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!

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.

Traveling Therapist Q&A: Considering Travel

This recent post on the discussion board from a new traveler had so many good questions in one place that I thought I would take the time to answer a little more in depth and share the dialogue more broadly. I hope this helps other therapists who are new to traveling!


I’m a Respiratory Therapist with 5 years of experience and am considering doing Travel Therapy for a few years. The thought of traveling to new states and having increased income is very attractive. However, I do have a few concerns that I was hoping someone with experience could assist me with.

Housing/Insurance

On paper, it appears traveling is a tremendous increase in pay versus permanent jobs and with allotments boost the net even further. My question is if I elect to have housing provided to me and to have health insurance coverage, does that negate the increase in pay? To those who have traveled before: where else could you live short-term (3-6 months) and come out ahead instead of electing to have housing provided?

Yes, taking health insurance through your employer and allowing them to place you in housing will cut into your hourly pay. Insurance will only minimally cut into your pay. For most of my time traveling, I carried my own insurance and was only able to get $1 extra per hour worked into my contract. So, figure $1/hr out of your contract for insurance,

There are a lot of different options for housing, and in my opinion, taking the housing assigned by the agency is the worst option. If you do take housing through the agency, as I did on my first travel assignment, you will find it very convenient. The agency will arrange a nice apartment for you with furniture, ready to move in, but it will cost you considerably. It will take a little more footwork to find a furnished space on craigslist or by looking up local classified ads in the community you are headed to, but you will be able to choose a living space in a neighborhood of your choosing, and you will likely be able to beat what the agency will charge you for housing.

The camper I lived in on Martha’s Vineyard. We had considered a houseboat initially…. maybe next time.

The final, more eccentric option, is living in a camper. A lot of people who plan to travel for a a while in temperate places take their whole life on the road with them. This can also be a more convenient option for travelers with pets. If this appeals to you, the facebook group Highway Hypodermics can be a great resource.

Taxes/Reimbursement

If I work in multiple states as a traveler, are there any tax exemptions? I don’t want to owe a great deal at the end of the year. Will I be reimbursed for travel, new licenses, uniforms?

One of the main benefits as a traveler is the tax free monies you can receive. First is your housing stipend. If you don’t take the agency’s housing, they provide you a tax free stipend – hopefully you find housing for less than the stipend so you can pocket the rest of the money. The second main source of tax free money is your per diem. The IRS regulates both the housing stipend and per diem – a cap is set on each by cost of living in the area code you are working in. If the per diem or housing stipend is low compared to your hourly pay, there may be an opportunity for you to negotiate some taxed hourly wage into a tax free category. It’s one way to maximize your take home without too big of a hit to the agency. However, too low hourly pay compared to your tax free monies can be a red flag for an IRS audit of your employer, so many agencies will have a limit to how far they will push that barrier. With all of this said, income tax laws vary wildly by state and you may find you owe states a certain percentage of your earnings at the end of the year – but this only applies to your taxed hourly wages, not your tax free money. 

It’s good to ask for any potential reimbursements prior to signing your contract. Licensure fees are typically reimbursed. You will usually get a set amount for relocation – anywhere from $500 to $2000 at most (another good area to target for negotiations to squeak in a little more money. I’ve never had uniforms reimbursed, but it sounds like a very reasonable item to ask your recruiter for reimbursement on.

I’m an adult RT therapist with experience in acute and an LTACH, are the opportunities less if my Peds experience is limited?

As long as you are open to new experiences and settings, I think you will find your options wide-open. Traveling has been a wonderful way for me to gain experience in settings I otherwise never would have worked in. After a couple of assignments, my breadth of experiences had expanded greatly and even more opportunities were available to me. After those initial experiences, I could confidently step into almost any setting.

Cancelled Contract

Has there ever been a time when a contract is rescinded prior to start? In that case what does the company do?

I have never had a contract cancelled in 10 years of traveling – except for one time when I broke my arm and couldn’t work. However, it does happen. That is the main risk in traveling and you just have to be willing to roll with the punches and be flexible to adapt. Typically, there is a clause in your contract that allows you to leave a contract with 30 days notice, but you do not necessarily receive the same protection from an employer cancelling the contract (ask your recruiter about the policy for your company). Typically, a facilities staffing needs are well thought out. They don’t hire a traveler unless they need one. If you are a good employee and good fit for the facility, you shouldn’t have to worry about your contract being cancelled.

Recruiters

Since I have a lack of experience in traveling, I also don’t know which companies are the favorable ones. Any suggestions?

I’m going to refer you to this blog post on your first travel job for a couple tips on selecting a recruiter. Basically, if you don’t feel well taken of, move on to another company. There are many, many agencies and a lot of them recognize that the clinician is the commodity. Without us working, willing to take travel jobs, there would be no travel industry and there would be no recruiters – find one that’s willing to make you feel needed.

Surfing Waikiki after work one day. Traveling therapy is the best thing ever.

Overtime

Can you sign up for overtime?

If you are considering overtime, take that into consideration when arranging your contract. Typically, overtime is paid at 1.5 times your regular hourly rate. However, your hourly is going to be pretty low because of all the tax free money you will also be receiving. On one job, I knew I would be working some overtime, so I was able to negotiate a flat rate for any overtime hours to make sure I was making reasonable overtime pay for overtime hours.

It is really going to depend job-to-job on whether overtime is available – make sure to ask during any interviews you have.

Overall, I’d like a good experience and to be able to earn enough to pursue my dream location. I just want to know it’s worth it.

Traveling therapy is awesome. Pay can vary greatly place-to-place. Just weigh your priorities and if getting out and seeing new states and facilities is one of your priorities, then travel is definitely for you!

For other therapists trying to figure out where to start, this link is a great place to get started with travel therapy. Also, don’t forget to follow HoboHealth on Facebook and on Twitter @HoboHealth.

Search With One Travel Recruiter or Several?

Introduction

HoboHealth:

When I first started traveling, I worked with just one company, I had steady health benefits, I would accumulate PTO, and I even got a free wifi printer as a loyalty bonus. The printer was too big to travel with, but I still use it when I have it with me. The company I worked with initially has big name, and they were always able to find me a job. But, when I started looking around, I realized the deal I was getting might not be as good as I thought. Other companies were offering me as much as $200 more per week for similar jobs and seemed a lot more attentive to my needs. $200, that’s one wifi printer per week! That started me down a path of searching with multiple companies about 7 or 8 years ago.

The Vagabonding DPT:

I started traveling about 2 years ago as a new grad.  I was fortunate to have a Travel PT mentor who set me up with my current recruiter.  Yes, that’s singular.  I have one recruiter.  I know that the majority have multiple recruiters, but for now, having one recruiter has helped me build my career as a physical therapist. My recruiter is fully aware of my abilities, professional goals, minimum pay rate, and setting preferences.  He’s submitted me for positions that I may not “qualify” for (i.e a requirement of 5+ years for a job assignment) because he was confident in my skills and that the position would be a perfect fit for me. Even as a new graduate with my first assignment, I’ve stood firm on negotiation of time off as well as pay rates.  I got exactly what I wanted because I had a recruiter who was willing to negotiate those terms on my behalf.

What are the advantages of having one recruiter vs. multiple recruiters?

HoboHealth:

Compare pay rates between companies. It becomes clear very quickly whether what you have been making is competitive with other companies’ rates or not. Knowing what other companies are able to pay you in a given area can be a great negotiating tool if you do decide to stay with just one company.

Different companies have different jobs. You will see many of the same jobs posted across most agencies – the jobs that are the same across agencies are all listed on databases that many facilities contract with to fill their jobs. The databases sell subscriptions to the staffing agencies to have access to their jobs (the databases also charge 3-4% of the total contract price to the recruiters). To beat this system, agencies have gone out of their way to make contracts to exclusively staff particular facilities. So, it is possible that you can’t find a job in a particular area because you aren’t looking with the agency that has an exclusive contract with a facility in the area. Also, some agencies rely solely on what comes across the databases; Other companies are willing to call around for you. All recruiters will say they are willing to canvas an area for you, but less will actually do it (the smaller agencies tend to be more willing to put in the footwork of tracking down novel contracts). Broadening your agencies, may open up additional options.

The Vagabonding DPT:

Each travel company provides different perks the more time you spend with them.  The benefits listed below are solely representative of one company:

Paid Time Off: My company provides paid time off for 40 hours after working 2,080 hours and 1 year with them.  A travel therapist would be free to cash out that PTO to fill any requested time off during an assignment or in between assignments. From that point thereinafter, you accrue some PTO for every hour you work.

New Grad Bonus: A new grad who works 3 consecutive contracts with this company will earn a $1,000 bonus.

Continuing Education Bonus:  When you’ve stayed with this company, you receive $400 of continuing education credit valid also for conferences such as Combined Sections Meeting or NEXT.

Less Paperwork: Every company has a set of protocols that they must follow to be compliant with TJC including BLS certificate, licensing, NPI number, vaccinations, physical exams, TB tests, drug screen and physical examination. In addition, each company will have a mound of paperwork in regards to the company’s policies and procedures about expectations, benefits, clinical competency, etc.

Staying with one company allows you to focus on what you need: less paperwork and more time to invest in your passions and interests.

Health Insurance: If you choose to go with one company and choose to go with their health insurance, you won’t have to worry about switching health insurance companies.  Travel PT companies will typically allow you a 30 day grace period in which you will be covered by the company while you’re between assignments.

Consistency: Some larger Travel PT companies will bounce you around with various recruiters who manage a particularly region.  If this is the case, then you will have to take the time to let each recruiter know your preferences and want-list.

Do you feel there are any disadvantages to the approach you have taken?

HoboHealth:

The obvious downsides to working with multiple agencies are the benefits you don’t get for being loyal to one agency and the extra paperwork you do get – as April mentioned above.

If you do work with multiple companies, remember this cardinal rule: “You take a particular job with whichever agency offers it to you first.” Meaning, you can’t take an assignment offered by one agency, and tell a different agency about it to try to get a higher pay rate. Things can get sticky fast.

It takes some management to work with multiple companies. At one time, I was searching with 6 or 7 different agencies. One job came up and they had received my resume from multiple different agencies, each claiming I was “their guy”. While I went with the first agency to present the job to me (the only agency who had permission to submit me for the assignment), another agency bullied the facility into only accepting my interview through them. I was unable to go with the agency I liked best and who had presented me the assignment first. It was embarrassing and it’s why I now limit my searches to 2 or 3 agencies. When you are working with multiple agencies, you have to be clear that you need to be contacted before being submitted to a job, otherwise you may end up in my situation with companies bickering over ownership of you with the facility – it’s embarrassing and a good way to blow the interview before you even have it.

The Vagabonding DPT:

As James mentioned above, working with one company requires much trust in one person to provide you with the best pay rate, location, and setting.  By doing so, you may limit your options for future possibilities.  You must trust that your recruiter is negotiating the terms of your contract to the best of his/her ability to provide you with the best overall package.  To decrease this, you could also ask other Travel Therapists about their pay rate for that setting in that specific region.

The same facility may be working with several travel recruiting companies to fill a need. So when you work for multiple companies, you may be offered the same position via two different companies which can actually work against you. In the end, you may not end up with the assignment.

Conclusion

We present you with the advantages/disadvantages to assist you in making the best informed decision for your travel career path.  We’ve each done our research to negotiate our contracts.  Stay informed and ask around.

This is the second blog HoboHealth and The Vagabonding DPT have done together, you can link here to our first blog together about whether or not to travel as a new grad.

Check out our websites: www.hobohealth.com and www.thevagabondingDPT.org. Follow us on Twitter @HoboHealth and @AprilFajardoDPT. Finally, follow our Facebook Pages to keep up on our latest blogs and what/where we’re up to: HoboHealth and The Vagabonding DPT

 

Traveling Therapist Taxes – It’s Complicated

I haven’t shared an email in a while, so here’s one I received recently that I thought offered some insight into the complexities of traveling therapist taxes.

Traveling Therapist TaxesTraveling Therapist: My wife and I traveled for a while but then had accepted permanent jobs, we are considering the traveling therapist life again and this brought up some questions in our minds. We are currently renting in Kansas, but when we go to travel again, we are trying to figure out what we need to do as far as claiming a tax home. I was originally living in my parents’ retirement house in Florida and was paying rent to them. My concern is that I might not have a place to claim as my tax home when we go back to traveling. Have you bought a house? What is the best way for us to claim a tax home?

HoboHealth: Oh man. Good questions, complicated questions, more complicated answers.

A while back, Kate and I bought a cheap condo up in Maine that we thought would be our tax home. We figured it would be an easy return on our money: 1. The market was way low, and we bought the place dirt-cheap 2. We were paying monthly storage fees that would be eliminated by moving our spare furniture into the condo 3. We’d have a nice, solid, unwavering permanent address as our tax home to collect all of our tax-free bene’s.

Unfortunately, at the same time we purchased the apartment, we had racked up a few years in a row returning to the same job in Colorado seasonally in the winter. Apparently, this is one overriding exception to the standard rules for maintaining a tax-home. If the majority of your work is done consistently in one place year-after-year, that becomes your tax home. The example I get from my tax guy is always pro sports players. If a player maintains his permanent home in Green Bay, but plays for the Texans, the majority of his work is consistently in Texas, and Texas is his tax home despite Green Bay being his permanent address.  You see, Texas is his work place, that’s where he consistently makes his money, it doesn’t matter that he lives in Green Bay. This doesn’t apply to most travelers, because they move often enough to avoid establishing a consistent place of work.  Confused yet?

The other thing that completely blindsided us was that Maine was taxing us at 4% income tax on everything we made, everywhere we worked – despite Colorado being our tax home, Maine considered us permanent residents by their law. We owed Maine over $5000 at the end of that first year with a condo there! Bush league, we got hosed. Just thought I would share my convoluted situation to demonstrate some of the complexities of the tax-home issue before actually answering your question.

So, to summarize your situation: You had a tax home established at your parents and were paying them “fair-market” rent to maintain a home there, but then went to live and work in a different state and have been renting a place there. You’re wondering how to establish a new tax home for when you return to traveling shortly. Has it been less than one year? …I’m thinking you may just be able to pay your parents back-rent for the year and file your 2015 taxes at their address, then you can just carry-on with the situation you had.

The other thing I have heard of, but not ever from anyone that I actually know first-hand, is purchasing super-cheap housing in a 0% income tax state like South Dakota or Florida and establishing that as your tax home. If only it were really this easy. My understanding is that there’s a lot of other factors that the IRS looks at to strengthen your claim for a tax home – driver’s license, vehicle registration, memberships (gyms, clubs, etc), bank location – the more things in your life you can put in one place, the better your argument for that place as your tax home. It is not black-and-white.

Now, let’s say you either re-establish your parent’s home as your tax home, or you somehow establish somewhere else as your tax home. Remember this mantra that has helped me keep my life more sane: You live at your tax home, you are only working temporarily at your travel destination. This is an important distinction. Some states want you to get a driver’s license in their state or register your vehicle there after living there 30 days or less – in your case, you are not living there, you are only working there temporarily. If you are pulled over, you should be clear with the officer that you are only in that location working for several months, you live at your tax home location. Clear?

Staffing agencies will try to make these issues very clear-cut. They’ll frequently give you a checklist for tax home and if you are able to check off a certain number of boxes, you are OK in their eyes to receive tax free money. They may tell you if you work 60 miles from your tax home, you are OK to collect tax free money. There are no laws related to travelers that are this precisely defined. The real laws are much more vague and open to interpretation. Do the best you can to strengthen your case of claiming any one particular place as a tax home so you can confidently defend when/if the IRS comes knocking. And when a recruiter assures you that your tax home is legit, remember that the end responsibility is YOURS and yours only.

Your best bet to get your taxes right is to talk to a tax professional who specializes in travelers. Searching for “travel RN taxes” on Google will give you a variety of options. Good luck trying to understand all this stuff, it’s complicated.

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.

Locum Motion

This website is about being a traveling therapist, right? Then, why so often, do I get myself off-topic blogging and twittering about issues in PT and healthcare? Answer: Because I like it. Only once in a long while do the stars of the interweb align so that I can write about travel therapy and healthcare issues at the same time.

We call ourselves travelers. Traveling therapists, traveling nurses, travel PT or OT assistants – we are all “travelers”. But not MD’s, they, call themselves locum tenens, or just locum for short. Locum!? What the heck does that mean? locum tenens; locum – place, tenens – to hold; all together now, “Place holder”. Turns out locum tenens is actually a Medicare term that applies to someone temporarily filling in for another provider. When someone qualifies to work as a locum, they are able to skip a lengthy credentialing process to be able to bill Medicare patients. The list of providers that are currently eligible for locum status during temporary employment include Physicians, Dentists, Certified Registered Nurse Anesthetists (CRNAs), Nurse Practitioners (NPs) and Physician Assistants (PAs).

There is a Medicare bill currently working its way through congress that would extend locum tenens status to Physical Therapists in certain situations. Currently, in PT private practices, if a temporary therapist is brought in, it can take 3 months to be able to bill to Medicare under their own NPI. Most private practices doing their billing above board and truly the “right” way avoid travelers for this reason. I’m not sure what happens when a private practice hires a therapist through an agency – what I believe happens, is that the private practice bills under one therapist’s NPI. The practice of billing for an entire practice under one NPI, as far as I am aware, is frowned upon, but not illegal. I have done a couple independent contracts with private practices who have made me become in-network at their facility with Medicare, it’s a long process (2-3 months), mostly paperwork, and discourages a lot of employers from getting involved with short-term staff. This bill could change the whole arrangement.

bill

Forget how this whole bill to law thing works? Click above and return to being as smart as you were in middle school.

This new Medicare/locum tenens bill, titled the Prevent Interruptions in Physical Therapy Act (House bill: H.R. 556 and Senate bill: S. 313) would create some exceptions for certain PT private practices. The bill, if passed, would decrease interruptions in patient care that may occur through a PT’s temporary absence due to illness, pregnancy, vacation, or for continuing ed by allowing practices to hire PTs on a locum tenens basis. That would cut out the whole Medicare credentialing process that currently takes place when hiring a temporary PT. While this bill is certainly patient-centric, I do see a secondary opportunity here for travelers. If there’s a current process that inhibits some clinics from taking on travelers (Medicare credentialing), and that process is eased, there’s a lot of opportunity for an increase in the number of available travel assignments. As this bill stands in the Senate, locum tenens status would only be allowed in areas designated as non-Metropolitan Statistical Areas, or areas designated as Medically Underserved Areas (MUAs) and/or Health Professions Shortage Areas (HPSAs) – that’s a lot of private practice clinics that could soon hire temporary employees with less fuss when billing through Medicare. Ideally, the bill would be amended to include ALL areas in the country, not just those of special designation – that would be pretty sick. (it’s a Medical pun, get it?) Be sure to let your Senators know that ALL Medicare beneficiaries deserve uninterrupted access to PT, not just those in underserved areas.

All traveling PTs, everyone in private practice, and all recruiters should be pretty psyched about this bill and should definitely be contacting their Congress Men and Women today. Jump over to APTA’s website to get more information on the bill. From there, you can link straight on over to contact your Senators and Representatives. Get on it now!

SLPs and OTs, don’t worry, I haven’t forgotten about you. If the legislative bug gets you revved up, you have good resources to contact the people who represent you in congress. For OTs: http://capwiz.com/aota/home/ and for SLPs: http://takeaction.asha.org/

I do get fired up about issues, and this one is more special to travelers than most issues are. It was too good not to write about, but I realize healthcare politics can get a little dry. I promise more excitement in my next post!

Your First Travel Gig

first traveling PT assignmentAfter being a traveling PT for 8 years, I sometimes forget that what now seems like a pretty routine process was very intimidating and complicated at first. This post describes what you can expect in the process of getting your first traveling therapy job. I have another page that you can link to under the “Getting Started” tab. There’s some similar information there, but with a slightly different focus. Here I have tried to focus on the details of your interaction with your recruiters and the order of how this should all happen to get your first job in traveling therapy. Here we go!

Get a License

Do this first. Start working on a license for the state you want to go to as soon as you decide you want to travel. You can start this process after you start looking for jobs if you are still trying to figure out if you want to be a traveler (trust me, you do). But, if you wait too long, waiting on a license can delay the start of a job or prevent you from getting a particular job all together.

Contact a Couple Recruiters

This section was the impetus for this whole blog. I have heard more and more from people that their recruiters are telling them, “If I’m not your only recruiter, then I can’t give you my full effort.” If a recruiter ever says something like this to you, my suggestion is to hang-up and never talk to that recruiter ever again. Of course the recruiter wants you to work solely with them! It takes any competition or reason to hustle for you out of the picture. A good recruiter will understand that you are working with some other recruiters and will work harder to be the one to get you the assignment you want. Recruiters usually work on commission and get their pay from getting you a job. YOU, the therapist, are the commodity, without YOU, nobody gets paid. Seriously, if a recruiter says you have to work with them exclusively, they are playing you – ditch ’em!

Here are the reasons for working with multiple recruiters: First and foremost, talking with a few different recruiters should give you an idea of the going pay rate in a particular area which can vary wildly place-to-place. While different recruiters will have many of the same jobs available, there will be some jobs that are different between companies. Some companies have exclusive contracts with certain hospital systems – it all gets very complicated when you get into the details of how temporary jobs are posted and who they are posted with, but the bottom line is that having multiple recruiters working for you increases the number of potential jobs available to you. Also, when you do get ready to accept a job, having several irons in the fire will give you more leverage in negotiating better pay.

Get Submitted

When you are “submitted” for a travel assignment, it means that you have heard of a job from a recruiter, and you want your resume to be put in the applicant pool for the job. Some jobs will have dozens of applicants, while for others, you might be the only applicant. The number of applicants for an assignment has very little to do with the job itself and likely has more to do with the location of the job and how the facility chooses to post their available position with agencies.

Once submitted for a job, you cannot be submitted for the same job by a different agency – this is where having more than just a couple agencies working for you can trip you up. Early in our traveling, my wife, Kate, and I had 6 different companies we were working with, it got complicated. We had multiple agencies submitting us to the same jobs and arguing with the facility that that each had submitted us first. It was embarrassing – don’t let it happen to you.

Different agencies will vary in how they handle the process of submitting you. Some agencies will want all your information right away, I prefer not to give them my info (references, resume, etc.) until they have found me a job to be submitted for. So, if you can, delay giving a company all your details until it’s time to be submitted – but, some companies just won’t have it and want your info before they do anything for you. Some recruiters may ask if they can submit you for jobs without contacting you first – basically, they find a job that meets your criteria of location and setting, and they will submit you without hopping on the phone to notify you first. If you are working with just one recruiter that you trust, this is fine. Also, if you are searching in an area where there are many people looking, like Hawaii, and want to be one of the first people to apply, then this can be a good strategy. But other than those two situations, I have a hard time justifying giving my recruiter a “green light” to submit me for whatever, whenever. By having the recruiter check in with you, you are keeping control of what jobs you are applying to and where your resume is being pumped out to.

Interview

If a facility you have been submitted to is interested in you, your recruiter will arrange a phone interview for you with the facility. Simply remember that this is your chance to interview the facility as much as it is their chance to interview you. Ask questions, but come into the interview knowing some stuff about the place you are interviewing with. Usually, at the end of the interview, you and the interviewer will report back to the recruiter separately to let them know how the interview went.

The Job Offer

If the interview has gone well, you will receive a job offer. If your recruiter does this verbally, ask that it be sent by email also so that you have it in writing and can crunch some numbers. Swiftly move along to the next step.

Negotiate!

Therapists. We are really bad at this step. But, if the pay seems low compared to what you’ve been hearing through other recruiters, or if there is a benefit that you want that isn’t included in your package, ASK! It never hurts to ask. Don’t underestimate your ability to name a price and see if it can be matched. Remember, YOU are the commodity!

Accept

Don’t get so wrapped up in your negotiating and getting every little bit out of your contract that another therapist signs their contract first and takes the job. Sure, negotiate, but do it swiftly.

 

That’s probably more details than you really need, so I’ll stop here. I’ll again refer you to the “Getting Started” page that is somewhat redundant to this post, but offers some other details including a link to what benefits you should expect or ask for. Happy job searching, I’ll say something here that I don’t say nearly often enough: I love being a traveling PT. If you have the itch to get out there on the open road, you should do it now, because life is a funny thing, and you don’t know how long this opportunity to travel will last. Happy travels!

Feast or Famine

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

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

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

O'hana Papaya

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

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

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

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

4runner

The roach mobile, o’hana in the background!

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

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

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

Happy Memorial Day! Aloha!

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

Email From Traveling Physical Therapists

Traveling Physical TherapistI’ve been getting the same type of question from new traveling Physical Therapists a lot lately…. so let’s hash it out in public. The question goes something like this: “I want to travel, I know where I want to go, but where do I start?”

I have had a “getting started” page for a while now, but just tuned it up, it should be a good companion resource to this blog: https://hobohealth.com/wordpress/faq/

Below I have pasted an email conversation I had recently had (lightly edited for anonymity). I hope this helps some of you out there get your travel career going.

Email:

Hi James,

I am a PT, and I happened upon your blog after beginning to research travel therapy. My husband (also a PT) and I have been working for almost a year and are planning to become traveling Physical Therapists this summer. We have a couple of PT friends traveling now and have gotten some perspective from them, but their experience is still pretty limited.

Thought I would reach out to you for a bit more perspective. Here are a few things we’re curious about:

-best companies/recruiters to work with
-states requiring significant paperwork/time for obtaining license
-what comes first: obtaining a license or obtaining an assignment

Any other tips to get started travelling would be greatly appreciated!

Response:

Very glad you found the site!

My wife and I have been traveling Physical Therapists together for 7 years now… we originally thought we would travel for 2 years. We absolutely love it, and I hope you guys find some fun in it too! I started into travel after 6 months of working in private practice, and my wife started after a year of practice. I think you guys have done it right by getting a little steady experience before jumping into travel. I so often find myself trying to convince new grads to get just a few months of experience becoming a traveling Physical Therapist. So, good work, you’ve gone about it the right way!

We have worked with a bunch of different recruiters and companies at this point, and always search with 2-3 companies when looking for a job. I have heard of people sticking with one company for years, but I definitely don’t think that working with just one agency offers you the best selection of jobs available. I make sure to use recruiters that will have my back if something is not right about an assignment, and who won’t encourage me to continue working an assignment if it is toxic (i.e. ethical or scope of practice issues – rare).

California is notorious for licensure taking forever (4-6 months). I recently heard from someone that New Jersey is a pretty big process too. Otherwise, the process varies state-to-state, but shouldn’t take more than a month or two if you get all your ducks in a row with the paperwork. The more licenses you have, the more complex getting additional licenses becomes. So, I recommend that if there’s a few states you know you want to work in, get all of them now.

Start licensure ASAP, a lot of jobs won’t hire you until you have a license – but some will higher you conditionally with a projected start date if you’ve started the process. I would also get in touch with some recruiters soon. They can help inform you of how long licensure takes for particular states and help you start getting an idea of what kind of jobs may be available where you want to go – some agencies have resources to help you with licensure. New jobs pop up constantly and other jobs are filled quickly, so the sample of actual jobs will change, but the recruiter will be able to help you see what a particular geographic market is like.

OK! I’ve gone on too long. Here’s a simple page about starting travel PT if you haven’t seen it yet. https://hobohealth.com/wordpress/faq/ Let me know if you have other questions, and keep in touch about what happens with you guys!

James