rake it in. If you are doing traveling PT for the money as your first priority, do us all a favor and don’t. Travel PT should be about traveling. Enjoy seeing the places you go to work. Take time between assignments to relax and soak in some leisure time. Maybe you do a couple contracts as a traveler to explore different employment options or get a variety of experiences. But don’t do it for the money. The extra money is a nice addition to a lifestyle that you should enjoy for other reasons. Travel to travel, you’ll be a lot happier than slaving away in a terrible facility that will pay anything to anyone because it’s an awful place to work. My recommendation would be the same with permanent jobs. Money should not be the only factor – quality of life, work-life-balance, enjoying your job, being supported by your employer to provide the best care you can to your patients – these are good universal reasons to work anywhere as a therapist.

If you have an interest in doing traveling therapy to see the different ways to practice in a variety of settings and a bunch of different places, get out there and do it! You are in for an unbelievable experience and lifestyle. You’ll meet all kinds of different people, expand your clinical skills, and see some really cool places. As it turns out, while you’re scratching that travel itch, you could make a good chunk of cash while you’re at it.

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.

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.

Enter Island

A hike in the Haleakala National Park on Maui. Insanely beautiful bamboo forests.

A hike in the Haleakala National Park on Maui. Insanely beautiful bamboo forests.

As I write this, the sun has recently set and I’m sitting in the house Kate and I rented today. Our landlord will soon return to Seattle, but for now, he’s our quazi-roommate staying in the separate studio attached to the house. He’ll be finishing up a few house work tasks before eventually returning to Seattle. Nice guy, interesting guy. Apparently he’s a lawyer by trade, but has spent some time working in Denali National Park. At some point, he bought this house out here on the most remote of the publicly accessible Hawaiian Islands and clearly enjoys all the great nature activities here. He has two large lockers of camping and snorkeling gear in the garage collecting dust that he has encouraged us to use, so that’s a real bonus with this short-term rental. There’s also a mountain bike thrown into the deal that he spent part of yesterday afternoon fixing-up, JACKPOT! I’m sure we’ll get some more stories out of him before this is all over. Before getting on island here yesterday morning, we spent 5 days hiking, camping, and relaxing on Maui. My visits to Maui in the past have always been short, usually over a long-weekend from Honolulu, and usually packed with as much activity on as much of the island as possible. This time around, we concentrated the trip on two main areas of the island with a few days at each place, and we were really able to soak it in and relax. In coming from the Big Island, Maui was actually an increase in pace. More cars, more traffic, more busy, more tourists – my disdain for tourists is really quite impressive considering my living the vast majority of each year as a tourist in various tourist towns. I fear for my reintroduction to the mainland in 3 months – if Maui’s pace is too fast for me, I can only imagine the shock a city or metropolitan airport would bring.

Man, I hate tourists. We camped wright by the beach, it was really peaceful in the morning and evening hours.

Man, I hate tourists. We camped right by the beach, it was really peaceful in the morning and evening hours.

I’ve grown used to the small 9-seater planes we have been taking between islands. This trip to Maui was the 4th time flying by small plane in the last several months. To sweeten the deal on Mokulele Airlines, legs between islands are $50 flat rate and free from TSA searches and waiting in a line of any kind. It’s definitely flying with all the airport hassle removed. Yesterday, however, we did not fly, we took a ferry boat over to Molokai from Maui early in the morning. We rushed off to look at the house and then were able to quickly and truly settle back into relaxation-mode. Maui is slower paced than Oahu, the Big Island is slower than Maui, and Molokai is the slowest by far. The past 36 hours here have already been an experience. Afternoons have been filled with empty beaches and sleepy, small-town diners and bars. The land here is dramatic and beautiful. This afternoon, we took a walk up a small dirt path from the beach we were on. We knew the dusty red path would lead us to some secluded beaches down the shoreline that are inaccessible by car. During a short walk down the path, we saw wild turkeys and a bunch of deer. The deer here are cool to see, but are not-native and highly damaging to the vegetation. The damage to vegetation ultimately leads to a whole other chain of erosion events and has big negative affect on water quality and sea-life. Luckily, these deer are tasty, so local hunters are able to put a significant dent in their population. Our beach-stroll turned nature-walk got really interesting when it opened up to an abandoned beach formerly occupied by a resort company that used to run this part of the island. As Kate and I strolled down the beach looking at the decaying buildings set a ways back from the water, incredible views in every direction, and crystal clear water breaking over shallow jet-black lava rocks, we somehow both failed to see the 500 lbs monk seal sleeping in the sun that we were literally about to trip over (when I say “literally,” I mean it). Kate was about 3 feet from the huge monk seal and his partner when in an instant we and the seals all realized the others were there. The huge seals rolled over and Kate and I did a super-speed reflexive sprint about 10 yards up the beach. I’m not sure about the true ferociousness of a monk seal, but I know they can move faster than you’d think and can pack a wallop with their teeth or tusks or whatever it is they have. As we cautiously circled to the other side of the seals at a distance, we watched the seals, they watched us, and it seemed like everyone understood that all four parties involved were equally surprised. There’s only about 1,100 of this species left, and here we are just running into two of them on a day at the beach… crazy. We continued a short distance down the beach and saw some fish and an eel swimming in a tide pool – nearby, there was a “lahge lobstah” shell dried out on the beach. This beach, departed only a short distance from humans was just totally saturated with life. Kate and I had been in the sun long enough, and headed back to the car. As we passed the seals, the huge one let out a bark at us, I think just to see how fast we could move again.

Taken as we approached Molokai on the Molokai Princess Ferry. A dramatic island.

Taken as we approached Molokai on the Molokai Princess Ferry. A dramatic island.

I can’t believe we haven’t been here two days yet. We’ve experienced a lot in our short time here. It will be a wild 13 weeks for sure. Work starts tomorrow morning! But for now the night is pretty quiet except for the roosters I can hear clucking around the neighborhood. More updates and pictures to come soon – I can’t believe I didn’t bring a camera on that walk today. Oh well, next time.

Feast or Famine

When we last left off (Just Go With It – 5/9/14), I was headed 3,000 miles west out to Hawaii with the verbal assurance that there would be work when I arrived, but without anything in writing. Would there be work when I reached the islands? Would I be a kept man depending on my wife to bring home the bacon? Exactly how much snorkeling can one unemployed PT do in 13 weeks?

After some flip-flopping* back and forth, the work seems like it’s coming. In fact, I think I’ll have too much work in 2-3 weeks.

I arrived here 6 days ago, on Friday night. Luckily, the day before, my employment packet and job offer arrived in the mail from a private practice I have been speaking with. So, I learned how much I was going to be paid hourly if I worked, but had no guarantee of any hours. All there was to do was to get my feet on the ground in Hawaii and hope for the best.

O'hana Papaya

Papaya from the back yard garden! Included in the garden are the following trees that I can identify: 4 papaya trees, 2 mango trees, a hot pepper tree, and a coconut bearing palm tree.

When we arrived, we spent the weekend Craigslisting to find an apartment and a cheap car for the next three months. We found an awesome o’hana apartment! O’hana is the Hawaiian word for family, they call what we know as a mother-in-law apartment an o’hana. Because this island is essentially a big volcano with the top portion sticking out of the ocean, everything is on a hillside, and, therefor, everything has an ocean view. Our ocean view mother-in-law apartment is quite the pad – it also has a pool and a fruit-bearing garden in the backyard. Bugs, mostly cockroaches, are simply a fact of life in Hawaii. When we were out here a few years back, I had an old Toyota Camry with a roach problem. This time around, I have upgraded to a Toyota 4-Runner with a roach problem. I think bigger cars come with bigger roach problems…  back to the contract story.

I didn’t have any wok scheduled for this past Monday, so after dropping Kate off at her job, I popped in to visit the contract manager at the community hospital who I’ve been talking with about setting up an agency contract. All I had heard at this point was “we will need you, we will have work for you.” When I arrived on Monday, the story had changed, “It sounds like we may not need you at all,” says the contract manager. Uh oh, I was depending on there being work when I got out here. So, my efforts were refocused on the independent contract with the private practice. Originally I had told them I would be available Mon/Wed/Fri with the hopes of filling in at the hospital on Tues/Thurs, but with the changes in what I was hearing from the hospital, I offered to work all five days per week at the private practice. Right now, I don’t have a lot of appointments scheduled, but I can see how after evaluations are performed, and a few days go by, the schedule will grow considerably into a full 30-40 hours of work. This one private practice job should be just fine.

This morning, I heard from my recruiter on the hospital job, “James, call me when you wake up, I have good news.” The hospital changed their tune – census is up, and they need some extra help. At this time, I’m feeling conflicted about what to do. The private practice is bending over backwards to accommodate me and to try and fill my schedule. At this time, there’s not a very full schedule, but a couple weeks will fix that – unfortunately, they aren’t will to guarantee any hours. The hours patients are there with me are the only hours I get paid. On the other hand, the gig with the agency at the hospital will pay more and there may be a couple days worth of guaranteed hours.

4runner

The roach mobile, o’hana in the background!

When it rains, it pours. I’m currently working about 10 hours this week with a long-weekend quick approaching, it’s been a nice break, but I need to get back to consistent work. On the horizon, I can potentially expect 60+ hours of work any given week. While the thought of bearing down, working long hours, and stacking up piles of cash is appealing to me, I’m in paradise (again) for 3 months, and I’m not going to blow it by working indoors 60 hours a week.

For now, it’s back to waiting. I’ll have to see what the hospital really wants from me before I commit to anything. If they do guarantee hours, the decisions will get difficult – will I choose the higher paying guaranteed hours? Or will I stick by the practice who has not guaranteed me any hours, but has been good to me thus far?

Time will tell, for now it’s back to researching which beach to camp on for my 3+ day weekend.

Happy Memorial Day! Aloha!

*In Hawaii, flip-flops are called slippahs. example: Take ya slippahs off when ya come in da house, brah.

Just Go With It

I’ve returned to my natural state. Everything I own is in a bag. The rear-end of the car is dragging on the tires from the weight of stuff that will ultimately end up in a storage container. Kate just got home from her last day of work with a bottle of wine. The corkscrew is packed away at the bottom of a box, but at least my camping gear is coming on the trip, so my Swiss Army knife is available. We’re each wearing different white Red Sox shirts as I twist the corkscrew portion of the Swiss Army knife into the cork and pull like hell while hoping not to splash red wine on either of us. Success! It’s going to be a good week off.

Map of lava flow hazard zones for Island of Hawai`i

The USGS’ Lava-flow Hazard Zone Map. I guess we’re supposed consider this when looking for housing? It’s going to be an adventure.

It’s been a wild ride to get this next assignment’s contracts in place. Actually, they aren’t really in place, I’m just going in on blind faith with fingers crossed. Kate got an assignment set in Kona, HI through a recruiter. We thought long and hard about whether Kona was where we wanted to go and what our other options were. When it became apparent that there were some more jobs around Kona and a couple opportunities for independent contracts presented themselves, we committed to Hawaii.

People ask me about independent contracts a lot. Let’s be clear, I am no expert on independent contracts, but I do have a little experience. Whatever I’ve done this time around is not the way independent contracts should be done. I’ve verbally accepted two PRN jobs with no idea what the pay is.

It all started well. I have had two different interviews at places that would like me to work for them. Seems simple enough from there, right? Let’s sign the contracts and get started with work. Unfortunately, neither of the jobs has 40 hours for me, but they both say they have 20-30 hours for me. We have talked pay, but I have no commitment from either job on exactly what the pay will be. I supposedly have a job offer in the mail from the private practice, and the hospital I have spoken with has cautioned me that they are run by the state, so “it can be quite a process to set-up a contract.” I’m antsy to have a contract in hand, but Kate keeps reminding me about “Aloha time.” Aloha time is the Hawaiian equivalent of “Don’t worry, be happy.”

The start of the Ironman Kona swim is right around the corner from my job. The locals call it “The Pier,” and I cannot wait to go get some open water swimming in.

Kate’s right, things are going to go fine, we always land on our feet. I have two places in Kona that want me to work for them and want me to start in under 10 days – that’s a pretty good situation. It’s Hawaii, they’re relaxed, and I should be too. No one else is worried, they expect me to show up on the 19th and start work. Nothing left to do but knock on wood, hop on the plane, and hope someone has scheduled me some patients when I get out there.

Remember, don’t do this. Be more business savvy than I have been. When talking finances of a contract, be clear, be confident. Because I have not been clear or confident when talking about the business parts of my independent contracts, there’s nothing left for me to do but wait and start working on my transition into Aloha time. Patience is a virtue, don’t worry brah.

To Be Continued...

Island Dreaming

Just a quick entry for you folks today. Thought I would give an update on my current job search and some of the obstacles I’m running into.

Regular readers know my wife, Kate, and I are both PTs who travel together and know that this sometimes presents some unique challenges. Mainly, we need two PT jobs when we travel instead of just one.

Island of Hawai‘i, Hawaii

Kona coffee every morning.

Our hope this summer is to return to Hawaii. We worked in Waikiki a few years back and after a couple consecutive years of assignments in the more Northern reaches of our country, we’re ready for some sun and water. This time, we’d like to try to avoid the city and check out an island other than Oahu.

I try not to rant on here too much, but I really wish we could have some more reciprocity between states with our licenses, like the nurses do. It took almost three months to reinstate our Hawaii licenses – a process which should have been easy, but dragged on mostly because of mistakes by state board staff in several different states. Anyhow, we now have our Hawaii licenses current and even have a possible job on the big island (Hawaii).

Normally, we would be psyched to have a lead on a job in Hawaii this far out from our start date (4 weeks), but our situation got a little bit spicier this week. Two jobs on Nantucket materialized and got us thinking a bit more Easterly.

Nantucket, MA

Nantucket – 30 miles off the coast of Cape Cod. Very expensive.

Nantucket sounds like a great time – but, it comes with a few challenges: 1. We’d really like to be in Hawaii. 2. Housing prices are ridiculous. The only Nantucket posting on airbnb.com right now is a house available for rent at $40,000 per month! There’s no camping on Nantucket, so a trailer or RV are out. I’m trying to wrap my head around how living in a house boat for 3 months would go. (I think it would go pretty awesome!) If these Nantucket gigs work out, I think we’re going to have to ask for higher pay to help buffer the cost of living.

That’s all for now, just a quick update and I hope to have more to share soon.

A Little Ketchup

One of the many beautiful sunsets this fall from our apartment looking back on Boston.

One of the many beautiful sunsets this fall from our apartment looking back on Boston.

Another travel assignment has flown by and I again have written far less frequently than I intended. I have a short list of meaningful topics I’ve been wanting to get to, but today you’ll have to settle for just an update on the travel life.

It’s been a great autumn in the Boston area. Kate and I got a killer apartment on the coast just north of the city and have made up for a lot of lost time with old friends. Lots of fun, a few shenanigans, nice cold evening sunsets, and being here for another World Series championship have made it a great fall! It’s raining right now, but its probably one of less than 7 days it has rained during our 3 months here. It’s been a fantastic fall… but, man, am I ready to get out of here and head to Colorful Colorado!

Highland Bowl

Highland Bowl, one more reason to get out and get acclimated… that bowl ain’t gonna hike itself!

This will be our 6th year working seasonal positions out in Colorado. I have worked for the same hospital out there for 5 years now – I am so excited to get to the mountains, see good friends and co-workers, start up the low-stress life of a professionally employed ski bum, and most importantly,get to laying down some powder turns. After a delay in finding a job for the fall, this contract is running a little later in the year than I’d like it to, and some weeks of the ski season are slipping by. I’m also losing out on some precious time for altitude acclimation that makes a huge difference for some mountain races later this winter – and just trying to keep up with the other locals around town – and not being out of breath sitting at my desk at work.

 

Accord

The ol’ Accord road tripping in all its glory.

I think part of my extreme anxiousness to get out there lies in a newly fine-tuned proficiency for getting ready to move. I have no bags packed, but I feel like I have been preparing to move for 3 weeks now. Just a few drawers of clothes to shove in bags and we’ll be packed up. To add to the ease of moving this time around, we have upgraded to an SUV. I sold my old Honda Accord that I had put 120,000 great miles on (plus 70,000 miles from its original owner). It drove some of the great roads in North America – made the trip up the Alcan Highway to Alaska, drove East through Canada to Prince Edward Island, and touched the Southern and Northern tips of Rt 1. But, for two people routinely moving cross-country multiple times each year, I can’t believe it took us this long to get a bigger car. I sold the Accord this weekend on Craigslist and I am driving a rental for my last week working in home care – 4 more days on this contract – head down, nose to the grindstone. Short-Timer Syndrome be damned!

I, of course, will be updating on the Facebook and Twitter (@hobohealth) pages all along the road trip, but this trip will be less of a meander out west than some of our previous trips. We will get to catch up with some friends in Chicago along the way, but otherwise this trip is going to be a straight-shot westward in just a couple long days of driving. Expect updates soon and travel safe! -James

Borientation

Travelers. We are trained and practiced in hitting the ground running under any circumstances. After a few assignments, every traveler realizes that all documentation systems are bad, but not equally bad, some are far worse than the others. Aside from a few operational issues, the job is the pretty much the same where ever you go, and it’s not too hard to blend into most teams quickly.

After a traveling on a few assignments, I realized a long orientation can be torturous. Given the choice of a HIPAA presentation, a JCAHO powerpoint, or walking on hot coals, I would take the hot coals in a hot second… besides, I’ve always wanted to try that.


 
Thanks for that, Adam Sandler

For a few assignments, I tried telling supervisors that I didn’t need much of an orientation. “Show me where equipment is, give me a quick run through the paperwork, and I’ll figure out the rest.” This tactic went well for a few assignments, and probably gave me a leg up during a couple interviews. But, it finally backfired last summer. I showed up to a private practice gig up in AK and had seven initial evals on the second day of work. Whoops, that’s too much work for the beginning of any assignment, I definitely over-played my hand.

So, now I’ve toned it down a bit – I have been accepting whatever orientation is bestowed upon me. There’s one phrase that I hear over and over again when I have a light caseload for the first week or two, “Enjoy it while you can.” I guess that’s the lesson I have learned. Orientation isn’t that bad. Easy work, easy money. If I’m allotted an hour for a test on JCAHO regulations, I can hammer it out in fifteen minutes and the extra 45 minutes will break even on a really busy day later in the assignment. Time for a fun side story: I once had four JCAHO audits in one year. Every one of my three facilities that year got audited while I was there, and, also, one of the staffing agencies I worked for was audited. I did an interview with the JCAHO auditor for the staffing agency. At the end of my interview, I got a chance to ask her a few questions. She said that there are over 300 staffing agencies accredited by JCAHO… that’s a lot and really amazes me.

Anyways, the strategy to just take whatever orientation is given to me has totally run-a-muck. I am currently in week 8 of a 12 week contract and finished my last orientation class just a week ago. To give my boss some credit, I am very well prepared. On the other hand, I have been completing online modules until today. I am officially done with orientation and will have only 5 weeks of work without any orientation.

There has to be some middle-point where in the future I can effectively express that I need some orientation, but also that I am seasoned and will be good to go early in the assignment. I haven’t found the happy-medium yet, but I’ll keep on trying.