Tag: TravelPT

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Mother Nature

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An earthquake woke me up this morning.

I was pretty sure the ground was shaking, which was unusual since all that is under the house is hard, steady lava rock that doesn’t even budge when large vehicles drive by on the road. Kate was already out running, I quickly made a mental note that I needed to ask her if she felt an earthquake, and I was back asleep within 20 seconds. Sometime later, I found I had been laying semi-awake in bed for a while listening to the voices from the TV in the next room go on-and-on about the approaching hurricane. I sprung to my feet when the TV conversation shifted to the 4.5 earthquake that had struck this morning. I was a little surprised to find out it really was an earthquake and excited that I had finally felt one. We were in Anchorage 2 summers ago, where the earthquakes seemed weekly, and I never felt a single one. The news has been so inundated with Hawaiian hurricane histories and storm prepping tips, that I’m still not sure if any damage was done by the quake – it hit a fairly remote part of the island, so I suspect everyone is OK.

At the time of this posting (9 PM Eastern, 3 PM Hawaiian) we're about 5 hours from Hurricane Iselle making landfall here on the Big Island.

At the time of this posting (9 PM Eastern, 3 PM Hawaiian) we’re about 5 hours from Hurricane Iselle making landfall here on the Big Island.

Every single patient I have seen over the last 3 days has had an opinion about hurricane Iselle and the toll she’ll take on the Big Island, but the bottom line is we’ll just have to prepare for the worst, hope for the best, and wait. This storm is approaching from the East, the Hilo Side of the island, we are over on the West side in Kona. The Kona side of the island has sustained damage from hurricanes in the past, but these were storms that wrapped around from the South. This storm coming from the East will have to plow past two 13,000 ft volcanoes and a smaller 8,000 ft peak. These mountains may stall the storm and will likely take a lot of its force before it gets to our area…. but no one really knows.

In the meantime, we continue to wait. Kate and I both work for clinics that are closed this afternoon and tomorrow, hopefully we’ll scoot by with some wind, rain, and an otherwise relaxing long weekend. We should return to work on Monday for our last five days of work before heading off to Maui for a week’s vacation and then to the island of Molokai for the next 13 weeks… but that’s a story for another time.

Don’t worry about us, we’re prepared and we’ll be fine, but do keep Hilo in your thoughts and prayers, and hope they don’t get hammered too hard by the storm. Personally, after the earthquake this morning, I’m keeping a watchful eye uphill towards the volcano rather than downhill towards the sea. That Mother Nature, she’s a powerful one.

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Continuous Education

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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.

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Out of the Inbox

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Licensure issues keep coming into my life recently. Here’s a recent email I received that offers some food for thought on tricks to get around licensure hassles. Share any tricks you have used!

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Question:

Hi!

I am a recent grad (2013) and have been doing travel PT with my boyfriend for the past year in Wisconsin and Texas. We’re now looking at getting our next license. Since everyone talks about how annoying it is to get a verification sent from each state you’ve ever had your license in to the state you’re applying for, we thought of a better idea… but aren’t sure if it would work and wanted your opinion.

We were thinking that we should apply to about 5 more states at the same time so that we only need verification from Wisconsin & Texas for each of those 5 states, in the end, saving us the hassle of sending 2, and then 3, and then 4, and then 5 verifications to each state we apply for in the future. Would this work?

2nd question: We looked at Texas’ verification request form which allows us to send it to multiple states for one $50 fee. Can we send it to 5, 6, 7 states even if we haven’t applied for those states yet? Then in the next year or so, apply for those states which already have our Texas verification without having to pay another $50 fee?

Not sure if you know the answer to these questions but just thought they were 2 ways to save money with the multiple state license applications and fees that go along with it.

Thank you for your time and I look forward to hearing from you.
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Response:

I like the way you’re thinking about licensure – getting all of those done at once by verifying only the 2 current states is a good plan and will definitely save you time and frustration. Although, over time, I don’t think it will save you any money, just because of renewal fees and that sort of thing, but it may be worth it for the trade off in reduced frustration.

I like the idea of getting multiple licenses at once, but I would only do the states you are sure you want to go to at some point. That way, if another state comes up that you want to get a license for, you don’t have to verify licenses you held but never used. Also, check the renewal process on these states ahead of time – check cost, CEU requirements, and timing. By timing, I mean that in some states everybody’s license expires on the same day – i.e. If every license in a state expires on January 1st and you just got your license today, you would have to pay a renewal fee in only 4 months.

As far as the Texas question, I think it’s a great idea to send as many verifications as you can if it’s all covered under one fee. I don’t see a downside. Typically, when a state receives any licensure paperwork on you (like a verification from Texas), they start a file. Some states keep an incomplete file 6 months, some keep it a year, some might keep it longer. You likely won’t have unlimited time to start the licensure process before they discard your verification, but I see no harm in requesting the verifications just in case you do decide to go.

After requesting all your verifications, I would follow up by phone to make sure they have all been sent/received. Also, I would send yours and your boyfriend’s in separate envelopes. In my experience, when my wife and I try to share an envelope, one of our verifications usually gets forgotten and our new license is delayed. Sadly, requests getting lost is the rule rather then the exception.

Hope this helps, I like your thinking!

James

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The Downside

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I have written many uncompleted drafts of this post over the years. For about 4 years, it sat uncompleted in my drafts folder titled “Trouble in Paradise.” I deleted everything I had written and started over – like a waste bin full of crumpled papers by a typewriter. I have a hard time expressing the cons of traveling PT because I do really enjoy it and can’t even seriously consider how different my life would be working the last decade in one place, doing the 9 to 5 grind. Uhg, the thought disgusts me. 🙂

But here it is, my attempt at talking frankly about the downside to travel PT. I’d also like to hear from other travelers about what they think the downside is. Here we go, back to rainbows and unicorns next week.

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There’s not much to gripe about with traveling physical therapy. After almost 8 years of travel, I’m beginning to think that the nightmare-assignment barely exists. In about 20 assignments, there is only one I’ve had to terminate the contract on early. If I had asked the right questions during the interview, I don’t know that I ever would have worked that assignment. Over time, I realized my boss was a unlicensed foreign chiropractor. I also realized that I was a PT giving massages, not a PT doing PT. After a couple agonizing weeks and all of the full-time staff quit, I managed to get that contract terminated. From that experience, I believe two things about bad assignments: 1. Awful assignments are pretty rare; 2. If you perform your due diligence in researching your assignments, you can easily avoid disaster;

Therapists that repeatedly finds themselves in difficult situations or putting out fires with their bosses needs to take a deep look internally and know their roll. As a traveler, you are frequently not treated as a full team-member; you are a temp filling a spot and may be a bit of an outsider from the other staff.  Even with facilities that are very welcoming, you may find yourself the work-horse while other overworked staff gets their long-needed rests. If you eventually accept more permanent employment from a facility, then, your role may change, but until that time, do not tell your boss how you think the facility could improve. I did this on assignment back in 2010 at a home care company – I was told, “We welcome your feedback, we want to know what could be done better.” Even if you are begged for feedback, you are a temp, do not tell your boss how the facility could improve. I have learned this lesson, don’t repeat my mistakes. The last day of that assignment came with one of the most unfriendly goodbyes I have ever experienced. That home care company has since closed their doors. OK, so maybe 2 assignments out of 20 didn’t go as smoothly as they could have for me. That’s a 90% success rate, I still believe really bad assignments are a rarity.

The only thing in travel PT that gets me riled up on a regular basis is the licensure juggling act. I think I have ranted about licensure in the past. After a period of time, Kate and I had let all our unused licenses lapse. We found ourselves in a jam last spring and started re-upping many of our licenses. We decided at that time that we would maintain all our current licenses as long as we traveled, because it’s too much of a pain to renew a license you have let expire. That strategy went to junk last week.

All Alaska PT licenses expired on June 30th. Can you imagine what this month is like in the Alaska licensure office!? Holy Cow, just hope you don’t have to contact them to get anything done in the next couple weeks. Anyways, Kate and I set into filling out the paperwork for licensure renewal which included a 20 question juris prudence exam heavily focused on the new continuing education regulations – also, you had to write down the statute number that contained the answer to each question. Over the last two years, I’ve attended several multi-day national meetings to discuss PT issues and practices, but this is not considered continuing education by Alaska. So, I set off on the internet to find a cheap courses that would provide the CEU’s I needed. Two hours into this process, we had the applications in the envelope (no email or faxing allowed), $240 checks written each for renewal, and I was about to order a lousy $300 online course for my CEU’s when we finally decided to pull the plug on staying licensed in Alaska. Kate and I may renew in the future, but the prospect of shelling out $800 to keep a license we might not use seems a bit ridiculous. I did end up ordering a much higher quality, online course from APTA that I’ve been wanting to take, so the 2 hours spent not-renewing wasn’t a total loss.

The licensure process stinks, it’s an antiquated process that bears no real function in the modern world, other than to satisfy the outdated rule books. I will soon write ANOTHER letter to FSBPT expressing my displeasure, but in the meantime, I just take it as the way things have to be done to continue traveling.

Licensure is the thing that bothers me most about traveling, but it’s a relatively small inconvenience. I think people’s primary fear about traveling is getting stuck in a nightmare assignment. As I’ve expressed, the really bad assignments are rare. If you find yourself in a bad assignment it will only last 13 weeks, and it will probably take you half of the 13 weeks to even realize you have accepted a bad assignment.  If it’s exceptionally bad, there are ways out, and a good staffing agency will have your back. Other than what I’ve already talked about, there is very little downside traveling physical therapy. The frequent moving can get a little old at times, but that process streamlines itself with practice. Who am I kidding, packing and cleaning will always be the worst – just awful.

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Stay tuned, lots of excitement happening in the initial stages of searching for an autumn assignment. I’ll keep you posted. And please do share your gripes about traveling PT… a one time chance. I will not write another negative blog for a long time.

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How Should I be Paid?

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With any job, there are a number of different ways you can be paid. There’s straight-forward salary, hourly, or some sort of productivity-based pay. Of course, when considering pay for a typical job, there are things to consider besides just the money – health care, retirement, life insurance, employment-related discounts, and the list goes on. In traveling physical therapy, the list gets a little bit longer and more complicated. A traveling therapist has more say in how he or she would like to be paid and needs to determine how much he would like to weight his taxed versus untaxed wages. There are IRS limits on how much you can take tax free in each zip code, but I have been told that taking those upper limits with low taxed pay can be a red-flag for an audit. So, I typically take $20-$30 hourly (taxed) and get the rest of the pay as stipends/reimbursements. I know a lot of travelers think hourly should be near the normal hourly amount a perm PT makes with the reimbursements being in addition to normal pay, but that’s just not the way it works. A more adventurous travel assignment can have some perks that can make the math of take home pay a bit more complicated: a loaner car from a boss, employee housing, a coworker’s mother-in-law apartment, or other non-monetary compensations.
Productivity arrangements in healthcare can get iffy real fast, think anti-kickback laws. I am not a fan of pay-per-code or percentage of billing situations. These can quickly turn an honest therapist nasty. It’s just too tempting to bill an extra modality or therex that may not be necessary when you know your own bottom line is linked to it – I don’t like it one bit. I’ve seen a number of positions, particularly for therapists in management, where bonuses (boni?) are paid for meeting certain productivity thresholds – number of patient visits or units billed. I occasionally see pay-per-visit systems go awry with a therapist seeing many patients at once, episodes of care dragging on, care extenders over-reaching their scopes of practice, patients getting less attention, and therapists getting burnt out. But, I can’t speak too harshly about pay-per-visit, since it is how I’m getting paid right now. Luckily I’m in a practice where all treatments are provided by PTs 1-on-1 for an hour. With the focus of 1-on-1 patient care, I find the arrangement ethically acceptable, but it’s definitely got its pros and cons. I’m well paid for my hour with a patient, but there is nothing worse than an initial evaluation that no-shows and leaves me unpaid with nothing to do for a full hour. I would encourage anyone considering a pay-per-visit position to first strongly scrutinize the care patients are receiving, and secondly, to ask for a little more money than you normally would, because the chances of batting 1.000 for attendance in any given week are slim.

Advance Healthcare Network

From Advance – Click to access their full report

New travelers are always asking me what they should get paid – I don’t know. Pay varies so much regionally and even town to town. It can be real tough to know if you’re making all you can of if a recruiter is taking you to the cleaner’s. Just find a recruiter you trust and get as much as you can out of each contract. I may try to establish a database where travelers can anonymously input how much they got paid on assignment. It would likely be a small sample size, but may provide all of us some information about what other traveling PTs are getting paid in each state. As I mull over that idea, here’s a nice piece that Advance puts out each year based on their survey results of PT pay. I just stumbled across the APTA Workforce Data page, not as sexy or user friendly as the Advance survey, but lots of good info in there if you click around (APTA Members only).

Some advice for the new traveler: Remember that your recruiter is working on commission and doesn’t get paid if you don’t get hired- it is in their best interest to get you on board even if it lowers their own bottom line. You are a temporary worker for a facility that needs help immediately, you are willing to pick up your life and move to that job to fill a position they desperately need filled – this has big value to it. With all these things working in your favor for higher pay, the costs of travel, furnished apartments, and miscellaneous other will likely cancel out a big chunk of the extra moolah. But, traveling PT can be an exceptional lifestyle that is worth so much in personal experience and growth – so get what you can financially out of a contract, but more importantly, just get out and see some more of this world.

In other news, a series of conversations this week have lead me to believe that the travel PT market is rebounding from a couple of more difficult years, I’m finishing up my SCUBA certification with four dives off the coast of the Big Island this weekend, and (in a crazy out of this world experience that only traveling PT could provide) a hospital has bought Kate and I plane tickets to fly out to interview for a possible once-in-a-lifetime travel assignment this fall – we shall see and more on this later.

Keep living the dream 13 weeks at a time!

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Wiki Wiki

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The increasing infrequency of my posts is a clear sign that my work hours panned out. Just a wiki wiki (quick) update on the travel and jobs in Kona.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back - interesting history everywhere you look.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back – interesting history everywhere you look.

The hospital gig, which was a wishy-washy thing from the get-go did not work out. I had tried to get something going at the hospital through one of my go-to recruiters. When he wasn’t able to come to an agreement, my recruiter gave me his blessing to try to establish a contract with the hospital on my own. So I tried. I spoke with the rehab director and later on the contract manager (the fact that they have a full-time position dedicated to manage contracts should have been a dead giveaway to steer clear). They were very encouraging that something would work out for me to be at the hospital. As they requested, I sent them a written proposal of what I would expect in my contract – 2 weeks went by and they requested I establish a contract through one of the recruiters I had used previously. The situation started to feel a little icky since my original recruiter had found the job, and working with another recruiter on the same job can start to cross travel PT ethical borders quickly.  Hesitantly, I went along with it. As everyone who has been doing travel health care for any period of time knows, credentialing for a job can take up a fair amount of time. So, I got underway on getting my paperwork and vaccinations all set for the staffing agency; I did the tedious skills checks online, I requested old varicella titre reports from my alma mater, I took a drug test at one facility, and I went and got my TB test up to date at another facility – all to find out just a couple days later that the contract wasn’t happening. Bummah. At least I got a free TB test out of it…. silver lining? Whatever, ainokea (“I no care”).

Waipio Valley - "Valley of the Kings" - We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

Waipio Valley – “Valley of the Kings” – We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

BUT, I got lucky, again, and landed on my feet. Everything is coming up James! The private practice prn job now has me booked 40 hours/wk and would gladly book me 50 hours if I let them. That job is doing just fine. And the kicker is that some of the staff at the clinic also work for a local coffee shop up the street, so I have found my Kona Coffee hook-up!

I have to get going, time to get to work. Upcoming island excitement includes a state holiday tomorrow, Kamehameha Day, celebrating King Kamehameha “the great” who united the Hawaiian islands which has previously each been under separate rule. He united the islands primarily through war and execution, and he also ended human sacrifice in the Hawaiian Islands right around the year 1800… different stories for a different day.

We will start SCUBA training this weekend, so that should lend itself to some good stories and pictures.

Aloha!

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Feast or Famine

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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.

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Just Go With It

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

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

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

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

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

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

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

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

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

To Be Continued...

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Island Dreaming

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

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

Island of Hawai‘i, Hawaii

Kona coffee every morning.

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

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

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

Nantucket, MA

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

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

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

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Community Chest

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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

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^ 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.