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: https://www.orthopt.org/uploads/content_files/files/2020%20Strategic%20Framework.pdf

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.

Interview a Travel PT Recruiter with Anders Group

Last month, at APTA CSM, I got together with Stacy and Melissa, two recruiters from Anders Group to discuss travel PT. The premise of the conversation was getting into some of the “next level” topics that recruiters and travelers never get to discuss together.

At just under 40 minutes long it’s a good listen for your next run, commute, or road trip. Either stream it right now or hit the three dots on the right to download it for later. Happy listening!!!

I’m very happy with the conversation we had and hope all the things we discussed will help you find the assignments you want!

Many thanks to Stacey, Melissa, and Anders Group for taking the time out of a VERY busy conference to chat.

THE BEST Travel PT Job

I get questions like this all the time: Where should I go on a travel PT assignment? How do I find a good travel PT assignment? Is working in this particular health care setting the best I can do?

The answer: I don’t know what is best for you!!!! These are personal decisions that rely on the balance of many different factors. The right assignment for you may be very different than what somebody else wants. To be successful in travel therapy, you need to be flexible where you can, but you also need to know what is important to you and pursue it. I’d like to explore a few of the factors that will play into you choosing the assignment that is (hopefully) the best one for you.

Location

Location has ALWAYS been my top priority traveling. Where you should go as a traveling therapist is a very personal decision. For instance, in the winter, I want to be where it is cold, snowing, and I can ski. I recognize that many other people want to be somewhere warm in the winter instead – our wants and preferences will vary wildly. If you have a very specific city or town in mind to travel to, you might need to be much more flexible in other details of your job search. If you don’t have any specific places in mind at all when you start to travel then you already have some good flexibility to your options.

…or mountains AND ocean… jobs available now in Sitka, AK. Click the picture for more info.

If you’re unsure where to go I recommend thinking about the types of things you would like to have around you when you arrive at your assignment:

  • Coast, Mountains, or Open Spaces
  • Hot or Cold
  • Rural or Urban

If you can easily pick a favorite in each of those categories, you are well on your way to finding a location that will make you happy. Some logistical issues that may help you further narrow down where to look for a job are the speed of a certain state for getting a license (perhaps fastest through the PT compact) and availability of travel jobs in a given area – your recruiter can help guide you in either of these criteria.

Traveling as a couple, my wife and I typically picked a city we wanted to live in and would give our recruiters an amount of time we were willing to commute to find two jobs within a reasonable radius of our homebase. More often than not a community hospital or home care agency would have two travel PT jobs available at the same time, but that’s something that can be very dependent on the region.

Clinical Setting

This is another very personal decision, but the more flexible you can be on setting, the better chances you’ll have of checking the boxes on all of your other priorities…. but is there such thing as being too flexible?

So often, I talk to new grads who have leapt straight into traveling. Many of these new grads are looking for outpatient jobs, but often told that SNF jobs are their only option. If you have no experience as a therapist, then you have very little bargaining power to explore anything but the options that are first presented to you. So, I advocate for two things – get at least a little experience before you travel and put up a bit of  fight before accepting a setting you absolutely do not want to work in – hold out, be patient, and be flexible about where you might travel to to get a setting you desire.

On the other hand, one of the things I love most about traveling is the variety of practice settings I have been exposed to. There is so much in PT that I never would have experienced if I hadn’t gone into travel. There is a balance to be reached between pursuing the setting you want and being open to other settings that you are willing to work in. Yes, please strive to be in the setting you most want to be in, but also work to acquire the experience and expertise you need to pursue those jobs. Also, be open to accepting jobs in other settings that might expand your clinical experience and allow you to grow with more diverse clinical skills.

Pay

Last, and least, pay. Yes, you can make lots of money in traveling therapy. But if you go into traveling for only the pay, you won’t last very long. I’m not saying to cast aside all thoughts of pay. It is very important that you are paid well for being highly educated and having the flexibility in your life to pick up and move for work. If two otherwise equal options present themselves, by all means, take the one that pays more! But don’t set pay ahead of all other factors, I believe you’ll eventually come to regret chasing the money in the absence of person and professional satisfaction.

You have to find that balance between your pay and the other factors that can make or break an assignment. If you’re not happy, you won’t last long in travel – the best travelers go into traveling therapy to live a better life. If you are doing it only to pay off loans or make as much of you can, you will burn out quickly and head back to a settled life in order to gain satisfaction in other life-areas you have neglected.

Finding both happiness and success in traveling requires a balance of several factors. Sit down, write down your priorities, and figure out where you are willing to be more flexible. Finding the balance that uniquely suits you is what will help you succeed, find joy in your work, and allow you to continue traveling.

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.

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!