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!

Get a Haircut and Get a Real Job! (Part 1 of 2)

I have had one heck of an experience finding a job this last time around. I wanted to share the experience, but felt that there was some hard fact searching and job market research that needed to happen before we got into the more entertaining stuff. So this post is really all about prepping for my next blog (to be posted next week).

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A semi-pertinent music video:

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A lot of the trouble I had finding a job this time around mostly had to do with very local/isolated trends, but I know friends in other areas having difficulty getting assignments too. I have begun to wonder if finding a job in travel PT is as simple and lucrative as it was several years ago. I’m not going to make you wait until the end of this post for my conclusion – the outlook is bright and sunshiny with increasing job numbers, increasing wages, and an overall prediction of continuing to live-the-dream! Onward we go with the discussion of why it’s not that bad and why it will soon be so good…

When I was looking at colleges as a high school junior back in 1998/1999, I remember the sage advice of my biology, genetics, and home room teacher Mrs. Sheffield, “Don’t go into physical therapy, there’s no jobs! You should go into computers.” Thanks for that. Wasn’t she supposed to be encouraging my young, vulnerable mind to head towards the sciences!?

The late 90s was a particularly bad time to be going into healthcare. The Balanced Budget Act had recently been passed , and everybody was in a panic cutting staff and freezing hiring in the medical sector. Somewhere in my search for college programs and a potential career, I (or more likely my parents) came across a chart showing trends in employment in PT. Historically, there was a cycle where employment would increase for 6-7 years and then dip downward for 6-7 years. Looking at this chart in the late 90s, I concluded that 1999 and 2000 should be the bottom of the market and that by the time I graduated in 2006, employment in PT should be back near the top! So, I proudly defied Mrs. Sheffield a pursued an education in the jobless field of physical therapy.

I don’t know why employment in PT follows this cycle, and I have tried relentlessly to find another chart that shows what I saw in 1999, but I haven’t been able to find a chart that graphs PT employment over decades. What I do know is that when I graduated from PT school in 2006 the market was great, classmates were turning down jobs that didn’t pay enough, and Mrs. Sheffield was dead wrong. Now, here we are 7 years later, and while I remain gainfully and happily employed, I am finding it harder to get the travel assignments I want than it was just a couple years ago.

I propose that we are maintaining this 6-7 year cycle and we now are at the bottom of that cycle. With the implementation of healthcare reform, similarly like following the Balanced Budget Act in the late 90s, we are in a period where hospitals are tightening their belts because of uncertainty. Soon, the full reform will be rolled out, employers will adjust to the changes in the payment system, and our job market will triumphantly march upward for another 6-7 years. Here’s the kicker! If this really is the bottom of the market for us, we are sitting pretty. Unemployment in PT remains ridiculously low, and there are still plenty of locations out there with a drought of PTs.

Below, I have included several links that I think help paint a good picture of what we are seeing happen in our job market currently and what we can expect to see over the next few years. I encourage you to take a few minutes and check them out, particularly if you are currently or will soon be searching for a job in physical therapy.

The writer in this first reference equates what he is seeing now in the PT job market with what happened after the Balanced Budget Act: Looking to the Future For The Rehab Professions. I wish the writer had gone into more detail about the parallels he sees between the BBA and now, but he describes, in more details than I ever could, the various forces that will influence our employment opportunities in the years to come. A good read for sure.

Some more of the details about what was happening following the Balanced Budget Act can be found in this 2000 article by CNN.

I’m sticking to my guns. If you want to be a travel PT or PTA, do it. It is a very rewarding choice and there are plenty of jobs out there. If you, like me, are in an area that doesn’t have a whole lot of travel jobs, consider working in other areas. Here’s two more links that demonstrate two facts: 1. The current market and outlook for PT employment is VERY good, and 2. there are areas where you can look for a job where it’s ridiculously easier to get hired… Fairbanks anyone?

Top 5 paying locations in the US for PTs

Upward and downwards trends in ease of filling positions in PT mapped nationally <-Really cool map

In my next blog (next week – part 2) I will tell the tale of my last job search that launched me into this look at the job market and offer what I think are some of the ways that each travel PT or PTA can do be more marketable and continue to take advantage of the wonderful opportunities that come through work in travel physical therapy.

Craigslist

I buy and sell a ton of stuff on Craigslist. If you’ve never been on the site, but know only of the more dubious publicity it has received, I’m here to tell you, “Craigslist is safe, and you probably won’t get kidnapped.” But seriously, I’ve met nothing but nice and honest people during my Craigslist transactions. To sweeten the pot, you can find fantastic deals on just about anything. There’s a blog-turned-book by a Canadian guy demonstrating the general goodwill of people and the good finds of Craiglist. Kyle MacDonald traded one large red paperclip up to a house in 14 even trades over the course of a year! Check it out at his website: One Red Paper Clip

Bottom line, Craigslist and a bunch of other online sites are a great way for you to find things you need on assignment for cheap and sell them when you’re done with them. In some areas, Craiglist isn’t necessarily the go-to site, there may be a better, local option – think about classifieds on the local paper’s webpage. In Maine, I’ve found that Craigslist has a good local popularity, but there’s also Uncle Henry’s, a long-time printed buy-and-sell listing that is now available online. If you’re on assignment near a military base, there’s a good chance someone has set-up a Facebook page to buy, sell, and trade on and around the base.

Here’s my hit-list of the best ways I have used the internet to barter for things I need on assignment:

Housing

My very first travel assignment, I had the staffing agency set me up with my housing. It was a great way to get out there on the road and do the traveling without having to worry about lodging. As I’ve gotten more comfortable over the years with how travel PT works, I’ve gotten better at finding my own housing.

The tough part is, and has always been, finding a place that is: (a.) Furnished; and (b.) available for a short lease. I’m yet to find something that has more in this niche market than Craigslist. Type in furnished and the town you are headed to, and you are bound to have a couple good leads on your pad for the next 13 weeks.

 

AirBnB.com is a newer site that allows people to rent out their places privately. I haven’t yet stayed in a place I found on Air BnB, but have heard of people getting great deals on this site. Depending on your tolerance to being a complete vagabond, you can find anything from a futon to crash on for a night in someone’s living room to a house all to yourself for the length of the assignment. The site allows you to filter your search well to fit your needs and displays ratings from people who have previously stayed at the crash-pad you may be considering.

Car

For my wife and I, we find it very difficult to take long road trips in separate cars. Two drivers in one car allows us to drive longer hours in a day and travel more safely and comfortably. Our solution is to drive one car to our assignment and buy a car when we get there. This also works well in places you may fly into to work like Alaska or Hawaii. We have bought six cars on Craigslist and one RV… only one deal ended poorly. My wife ended up selling a beat up Passat for $200 and a bag of mangoes – true story. More often than not, we are able to sell the car at the end of the assignment for more than we bought it for. Speaking of which, anyone looking for a 1997 Honda Civic in Maine? With only 208,000 miles on it, it’s a steal at $1200.

Hawaii Car

Putting the car I bought on Craigslist in Hawaii to good use. Not the Passat. Put a kayak on it!

The car I’m typically looking at is $3,000 to $5,000, but I have gone cheaper at times, like with the Civic. Two things I can recommend are to ask lots of questions, people are typically willing to be perfectly honest, and take the test drive into serious consideration. On that one deal that went south in Hawaii (the Passat and the mangoes), there were clear signs during the test drive that we shouldn’t buy the car, but got so wrapped up in the mentality of “we need a car now” that we ignored the lousy shifting and ended up transmissionless 2 weeks later.

With with all things bought online, but particularly with cars: BARTER! Everybody on Craigslist is listing their stuff for a bit more than they would actually take to let go of it. Find out how little money they will take!

Housewares

I have this buddy who used to be a traveler, but fell in love with a dietitian on assignment. Now, they are married and have a great house in a cool neighborhood. This guy buys everything on Craigslist and isn’t afraid to walk away from anything but a spectacular deal. I was visiting him a few weeks ago and as I walk into his kitchen he’s really ( I mean REALLY) excited and blurts out, “Guess how much all the appliances in this kitchen cost!” This guy has gotten a full top-of-the line kitchen for chump change including a killer oven, fridge, and microwave.

As a traveler, you can’t get too weighed down with larger appliances, but any furnished apartment is going to be lacking something you need – a toaster, a microwave, a grill, a decent coffee pot. Hop online, see what’s available. You can typically get good stuff so cheap that if it doesn’t fit in the car at the end of the assignment, it won’t hurt to part ways with it.

Surfboard

One of the Craigslist surfboards… just remembered that a teenage girl sold it to me. Hence the neon green ankle strap.

Toys

I don’t have a ton of toys. They take up a lot of space in small apartments, and it’s much easier to travel light. But, come on, there’s some stuff you just need. In Hawaii, I bought a surfboard at the beginning of the 6 month assignment and bought a second board halfway through. I surfed three days a week on these boards, used the heck out of them, and was able to break even by selling them on Craigslist when it was time to leave.

In Colorado, it’s ski and camping equipment. For anyone who spends significant time doing outdoor sports, you know there’s always something better, stronger, more light-weight, more durable, and better than what you have. I have also found that the upgrade doesn’t need to be brand new. There is a huge marketplace online for gently-used gear. There’s a slew of auction sites like Ebay that will do the trick if you know exactly what you want, but if it’s something you need to get the right size or fit, you’ll probably find yourself right back on Craigslist finding someone local that you can meet, take a good look at what they’re trying to sell, and come to a price that leaves both of you feeling like you ripped the other person off. And when you’ve worn out whatever it is you bought, there’s someone out there on the internet looking for that very thing who is willing to give you money for your worn out junk. What’s more American than that!? Happy bartering and safe travels!

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I had written this a couple months back for another travel website, so it needs some updates:

-The Civic sold 3 days after being posted on Craigslist.

-Using Craigslist, we found and bought a car that we hope will last us for the next several years. It has a small dent on the bumper, but got it for thousands less than we would have at a dealer.

-We started a new assignment around Boston this week. Found an awesome apartment just outside the city, across the street from the beach… on Craigslist.

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. 🙂

Traveler:

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!

Thanks.

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Hobohealth:

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 esurance.com 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!!!

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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. http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html