Careers in Travel PT

I had the opportunity to talk with Regis University DPT students. We covered a whole lot of topics in just 30 minutes – housing, tax home, finding a recruiter, searching for assignments, independent contracts, PT compact and licensure, health insurance…. and a lot more.

The presentation and Q&A were recorded and are here for your enjoyment!

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.

At Least It Wasn’t In Boston

Hang with me. I’m amped, I motivated, I’m psyched, I’m downright manic – and I only have a short time before this feeling fades to make as much progress as I can, including pumping this blog out to you.

Actually the weather when we left Denver, but Indy was very similar upon our arrival. The weather bothered a lot of people, me too actually, but at least I was used to and prepared for it.

Actually the weather when we left Denver, but Indy was very similar upon our arrival. The weather bothered a lot of people, me too actually, but at least I was used to and prepared for it.

I just got back from CSM (APTA’s Combined Section Meeting) and I have the same feeling I always do after one of these conferences – I need to make an impact, and I need to do it now. For those of you who may not be familiar with CSM, it is a 4 day conference held annually that brings together over 10,000 PTs, PTAs, and students for some high level education. Well, education is the pre-text, I find myself more drawn to the social… excuse me, “networking” events. The reunions with old classmates, professors, colleagues, and friends are totally priceless. These people, automatically by being at the conference, are also all jacked up about PT and what we need to be doing to make it even better. So, while I indulge heavily in the social “networking opportunities,” I look forward to the conversations all year: Conversations about the research friends are engaged in, different practices in different clinics around the country, and what every individual therapist is doing to improve PT and all of healthcare in their communities and nationally. Don’t get me wrong, I found the actual, formal programming fascinating too and have several clinical-pearls to bring back to the clinic an implement immediately, but I just love getting together with everyone.

Lots of education, meetings, and receptions at CSM. Luckily many of the meetings come with ample networking and a cash bar.

Lots of education, meetings, and receptions at CSM. Luckily many of the meetings come with ample networking and a cash bar.

CSM is an ultra-boost, one of the highest forms of motivation, but not everyone can or needs to go to CSM. BUT! Everyone should do something to get a similar charge. As travelers we can exist very isolated in our individual silos unless we make a concerted effort to expand our horizons and take in some new information. There’s a certain stereotype of the traveler out there that just simply doesn’t apply to the vast majority of travelers – let’s give this stereotype a name, how about “Clint” – definitely just a random name, yeah, random. Clint is a lazy slob. Clint hasn’t had a meaningful continuing ed experience in 4 years. Clint is at work to survive the day and definitely not to excel. The thing about Clint is, I’ve never met a traveler like him. Travelers are generally insanely fascinating people who have the motivation, gall, and cajones to drop convention and get out on the road. A seasoned traveler can be dropped into a clinic on Monday and be completely indiscernible from the permanent staff by Wednesday – a true chameleon. In PT these days, autonomous is a hot word. If there’s anything more autonomous than loaning your services out for 3 months at a time to the flavor-of-the-month employer, I haven’t seen it. A traveler is truly autonomous, highly resistant to the negative influences that colleagues, bosses, and referral sources can build over time. The hyper-autonomy of the traveler’s life, moving from place to place and determining your own path, can be isolating. We must seek out education and motivation if we don’t want to end up like Clint. There are tons of great options out there: Courses offered locally during contracts, courses offered at a distance on a road trip between assignments, state meetings of your professional association, and more long-term certificate and specialization courses. We must make sure we get out there and get supremely jazzed-up by interacting with other professionals and finding out what else is happening beyond our small sample of personal experiences. There’s nothing worse than seeing a new traveler show up to a job with all the confidence in the world that they know everything there is to know. A traveler will learn over several assignments that while there are great things about the way they have been taught to treat already, there is much, MUCH more to learn. Let me be clear, mastery of treatment and skills does not come from one clinic or one model of treatment, it comes from exposure to a great expanse of different treatments and styles over years (another advantage of travel).

Sunrise in the Indy airport after the last night of CSM. As you can see, the weather did get better, it was actually pretty nice by the end of the conference.

Sunrise in the Indy airport after the last night of CSM. As you can see, the weather did get better, it was actually pretty nice by the end of the conference.

So, go find your own CSM. Whatever gets you excited about your PT, OT, or SLP career, explore it in more detail, get exposed to all the different tangents that surround it. Put yourself in groups of other therapists and talk about what you do – more importantly, listen to what others do. I’m psyched, I’ve got video gait analysis techniques to implement, new post RTC repair techniques to use, emails to send to old friends to tell them how nice it was to see them, and emails to new friends to ask them to tell me more about their projects and passions. While out exploring the country, get invigorated, don’t get isolated in your own silo, don’t justify the stereotype of Clint.

What’s Next?

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

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

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

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

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

::segue coming::

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

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

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

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

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

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

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

Jack of All Trades

On my very first travel assignment, almost 8 years ago, I quickly started appreciating parts of PT that I never thought I would be working in or ever need to recall from the most doodled-on pages of my college notes. But, there I was, 6 months into my career – that I had originally intended to be as a professional sports PT – and I was standing by a whirl pool doing debridement on a homeless guy. Alex, an experienced PTA with a crazy amount of passion for Physical Therapy, had recently taught me the ins-and-outs of the simple wound care we were performing and why we were doing what we were doing. On this first travel assignment, I was also baptized into the world of prosthetics. Alex taught me about shrinking the stump and different techniques for wrapping and making simple adjustments to the prosthesis itself. Alex was a neat guy who took a “non-traditional” path to being a PTA and was one of my best early mentors. Along with Alex, there was a handful of PTs with varying degrees of experience who were all willing to help me through my first travel assignment. Me, Non-Traditional PTA Alex, and a few other PTs were conquering all the issues of the good blue collar people of Lowell, Massachusetts – and were definitely not doing professional sports PT. The funny thing is, I enjoyed it. Prosthetics was a cool field. Wound care wasn’t anything I cared for, but it was different and new. I even got some early ER experience and found some excitement in the mayhem I would find every time I walked through those doors – cops, crooks, drunks, and broken parts of all kinds. I ended up spending 10 months in Lowell getting some quality mentoring and all kinds of experience in a wide spectrum of PT. This was the first place I experienced the kind of place where you treat “whatever walks in the door” (or rolls in the door), it certainly would not be the last. After a few contract extensions, I triumphantly left that assignment, nearing a year and a half of PT experience under my belt – I knew it all, nothing could surprise me now!

[Just something to listen to while you read – enjoy! About Kaunakakai, where we currently live.]

I’m somewhere around 20 travel assignments now – I’ve worked in about 30 clinics. It amazes me that I have learned something significant and useful on every single assignment. My new knowledge on each assignment comes from both the things my bosses and co-workers are doing well and the things that could be done better. Much of the time, I’m learning something positive directly from colleagues who have become specialists in their own unique mixture of whatever walks in their door. Often my education is purely experiential in working with a new population, a new culture, or in a new setting – home care, inpatient rehab, private practice, acute care, hospital outpatient, ER. There is just so much variety of what you can do with PT and how you can deliver it. At the end of every assignment I make a note of what I may have learned and confidently think, “Now I’ve seen it all, I can’t possibly see something at my next assignment that I haven’t seen before.” I’m being a little sarcastic here, but seriously, after a while, there can’t be too many surprises left… right!?

I knew on this current assignment I would have to be a true generalist and pull from many different parts of my skill-set. On this island, there’s no OTs, no SLPs, no nothing other than one other PT working at a community health center up the road. To really up the anti, there’s just absolutely no where else to find any specialists, there is open ocean between us and anybody else – referring out to someone more equipped for a particular job isn’t an option. We are essentially the only option for whatever ailment you can dream up. I took a phone call last week from a case manager in the large hospital system we are a part of. The main hub of this system is over in Honolulu, and there are many smaller community hospitals throughout the islands that are a part of this health system – although, I can’t imagine any one of these small community hospitals being any smaller or more isolated than Molokai General Hospital (MGH). Anyways, this case manager in Honolulu was wanting to send a Molokai resident back home but wanted to make sure we had both PT and OT for her referral. I explained to her that we do not have an OT here at the hospital and there are absolutely no OTs on the entire island, but that we are used to filling many roles and can handle the patient. The case-manager seemed unimpressed with a reply of, “OK. Thank you,” and hung up. After the call, I realized that in a way, I am fulfilling a very Molokai role. Nobody expects to have every resource available on Molokai, but many people fill multiple roles and help the community as best they can by wearing many hats. Many employees in the hospital have their main role, but then serve an adjunct role as the as infectious disease coordinator, or employee health director, or any other job title you can picture being a full-time position in most hospitals. A funny sidenote: I was talking with someone who was one of 3 employees of the local paper, a transplant to Molokai. She described how word got out that she was decent with computers, and people (mostly older people) started showing up with their computer issues at the newspaper office for her to help. People here don’t expect to have every amenity or service, but they help each other out however they can.

Kate and I have enough years experience behind us in enough different settings that we are able to confidently carry out the vast majority of our responsibilities. At MGH we cover inpatient, outpatient, ER, and SNF (14 beds in the hospital – 7 rooms). We are serving as hand therapists, neuro PTs, the Ortho Specialists that we actually are, and essentially work in the role of rehab specialist on every condition from the age of 1 to 100 with only modest resources. We have a surprisingly great clinic, gym, and staff, but are routinely having patients order equipment they need online – there is a local pharmacy, but it’s pretty limited in the DME department. Kate has taken on the wound care, and while I appreciate having learned some about wound care in the ol’ days with Alex, I’ll pass, thank you. My learning experience on this assignment was revealed to me early on when I realized all the additional roles I would be filling:

Social worker – Kate and I both worked our butts off last week to get 2 SNF patients discharged. We called family members, called outside services, and essentially fully arranged and negotiated these patients’ discharges. Kate even went to her patient’s house to help her transfer out of her car and into her home. Not what you would call billable hours, but good work that achieved great results.We are also a part of a team that is charged with delivering a decision on whether or not to admit SNF patients. The list of variables to consider is huge, since to even get here as a SNF patient, you are typically flying commercial on a puddle jumper. Also, you have to be thinking discharge ahead of admission – there’s no home therapy services, there’s no long-term nursing home, there’s no assisted living. If a person can’t ride a commercial flight with a nurse or be expected to discharge home – they shouldn’t be admitted in the first place.

There are no surgeons. When someone cannot or will not go off island for an Orthopaedic or other surgical consult, we are the next best thing. The PCPs, many of whom we have gotten to know well in a short time, are quick to refer anybody with an ache, pain, or movement dysfunction to us for more specific diagnosis and treatment. We are determining weight bearing status for acute fractures, managing follow-up appointments, and suggesting when someone might need additional imaging. It’s a unique experience to be working with a patient that you know should have surgery, but that off-island surgery is just not a realistic option in his world. I could write another entire blog about performing PT in reality – treating within people’s financial limits, having realistic/sustainable goals for patients, knowing when someone has reached their own individual ceiling of health. When a guy shows up needing a metal plate in his ankle, but that metal plate is a plane ride away that he’s not going to take, that’s when some real-world PT is needed and when we need to decide what the best conservative treatment option is for the patient.

I do feel well equipped for this assignment that requires a wide range of skills and a certain depth of knowledge. I would not recommend this assignment for anyone without a few years experience across a few settings. It’s nice to be in an environment where we get to use a full range of our skills as PTs. Most of the time PTs will work in a setting that sees only a very small slice of the full scope of practice. Sports and ortho is still my bread-and-butter, but I have gained a lot of skills and knowledge in other areas over the years. When I am back in Colorado in the winters, I work for a hospital that practices orthopaedics at a very high level. The patients with various sprains, strains, and fractures are handed down from a team of Orthopods and ER docs that absolutely nail their diagnoses. It’s a nice luxury, but to be honest, my diagnostic skills atrophy severely in the winter from disuse. As I’m bending and straightening joints all day, patients ask , “You had to go to school for 7 years for this?” I defensively explain how making their knee bend is only a very small part of what I learned in school and that PTs are trained across a large variety of diseases and dysfunctions. But, back here, I’m using every last bit of those diagnostic skills and every ounce of my education across a very broad spectrum of pathologies. The health community here may not have specialists or surgeons, but to be as comprehensive as possible, everyone else must work their role to its limits. It’s fun, challenging at times, and definitely a new learning experience.

Continuous Education

I recently gave up my Alaska license because I didn’t have enough CEUs to renew. For a long time, all the licenses I held didn’t require CEUs, so it hasn’t been on my radar. Alaska is the first license I have had that has requirements, but some of the states I’ve been licensed in for years are adopting new rules for continuing ed requirements. I am based in Colorado, the continuing education tracking will start there after the 2014 renewals. I’m somewhat personally to blame for this, I have long supported CEU requirements and have advocated for states to adopt these requirements. I’ve heard people openly criticize these requirements. They claim that all continuing ed requirements do is drive people out to order crappy CEU programs that have little substance. I think this argument itself is crappy and believe that most PTs who have to purchase continuing education to maintain their licenses are going to reach for something meaningful rather than be the bottom feeders of their profession and community. In my case, I have 3 years to meet my Alaska continuing ed requirements and can renew at any point during that time. I have already order and started a HIGH QUALITY home study course from APTA’s Ortho Section that I previously intended to get but have been procrastinating for almost a year now. So, to you naysayers of continuing ed requirements, here’s one PT that was forced into getting high quality education by the very requirements you dismiss. And to those who believe that your years of experience are a superior substitute for structured professional development, you are wrong. I may not have been practicing for 20-30 years, but I have been practicing long enough to see huge progressions in practice – the way we assess and treat low back pain, the way technology has drastically changed total joint replacements, the proliferation of dry needling and manipulation – the list goes on… Each year that goes by, I realize how much more there is to learn, if you don’t see this, you’ve already fallen behind. People have been criticizing con-ed repeatedly in public internet discussions (I’m looking at you PT Twitterverse) and finally I get to candidly respond: You don’t know what you don’t know, and by fighting continuing ed, you are making yourself sound self-righteous and crotchety. The majority of your peers will consistently choose high quality education over the path of least resistance. Stop talking down on continuing ed requirements, they are a good thing for our profession.

Whew, sorry about that. I guess that’s been building up inside for a while. I hope smoke is coming out your ears from reading that last paragraph (my hair actually burst into flames). OK! Back to the story!

On the beach? Best place in the world to read a journal or home study course for CEUs. Continuing ed has never been better.

On the beach? Best place in the world to read a journal or home study course for CEUs. Continuing ed has never been better.

It’s not that I haven’t been learning. I read JOSPT every month, I read other articles when I’m not sure of something in the clinic, I go to coworkers’ places to knowledge-mooch when they have ordered a webinar. Travel PTs are ALWAYS learning. Different clinics have different techniques, different patient populations, and all kinds of people to learn something from. As a traveler you may work at one hospital that has the latest and greatest in surgical techniques and then you’ll work in a private practice that runs a manual therapy fellowship. A traveler is surrounded by casual learning opportunities, but we are not surrounded by funding for formal instruction – that is our challenge, our weakness. Unless you travel with one company for more than a couple assignments, you are unlikely to see more than a couple hundred bucks for continuing ed courses. But, there are opportunities out there – great opportunities! Great courses! And many of them are convenient for the traveler.

I have written in the past (Traveling doesn’t have to mean professional sacrifice 4/11/2011) about the opportunities for travelers to take larger programs like residencies and certificate programs. These are a big commitment, but force you to stay on path of continued education. Many can be completed through a series of weekend courses offered all over the country, so you can access your next stage of learning where ever you go. As I eluded to earlier, dry needling is a technique that has gained popularity and has some very high-level and quality learning opportunities. It wasn’t on my list in 2011, but it should be now!

There are smaller things a traveler can do for continuing ed credits throughout the year. Many reputable journals have read-for-credit programs where you can hop online for tests to demonstrate your knowledge on their articles. Credits are small, but add up over a year or two. The Independent Study Course I recently ordered from the Ortho Section, Applications of Regenerative Medicine to Orthopaedic Physical Therapy, has me fascinated in the first portion of a 6-part home-learning program. It is very high quality and written by THE experts. I will take a test at the end and get 30 hours of continuing ed – 30 hours! I have a co-worker who is finishing up a Foot and Ankle course this way. It’s a great means for people on the go or far away from a big city to get high-quality learning.

There are ways to get continuing ed without a huge hassle and without resorting to lousy courses that blindly dole out CEU’s for entry-level knowledge. Plan ahead, learn your states’ requirements ahead of time, and you’ll be fine. I’m well on my way to being able to re-instate that Alaska license should an opportunity arise.

Community Chest

Being a traveling Physical Therapist really has its benefits. Seriously, getting paid to move all over the country? People take entire years off of their jobs and normal lives to do what we do. For the special person willing to live a mobile lifestyle, traveling PT is an easy choice.

But, every so often I consider the downside to being a gypsy, a transient, a vagabond. A few months in a place is plenty to let a community leave its mark on you – I have good memories and have learned something from every single place I have worked. But, it can be a real challenge to leave your own mark on the places you visit. Being a part of a community comes in a lot of different forms, and people will accept you as one of their own at varying rates. Some places are quick to accept you as a “local,” other places require that you are born local and see so many people come and go that they will never fully let you into their inner circle. Having a sense of community, and feeling like you belong and are accepted where you are can be a very difficult part of travel PT.

Being a part of a community is a two way street. You have to find a way to absorb some of the traditions and culture of a place into yourself, but also you must contribute to the experience of the people you work with, the larger community, and if you’re lucky, the great friends you make while on assignment. Every time a clinic asks you to extend your contract^ or your coworkers are sad to see you go, you’ve done something right and made your mark.

Lift Jan. 26th | Dr. James Spencer from Aspen 82 on Vimeo.

I’ve been coming back here to Colorado on winter contracts for 6 years now and am starting to have my own identity in the larger community. But, I’ve realized that many of the small things I’m doing now to strengthen that identity, could have been done years ago. I can probably do these things early on future assignments. What kind of things? Advocacy! Being involved in advocacy is great on so many levels. You’re becoming involved in your profession and advocating for your own self and interests, you’re taking an active role in your career and taking action on the issues that affect and matter to your co-workers and patients, and, when done right, you’re making a valuable contribution to whatever community you’re in. Advocate for your profession, advocate for your coworkers, advocate for your patients, advocate for yourself.

Up above, there’s a screen-shot from the interview I recently did on local cable. I talked about preventing ski injuries, focusing on knee and back injuries in particular. Super-easy, it took 30 minutes of my day, and these local channels love health pieces like this. Volunteer to talk about whatever matters to you, or whatever is easy for you to talk about. Last year, a local newspaper article about back pain pissed me off. It focused on all the wrong things – MRIs, surgery, and chiropractors. Rather than return an incendiary letter to the paper, I wrote a short letter advocating the use of PT early in the treatment of low back and neck pain. The letter went over well and did a bit to cement my professional role in this community. I’ve been seeing more neck and back patients ever since. And, that’s fine by me, I like treating those kinds of injuries, it has become my “thing.”

The return to Colorado each year has helped me fill that sense of belonging to a community that I otherwise miss in travel PT. I have built a social circle here with good friends, co-workers, and other acquaintances around town. But, outside of the personal relationships that take time to build, I believe there is a lot I could have been doing earlier to make myself a part of the community and not just a passer-through. I’m in the process of re-upping my Hawaii license for a second assignment there this spring. The locals there can be a tough group to gain acceptance from, so we’ll see if my ideas to advocate for the profession early in an assignment have some merit to them, or if I’ll flop. It can’t hurt, no publicity is bad publicity… an interview on preventing swimming injuries? Yeah, that sounds easy enough.

Until next time, travel safe. I’ll try to write more frequently!

James

^ Footnote: Most of us PTs and PTAs are just terrible at business and negotiating. I was talking with a friend recently and telling him a story about a friend who had done 3 contract extensions at one facility. He was surprised to hear that a contract extension should come with a raise. It is my experience that if a contract is extended for a few months (which happens frequently when things are going well), you should ask your recruiter for a small hourly raise. Just my input on another small way us PTs can better advocate for ourselves.

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.

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.

Ask James

Hey everyone. It’s hit that time of year where April comes around and I realize I haven’t posted in 3 months. Don’t worry, I haven’t been working too hard, just skiing too much. 🙂

I thought one quick way to get back in the blog-habit is to post a recent email conversation I had with a new traveler. I think he was asking the right questions and made the right decisions in the end. Maybe our conversation can help someone else out there who is working on getting into travel PT.

Happy reading and happy travels! I’ll write again soon.

 

New Traveler: My wife and I have ventured out to begin traveling therapy. We left sunny SC and drove 2800 miles to cloudy OR last week. My wife had a for sure job but my opportunity fell through somewhere around Wyoming.

But now I have been contacted by a SNF and they want to offer me a contract directly.

They asked me to name a price and I asked to have time to think it over a while.

I have a little idea of what to say because I know what the travel company is paying my wife. But before I respond to them I am hoping to get some advice from y’all.

Here are my details: This will be my first job; I graduated in December. It’s going to be a 6 month contract. I have no experience in a SNF but I had 2 clinical rotations in outpatient (1 manual focused), 1 acute rotation, and 1 inpatient rotation.

One traveling company recruiter told me I should make 1400 dollars a week if they didn’t cover housing or insurance. I have both through my wife’s job.

Any thoughts?

Thanks

HoboHealth: Awesome to hear you guys are taking the plunge and hitting the road!!!

I have two thoughts. If the SNF job sounds like something you wouldn’t mind doing, then go for it. But if you’d rather be doing something else, then I think holding out another week or two may yield some good results if you’ve been seeing other opportunities in the area come and go. So, make that decision first… Is this really an assignment that’ll be ok for you? (Also, since you haven’t done SNF before, are there other PTs to help guide you? …the more the better.) Do you need another recruiter?

My 2nd thought is that $1400 sounds really low to me. I know therapists that made about $1500 wkly after taxes through an agency on their first assignment after only 6 months PT experience. Figure on top of that (or whatever your wife is making) that the agency is charging another $10-$20 an hour. That’s a lot of bargaining room for you. I would say as a new grad doing an independent contract $1600 is a very acceptable starting place for take home ($40/hr). I think you should aim higher $2000 ($50/hr)? I’ve heard of independent home health contracts going as high as $70/hr. Depends how ballsy you’re feeling…. Doesn’t hurt to ask. Also, just make sure you’re getting what perks and reimbursements you can.

Here’s some links in case you haven’t read them already (the second is some sample independent contracts):
The Job Search
Independent Contracts

New TravelerGonna give you a quick update. I went in for the interview on Friday and loved the facility as well as the other PTs and PTAs. I decided that it would be a great first job for me as a PT. The managers do a lot of the extra stuff like billing, etc so it will allow me to concentrate on solidifying my eval and treatment skills. As you know it’s quite different being an actual PT than a PT student. No one looking over your shoulder and checking behind you.

It is a unique situation. The clinic is considered an outpatient clinic because it is in a retirement village and serves an independent living community as well as a SNF so I will see a wide variety of patients.

The pay is good. It’s right around what we were discussing. I feel like it’s excellent for a new grad. $42 an hour initially and $48 after a month because I will decline the benefits. I am insured through my wife’s job.

Thanks for sharing the link as well. I used some of the pointers from your blog when negotiating the contract. The whole process went pretty smooth. My wife and I are planning to stay in Oregon for 6 months and then move on. We want to hit up Alaska in the next year. Maybe y’all will still be there and we can get a beer.

Thanks for the help. Hope to stay in touch.

HoboHealth: Thanks for the update. Sounds like a great gig and like you made some good decisions over the past few days!

Good luck and keep in touch when you start working towards AK!