I am currently vacationing on the most rural island of the most geographically isolated islands on Earth (Hawaii). But, in 1 week, I will eventually go back to work at a PT clinic located within a walk-in clinic, located in a global-tourist destination. Yikes! 9 confirmed cases in town as of today.
I want to start a conversation. I’m hearing all kinds of info in the past 2 days. The hospital I work for has Rehab Services open, but everyone who enters the hospital is being screened. I have heard of Physical Therapists elsewhere with many, many cancellations. Many Universities are restricting the travel of their employees to professional meetings, or anywhere away from home. My alma Mater has moved to online classes. Professional and NCAA sports events are being scheduled without audiences. I am very curious about what’s going on in your work, schools, and life.
Is this all a complete over-reaction or is it justified?
Is it life as normal where you live? Are your patients showing up?
Does PT have some role in this that hasn’t been thought of yet? Or is our only role to protect our patients from something that could be harmful to them?
I found a Malaysian 10 cent piece at the Honolulu airport 2 days ago, should I have left it there?
My daughter and I had a cough with no fever 3 weeks ago – have we had the Corona already?
How is this affecting your work, education, and life? I am just curious what others are going though right now.
Stay safe out there. Bottled water is unnecessary in most circumstances, including this one – reduce single use plastics in your life. Wash your damn hands, always. And don’t hoard the toilet paper there is someone who just ran out right now and needs it more than you ever will.
I’ve had some trouble with delineating the roles in my life lately. I’ve always considered myself to have a variety of different personalities I can tap into – I initially come of as clean-cut, if not preppy, but my music interests lay primarily in heavy metal – very much at odds with my appearance. When on travel assignments, I have often heard I give an initial impression of reserved and quiet – but it doesn’t take long to learn that is far from the truth. For short periods, I have abandoned my clean-cut look for a shaved head and heavy goatee, which has served me well in scaring off tourists in Hawaii and has lead to fun nights blending into the crowd at biker bars in Maine.
I think we all have some multiple personalities within us that can come into conflict at times. I recently have experienced that conflict coming to blows between my personal and professional life… at least internally.
My Congressional Representative and I have very different views of our world. We disagree on most topics. I find him extreme in one direction, he would likely find me extreme in the other. Our district in Colorado, that I live in and he is elected from, is large and divided in its politics. I don’t think it’s moderate, but all the different extremes exist within it. I feel he should vote more moderately as to represent the average of his district, after all, he was re-elected with only 51.5% of the vote in the last election, hardly a landslide.
While my representative and I disagree on many topics, our lives and common opinions seem to be intersecting on one particular topic – the opioid crisis.
I currently serve as the Federal Affairs Liaison for the Academy of Orthopaedic Physical Therapist within APTA. Simply, this means I keep on top of the legislative issues affecting physical therapist and report back to the Orthopaedic Board. It also means I attend the annual Federal Advocacy Forum, put on by APTA, to meet with our Representatives and Senators in order to advocate for the bills and topics that will benefit PTs and our patients.
In the past couple years, APTA has targeted the opioid crisis. Afterall, Physical Therapists are positioned uniquely to help in reducing the amount of pain pills that need to be prescribed. We have extensive skills in decreasing pain (through exercise, manual therapy, and modalities), we are often the alternative to surgery or injection, and we do not prescribe medications. Every study I am aware of shows our ability to decrease the overall cost of a musculoskeletal injury in contrast to surgery or medication. A big part of Federal Advocacy Forum is PTs educating legislators on what it is we do in our daily work and how our skills can best be used to improve the lives of their constituents.
My Representative has championed responses to the Opioid Crisis and done a good job with it. We may not agree on much, but we agree on addressing the problems that have lead to Americans’ dependence on opioid medications to “fix” their pain or feed their addiction.
I have met with my Representative’s staff over the past couple of years, and very briefly with him. It’s an interesting exercise in burying my personal politics and focusing on what the priorities are for the Physical Therapy profession. I have heard other PTs at the Advocacy Forum ask about this conflict – personal politics vs professional role. The answer is always, simply, you put your personal politics aside for this role – but what about all the other days of the year outside of the Forum?
For 3 days per year, at APTA’s Federal Advocacy Forum, I try to be the consummate professional advocating my my profession, my patients, and their causes. However, I only found myself in this role because of my interest in politics and policy. Obviously, I have some deep, deep disagreements with my Representative. How do I reconcile that? I see a scenario where I could end up at a fundraiser for him, funding his re-election through my professional priorities, all-the-while biting my tongue and trying to get everyone I know to vote against him. I’m having a hard time putting this internal conflict to rest.
PT-PAC raises money to contribute to candidates who are supporting PT-friendly legislation. One PT I know, deeply entrenched in these positions and topics, stopped his donations to PT-PAC. He felt his personal politics were so greatly at odds with some of the candidates PT-PAC was supporting, that he could not be involved. I get it – my representative is a personal foe, but a friend of the profession. Where do we draw the line? To what extent do I let my professional roles define me? I often feel strongly about large societal issues and want to act to improve them. But, often, I think I’m just tricking myself into believing I can have an effect – do I completely abandon those large societal topics for the professional priorities that I am actually in a position to affect through face-to-face conversations with my Congressional Representative? Uhg, I think so.
In a different position, I participate in APTA’s House of Delegates as the Delegate for Western Colorado (quite similar to the chunk of geography my Congressman represents). The House of Delegates is a meeting held each year to develop the policies for APTA, and therefor, the profession. Some of the topics are meaty and contentious, while others are snoozers for me. Luckily, there are over 400 Delegates representing every state and specialty area in PT. Someone in that group has a passion an expertise for every topic that is discussed.
I was at a PT conference earlier this year and ended up in a conversation with a longtime PT leader that I respected. We were casually chatting, and with legislative issues and House of Delegates topics on my mind, I asked him a question: “What are the topics we need to be taking on today to make sure Physical Therapy is a thriving profession in the future?” It was like he had been waiting all night for someone to ask him that question…
This aging leader in our profession talked on-and-on about Physical Therapists’ effect on society and our need to speak out on a wide variety of issues external to our profession. That as highly educated professionals, we have a responsibility to drive not only our profession, but also our society, in the right direction to achieve their optimal health and wellbeing.
I don’t know how this guy did it, but he predicted the future. Maybe another 30 years in our professional association will give me the same foresight. The House of Delegates is taking on a large breadth of topics that are societal (political) in nature this year. The topics include Medical Marijuana, vaccinations, naloxone use in PT clinics, and gun violence. You often hear discussion around these topics about whether we should be taking them on at all, or if we need to re-focus on PT-specific topics.
Within my Delegate and advocacy positions, I find a wild contradiction. In my position as a political advocate, I bury my personal beliefs to represent the priorities of APTA. In my Delegate position, I use my personal beliefs to help determine the priorities of APTA. To which extent do I rely on my personal experiences and values, and to what extent do I suppress my personal beliefs to act in a silo as a clinician-leader in my profession?
The most contentious of the House of Delegates motions this year is about gun control. I think it best articulates our involvement (or not) as a profession in social issues, and it illustrates my conflict between personal and professional priorities. The original idea for the motion is quite different from the current version because of collaboration between many PTs from different states and backgrounds. These motions can change and evolve up until the very moment they are passed or defeated. In my opinion, the current (June 1st, 2019) version of this motion is far less political than its original form. It does not advocate for any specific gun control, but would add APTA’s support to performing a CDC study on the health effects of gun violence.
At the outset of writing this blog, I wanted nothing to do with the House of Delegates’ motion concerning gun control, but after writing this out, I want to discuss this topic more. If you are an APTA member, you have access to all of the Delegate discussions leading up to the House. Also, if you are the rare bird who wants to be involved in it all, you can live-stream the house.
As someone who holds positions both in representing the priorities of the profession and determining the priorities of the profession, I’m curious where you think I should draw my line between personal and professional politics. Do I let my personal political beliefs shape the profession? Do I bury those personal beliefs to advocate more effectively for our profession? It all seems very complicated to me.
As winter comes to a close, you might be wishing you were on an island somewhere…. if you’re a travel PT, you may have that option on your next assignment. Here’s (more than) 4 opportunities that could have you living on an island soon. Lots of links included to articles from when I worked on and visited several of these islands.
Kate hiking down from the 10,000 ft summit of Haleakala on Maui to camp in the base of the volcanic crater many hours and miles later that night in 2014.
Let’s not bury the lead. Hawaii is a tropical paradise within the borders of United States. All the advantages of really getting off-the-grid without any of the hassles or insecurities of international travel. Within Hawaii, there is a wide spectrum of opportunities – from uber-urban living to the very rural – a little different flavor for whatever your taste is.
Oahu is the main island and generally a good place for anyone unfamiliar with Hawaii to start. Oahu is home to about 1 million people, many of whom live and work in Honolulu, a major city and international hub. Honolulu offers all the perks and culture of a big city with the world famous surf beaches of the North Shore a short 30 minute drive away. Traffic can be brutal on Oahu, so plan commute between home and a potential job appropriately
Maui and Kauai each have occasional assignments available and tend to be a happy-medium for the traveler seeking a mix of social life and rural island-living. Both islands have thriving communities and also places you can quickly get off the beaten path. Each island has grown a bit in recent years, but also have huge swaths of land preserved for their beauty and recreation. On Maui, much of that land is within Haleakala National Park. Haleakala is a 10,000 ft volcano with astronomy observatories on top and it’s flanks running straight into the ocean. On Kauai, few views on Earth rival those of the Napali Coastline – a stretch of steep cliffs and secluded beaches spanning the coastline between where the two ends of the road circling the island end. I really believe you can’t go wrong with any opportunities that arise on Maui or Kauai.
Mother nature hard at work creating more land on the Big Island through the eruption of Kilauea volcano and lava running into the ocean in 2016.
The Big Island, which is actually named “Hawaii”, has it all. The Big Island is about 70 miles across and boasts 13,000 foot peaks, an active volcano, some of the best scuba diving in the world, and a thriving biking/running/swimming community that hosts the Ironman World Championships each year in October. Kona on the dry West coast of the island, and Hilo on the Eastern wet side of the island are the two major towns – each have a pretty steady stream of revolving travel assignments available.
When finding a travel PT assignment in Hawaii, luck and timing play big roles. Sometimes, very few jobs are posted, while at other times, you’ll find many jobs. Waiting just a few weeks typically resolves any drought of jobs, but be cautioned that Hawaii assignments draw a lot of applicants, so bring your A-game to the interview. Also worth noting that pay in Hawaii can be low… but you’re working in Hawaii, so….
On the beach below the Gay Head cliffs on Martha’s Vineyard in 2015.
Martha’s Vineyard, off the coast of Cape Cod in Massachusetts offers the true island-living experience. In the summertime, people are intent on fishing, beaching, and… outdoor showers? I believe that nowhere in the world is as passionate about outdoor showers than the people of Martha’s Vineyard. When assessing function and patient goals on my home health assignment on Martha’s Vineyard, it was not rare to have a primary goal for a patient to return to their outdoor shower. When Kate and I lived in a camper there, we caught the fever – although we had a shower in our camper, the campground opened a row of 6 outdoor showers, and we indulged daily, rarely, if ever, using the indoor shower.
Martha’s Vineyard Hospital and the Martha’s Vineyard office of VNA of Cape Cod often have openings because affordable housing is near-impossible on the Vineyard. Many of their permanent employees travel 45 minutes by boat everyday from The Cape for work. If you can figure out housing on The Vineyahd, you’ll have a great time. Also worth mentioning, the Cottage Hospital on Nantucket, a couple hours by boat from Martha’s Vineyard, also regularly seeks travelers.
The US Virgin Islands are part of FSBPT. Like any state, you can apply for a license in the Virgin Islands. St. Thomas is the main island and has historically had good availability for jobs. The Virgin Islands are definitely for the more adventurous traveler, or, perhaps, for the traveler who wants a tropical experience, but doesn’t care for the long distance to Hawaii. Most people on St. Thomas speak English, but Creole or Spanish may be primary language of some patients. I have read about concerns of safety, but travelers who have worked there tell me that if you are smart about your surroundings and company, then it is safe…. and highly enjoyable – basically like any major US city.
Hurricanes Irma and Maria may have changed the travel experience on St. Thomas. Largely overshadowed by the destruction in Puerto Rico, the Virgin Islands got hit hard as well – in fact, the roof ripped right off the hospital in St. Thomas during Irma. As best I can tell sitting at my computer in Colorado, it appears there is still an ongoing need for travel PTs in St. Thomas – it also appears there are many volunteer opportunities to continue helping with hurricane recovery. It’s worth mentioning that Puerto Rico is also under the umbrella of FSBPT, so you might consider volunteer work in Puerto Rico as well.
With more coastline than the entire rest of the US, there are many way-off-the-grid island opportunities in Alaska, but here are a few standouts.
Looking across the town of Sitka at Mt Edgecumbe, a dormant volcano. Also, I remember Sitka having a great brewery!
Kodiak Island currently has travel PT needs. Kodiak is 100 miles long and has a population under 14,000 making it a true outdoorsman’s paradise. Kodiak is best known for the Kodiak Brown Bears, which alongside polar bears are the largest bears in the world. Kodiak has ample fishing, hiking, hunting, and anything else you can imagine outdoors. Though, it is not for the faint of heart – no one is around to bail you out if you get yourself in trouble out in the wilderness. But for the therapist looking for a truly rugged off-the-grid experience, Kodiak could be a dream assignment.
Sitka, on Baranof Island, was the capital of Alaska back when the state was a part of Russia. On our way back from working in Anchorage, Kate and I stopped off to visit a PT friend there and quickly fell in love with the community. Sitka is a vibrant town with architecture reminiscent of it’s Russian past. Our friend took us down to a park to watch for whales, and sure enough, we quickly saw a pod of Orcas swimming by in the bay. Sitka has excellent access to the outdoors both in the mountains and on the ocean. Compared to most of the rest of Alaska, Sitka is relatively Southern and therefor more temperate.
If you are willing to make a longer-term commitment (starting at 2 years) in Alaska, there are opportunities to make substantially more money in the form of student-loan repayment. These opportunities are available both in private and government facilities through a government program called SHARP. When working for large health systems in Alaska, there can also be opportunities to take small planes out to remote bush towns reachable only by sea and air. PTs fly in to provide rehab to the residents for a couple days at a time. While I don’t think a typical 13 traveler in Alaska is likely to be sent out to the bush, it might become more possible to make these trips after extending a contract for a longer period.
Mendenhall Glacier in Juneau Alaska, 2012…. not technically on an island, but you can only get there by boat or plane.
There are many more islands all over the country where you can find work as a traveling therapist. Jobs exist off of Texas, in the Northwest corner of Washington state, off the far Northeast coast of Maine, and down in the Florida Keys. If you look, you will find the island that suits you fancy. Happy travels, and good luck turning those island dreams into your real life.
A lot has been happening behind the scenes to bring the PT Compact to fruition. We have a lot of good news and things to look forward to in the near future, but also some restrictive rules that travel PTs need to be aware of.
Let’s start with a couple pieces of good news about the compact:
The Compact Commission and Colorado have come to an agreement that officially ends Colorado’s suspension from the compact. Colorado had previously been suspended from the compact because of the state’s “Michael Skolnik Medical Transparency Act” that requires all healthcare workers in Colorado create an online profile. Per the rules of the compact, the requirement for a profile is an additional burden on compact licensees that is not allowed. Other states have similar requirements, but their laws exclude professionals seeking a license through a compact. APTA has worked tirelessly with contacts in the Colorado legislature and with FSBPT to come to an agreement. Legislation has been drafted that if passed would remove the additional requirements for compact PTs and PTAs. Also, the state has assured the commission that it will not seek disciplinary action on individuals participating in the compact in relation to the Medical Transparency Act. Given the efforts made by Colorado, the commission lifted the state’s suspension this past Friday.
The compact was passed into law in the first 15 states last year, and the compact is set to be live in “the first half of 2018” (per PTcompact.org). At the rate most bureaucratic processes move, it is amazing that it is scheduled to take less than one full year from the inception of the compact commission to having actual reciprocity of PT licenses across state lines. To make things even sweeter, 8 other states are currently considering the compact in their legislature, and more states are expected soon. Achieving a compact between over 20 states in less than 2 years would a great feat! I’ve said it before, and I’ll say it again – states that are not in the compact are going to have a hard time filling their staffing needs. Many travel PTs will choose to travel only within the compact states for the increased ease of license transfers. This will greatly shrink the candidate pool in the non-compact states that are still relying on an antiquated, cumbersome license verification process.
FSBPT has also launched a new website for the compact PTcompact.org, click this map to visit.
…but here’s the catch that every traveler should know about. The current compact rules restrict compact privileges to only those PTs and PTAs with a permanent address in a compact state. To be clear: your tax home has to be in a compact state to participate in the compact, you cannot merely hold a license in a compact state to enjoy the reciprocity. The PT compact came into existence largely because of traveling PTs, and now, the current rules cut out a great number of travelers. The reason for this rule is the commission does not want PTs “license shopping” – meaning, if one state has lower standards, or lower fees, they do not want to flood that state with thousands of travelers who are trying to get in on the compact. Travelers who do not hold a home address in a compact state must continue with the same-old process, even if they are traveling within compact states. I, personally, see a simple solution – grandfather all PTs or PTAs currently holding a license in a compact state – boom, tons more well-vetted travelers admitted to the system with no shopping. But in the meantime, state licensure staff will continue to review hundreds of paper verifications from PTs already holding licenses in compact states, travelers will spend weeks completing the appropriate, pointless paperwork, and the inconveniences that the compact was designed to avoid will largely continue – I digress.
So what can we all do to improve the system and allow more travel PTs into the compact? I wrote a letter to the compact commission prior to their adopting these rules explaining my aggravation and the need to allow more travelers into the system. I have since been in contact at length with APTA staff, Compact Commission Staff, and others. My concerns have definitely been heard, but it would helpful for the compact commission to hear that same concern from others.
There are 2 topics to take action on:
Travelers need to be working to make non-compact states become compact states. APTA members should be contacting their state chapter to let them know adoption of the compact rules is a legislative priority. Colorado wouldn’t be a compact state if I hadn’t spoken up to make it happen – but once I had mentioned the idea, it was quickly taken up as a priority and set into motion.
Travelers should be letting their licensure board, APTA representatives, and FSBPT know that the current compact rules that require residency in a compact state harm the efficiency of the compact. The purpose of the compact is to eliminate barriers to licensure between states for well qualified individuals. The current rules restricting compact privileges to permanent residents of compact states fail to optimize the potential of the compact to help travelers and the member states alike.
If you aren’t sure who to contact, your local APTA chapter is a good place to start. But, as the compact is an agreement among states, contacting your state board is an excellent next move after contacting your APTA chapter. The PT compact is moving forward, but it definitely needs the help of the travel PT community to move it in the right direction!
If you went into rehab to get rich, you’ve made some questionable decisions.
Physical therapy students are coming out of school with 100K to 200K in student loan debt. Insurance payments for therapy tend to be decreasing rather than increasing. It’s understandable that therapists, especially new grads, would want to come out of school and immediately maximize their income, but I’m writing here to plead you to take your time, be patient – you’re going to do better in the long-run taking “stepping-stone” jobs than going for big money as quickly as you can.
I’ll be the first to admit that the primary reason I show up to work each day is because I’m getting paid. If I weren’t being paid, I would blow off work often (or at least show up late). The reason I am there so consistently and for so many hours is simple . . . money. Don’t get me wrong, I like what I do. Being a Physical Therapist is a great way to spend many hours of my week directly helping people and doing something meaningful and good in this world. But, when it all boils down, we have jobs for one primary reason – money. If I won the lottery today – and not just a little, but let’s say a whopping retire-with-a-yacht-sized jackpot – I think I’d continue in therapy in some way, but it certainly wouldn’t be 40 hours per week, and it probably wouldn’t be before 10 AM.
My path as a PT, and specifically as a traveling PT, has not been a difficult one. Kate and I had a very reasonable amount of debt coming out of school and were able to eliminate it in just a few years through smart spending while working as travel PTs. I’ve written in the past about the financial advantages of travel PT over permanent work while I also maintain that new grads should not go straight into travel PT. This discussion I’m attempting to have here is much like my argument for new grads being patient, getting a little professional experience, and then going into travel therapy – a little patience greatly improves your ability as a traveler to pick the jobs you want and improve your overall experience traveling. This is the same mentality as having a little patience in your career, slowly gaining knowledge through your early experiences, and gradually transforming into an expert clinician that can confidently negotiate for top pay.
There are blogs and “gurus” out there that claim new grad Physical Therapists should be aiming to make upwards of 100K straight out of school. They purport that there are an abundance of jobs that any therapist with entry level skills could grab today and get rich quick. On the other side of this equation are new grads I talk to who are already burnt out. Recently, my lab partner at a course was 2 years into her career and already had classmates who had left the profession due to burn out. She, herself, was managing a clinic for a major national therapy chain seeing 4 patients an hour…. no other therapists in the clinic, just her, a new grad, pressured to see a patient every 15 minutes. Our entire profession should be appalled – even if she is a good clinician, this is a crap physical therapy model. The idea of seeing patients every 15 minutes should stun and sadden all of us.
High volume physical therapy clinics are giving us all a bad reputation. They should not be tolerated and we should insist that all of our friends and colleagues stop providing therapy in this manner. Superior patient care comes largely from increased 1:1 PT:patient time.
A close friend of mine has worked his way up in the ranks of the same national chain as the new grad I just mentioned. He has maintained a 1 to 1 PT-to-patient ratio in the clinics he manages, but he’s losing many of his therapists to another large chain opening in his area. He’s very willing to pay his therapist well, but the new chain infiltrating his area is paying relatively inexperienced therapists $90,000/yr. On the surface, that’s tough to compete with, but do you think these therapist see 1 patient every 45 minutes to an hour? They most certainly do not. These therapists leaving to make the much higher pay can kiss mentorship, paid professional growth, and anything that doesn’t contribute to the overall productivity of the clinic GOODBYE!
A lot of clinics and facilities bill poorly. I believe that’s where a lot of the perception of under-reimbursed PT clinics comes from. When employers put their efforts into billing properly and efficiently, clinics make reasonable money and therapists are paid adequately. I “grew up”as a PT in the Northeast where high-volume models are more the norm than in other areas of the country. I believed at that time that several patients arriving per hour being treated by a therapist and a number of PTAs, ATCs, and Massage Therapists was the only way therapy could be delivered while still making a profit – just not true – and I thought this was the way the whole industry worked. Sadly, so many people are willing to apply their own, personal circumstances to an industry as a whole. i.e. “I worked as a PT for 4-years, but healthcare is factory. I WAS FORCED to see 4 patient an hour, that’s why I got out.” In my personal experience, after 10 years as a traveling Physical Therapist, I learned that there is a huge volume of jobs willing to hire well qualified therapists to work 1-on-1 with patients for an hour at a time. I have worked for clinics serving patients this way in 7 out of 7 states I have worked in. The mantra that reimbursements are too low to allow for hour treatments is a complete farce and a product of either sloppy billing or greed. But, then again, most clinics seeing patient 1 on 1 for an hour are not paying as high as the clinics seeing multiple patients per hour.
A culture of continuous learning at work should be a huge deal to you. Without research discussion, coworker inservices, and other educational opportunities built into the work-week, keeping up on your own professional growth can become an arduous task.
So, back to our gurus who tell thousands of student and new grad DPTs that they can go out a grab their $100,000 per year straight out of school. I do think these guys have some big parts of their message right: each therapist should be advocating for him or herself. Learn to negotiate, and get more than your boss would like to give you. I bet the articles out there advocating high pay for inexperienced therapists are actually driving up pay of all therapists, and hopefully, in turn, insurance payments as well. Therapists are frequently undervalued and need to put more time and effort into advocating for themselves and seeking out the better deal. But, the better deal is not just more money, it should also include weighing the value of a happier professional and personal life as well as being incentivized at work to provide BETTER patient care, not just MORE patient care. Do you see 10 patients each day, or do you see upwards of 40? How many support staff is each therapist supervising? Is it all evals and discharges while someone else carries out the “treatment”? Is work time and money allocated for learning – or are you doing all of your continuing ed on your own dime? Is work time allocated for documentation – or are you doing paperwork on the weekends from home? Most importantly – ask yourself if your job is setting you up to provide the best care you can to your patients. Therapists being set-up to provide great care is important to our patients, our profession, and to our own self-satisfaction.
If everything else about two jobs is equal, by all means, take the one offering more pay. But don’t forget all the other factors that play into choosing a job. For me, time with my patients is huge; I don’t want someone else carrying out the treatment, I want to get to know my patient and provide top-notch care on my own. I believe that most of the high-pay jobs you find also tend to be high-volume. What on Earth can you effectively do with a patient in 15 minutes? …30 seems like a rush-job to me as well. While the instinct seems to be to flock to more money, I believe the majority of these clinics are a pipeline to burnout after providing awful patient care to hundreds (thousands?) of people.
The whole purpose of our jobs in healthcare is to help people, to make them feel less pain as they complete the tasks of their day, and to help them move better. As a profession, we should wholly reject high-volume rehab-factories. These clinics provide inferior care to patients, wear-out young clinicians, and are a poor representation of the abilities of therapists. If you or your friends are seeing multiple patients every hour, look around your area and see what other opportunities might be available.
Take your time choosing the right job for you. When coming out of school with seemingly insurmountable debt, it seems that getting the highest paying job ASAP is the greatest priority, but getting that job and then burning out quickly does nothing to pay off your debt. The slow road is not sexy, but if you choose good professional situations where high-value patient care is a priority, you will gradually gain experience over time. Those high-value experiences will eventually lead you to higher paying jobs, financial freedom, and most importantly personal satisfaction. By all means, take the job that pays you best, but it must also maintain excellent patient care and provide you the tools to be happy and successful at work.
A typical outrigger canoe – the #3 paddler happens to be a PT I worked with on the Big Island. Aloha, Therron. Serious Paddler Dudes.
Last time Kate and I did a travel assignment in Hawaii, we joined the Molokai Canoe Club and paddled every week during our 6 months there. We were scheduled to practice 2 days per week, but the paddling really hinged on whether enough people showed up. To paddle an outrigger canoe, you need at least 4 people to have any fun at all – there are 6 seats, and it’s best if you have them all filled. Also, we couldn’t go at all without one of the steersmen, someone trained in steering the canoe – a steerswoman in this case. I haven’t shared enough about this experience. I try to avoid too much talk about Molokai on this site, because it’s a quiet and special place, and I’d like it to stay that way. But I was recently reflecting on my evenings in the canoes and at the canoe shack. They were special times. The kind of times only had when you step a bit outside your comfort zone.
The first thing you need to know is that the entire club is centered at “the canoe shack”. The shack is kind of a big deal. There’s several canoe clubs on the island, but the Molokai Canoe Club is the only one with a roofed structure. About 10 yards down the beach is another club, Club Va’a – they are the more competitive canoe club, but they don’t have a shack, just a couple storage containers. Molokai Canoe Club has been run by generation-after-generation of paddlers. When one generation of the Rawlins family ages out of the daily operations of running a canoe club, the next generation takes over. As with any respectable canoe club in Hawaii, they have a koa wood canoe. Here, with the time I have to write, and with your limited attention span, I cannot properly explain the great significance of the koa canoe. It is brought out for parades, big events, and only paddled during the most important races – the koa canoe is special, it’s spiritual. The major paddling events all have Koa divisions reserved only for clubs racing koa wood canoes.
Paddlers getting ready for the 2014 Kaiwi Channel crossing.
Molokai is a mecca for Outrigger Canoeing. The biggest interisland races in Hawaii either start or finish on Molokai including the Kaiwi Channel Crossing – 40 miles of open ocean considered the world championship of Outrigger Canoe Races. Being first time paddlers, we were relegated to the recreational group, very recreational. Whether we had 6 people to fill all the seats in the canoe was always up to chance. Luckily, the recreational group got together on the same nights as the Uncles. “Uncle” and “Auntie” are respectful terms in Hawaii – best compared to using Ma’am or Sir. The Uncles at the canoe shack were legends back in their day. The local bar, Paddlers, has pictures on its walls of all the old teams that had won races and competed in the Kaiwi Channel Crossing – younger versions of the Uncles were littered through the pictures on the bar walls. Many of the Uncles are serious about their Hawaiian heritage and still take their paddling seriously, but they are more of a drinking club with a canoe problem. The canoeing is secondary to the comradery and social gathering that takes place every Tuesday and Thursday night after a solid paddle. Being with the recreational paddlers on the same nights, Kate and I got to know the Uncles well. We’d often hang out with them at the canoe shack after our paddle where someone showing up with dried octopus (taco in Hawaiian) or some fresh caught raw fish was commonplace. Frequently, we would combine numbers with The Uncles to make a full boat of 6 people – or to complete 2 boats of 6. Those evenings hanging at the shack with The Uncles were the most Hawaiian times I ever had. Even having worked in Hawaii 4 times previously, there were a couple of the Uncles that I couldn’t understand with their thick Pigeon English. Over the months, we built up hours and relationships with The Uncles, at some point I began to understand them all easily.
The Uncles share a celebratory shot before sailing their canoe 60 miles to the North Shore of Oahu.
On two occasions, the number of paddlers and water conditions were just right so that the Uncles wanted to go surf a canoe. On the first time Kate and I did this with them, conditions were perfect. We paddled out to some flat water beyond the wave break and enjoyed some beers from a cooler in the back of the canoe before surfing. We paddled into some waves a few feet tall breaking on the reef and let them lift the boat, carrying us in quite a ways. We paddled back out and repeated. Surfing the canoe was a much bigger rush and joy than I ever had surfing on a board.
The second time I went surfing with the Uncles, only myself and one other woman from the recreational group had shown up, but luckily there were four Uncles there who wanted to go surf some waves. In the boat that day were a couple of the local Molokai-grown Uncles, Uncle Clayton and Uncle Russell steering the boat; Sully, a transplant from the North Shore of Boston via Colorado who was a very serious paddler who had come to Molokai specifically to paddle with this group of guys; And Marty, a long-time Molokai transplant from the West Coast who must have been completely nuts as a younger guy, because all the local-Uncles respected him. These guys have all paddled together for years, making channel crossings between island and continuing to sail canoes great distances in races throughout the Hawaiian chain. I was in good hands that evening.
Closing out the canoe season with a final race followed by a full afternoon party at the canoe shack.
We paddled out in a channel on the left of the waves past the sets of big waves coming in and breaking on the reef – much bigger this time around, perhaps 6 or 7 foot waves. We made the big righthand U-turn to align the incoming waves behind us and paddled like crazy, there was a lull in the surf and we failed to catch any wave. We repeated our moves – made another righthand turn, paddled back out past the big waves and once again made our approach. Again, nothing. We repeated this one more time, again failing to catch a wave. We rested and decided on one last attempt. As we paddled out the fourth time, huge waves rolled past us – 10 or 12ft? We made our turn into the set between two of these huge waves. Being tired from the previous attempts, we didn’t get enough speed and ended up surfing IN the wave instead of ON the wave. The boat filled with water and the 6 of us were left sitting ducks with the walls of the canoe submerged underwater. We remained in our seats, water level at our waists and paddled like crazy with every ounce of energy to avoid the next oncoming waves. Somehow, we got out of the path of the breaking waves, back to the deeper water and had to get out of the boat to dump the water out. This dumping maneuver, rolling the canoe onto its side, got about half the water out of the boat and got the top of the canoe up out of the ocean – the rest of the water would have to come out through frantic bailing using hands, paddles, and two 1/2 milk jugs that had come with us for this exact purpose. As we all exhausted from swimming and bailing, someone noticed we had drifted back into the break. Another 10ft set was approaching off the right side of the canoe and it was time to GO! Everyone scrambled to get out of the water, into our seats, and paddle like our lives depended on it to get out of there. Maybe our lives did depend on it. We paddled like crazy and as the big set rolled in, our boat was gently lifted and dropped off the edge of the first wave as we scooted out from its path. I continued to bail the remaining water as the others paddled our soggy canoe and crew back to shore. I later learned that if that set of waves had caught us, we would hardly have been the first canoe to sink on that reef.
We skipped drinks and snacks (pupus) after that particular paddle. But out there, a half mile off shore, swimming around a sinking boat in a bad situation, I had a memorable experience with the Uncles. It wasn’t the kind of situation you could (or would ever want to) manufacture, but for me it was so unique. This was hardly the Uncles first time in that situation, but it was an experience I will remember forever.
The canoe shack was special, and I will remember it fondly. From sending racers off to open ocean races, to the big bash at the end of the canoe season, to near-catastrophe on the reef, to the simple evenings with the Uncles sharing pupus and Natty Light – the canoe shack left me with some of my favorite memories that leave me yearning for a return to Hawaii. Someday we’ll get back, some day. If you ever make it to Hawaii, join a local canoe club.
A quick video I shot one night out on the water paddling:
Join me for a run in Boston this Wednesday. The run will be around 5 miles and at 6 AM sharp. I hope to be back to the convention center at 7.
We will leave from the front of the convention center on Summer St and head through Downtown Crossing to Boston Common and the Public Garden, past the ORIGINAL Cheers to run along a stretch of the Charles River by the Esplanade and Hatch Shell. We will run past the Museum of Science, City Hall, and Quincy Market on our return to the conference center.
I’m from Boston originally, so I’m thrilled to be back running in the city – particularly along the Charles where I ran the majority of my miles when I was just beginning to run – I love that dirty water! I should be able to keep us pretty close to the intended path, but if you’ve looked at a map of Boston, I think you’ll understand if we go a tiny bit astray. It’ll be an adventure!
I’m currently training for the Reykjavik Marathon which I am running with Challenge Aspen, a nonprofit that provides adaptive outdoor recreation for people with disabilities of all kinds – skiing and snowboarding in the winter, and a huge variety of activities in the summer. Please consider a $10 donation to Challenge Aspen: bit.ly/2pymexC
Join me! It will be a fun way to see a big chunk of the city on foot!
Update: A great run! Thanks to everyone who joined. I’ve shared some pictures below.
Samuel Adams statue in front of Quincy Market. The ocean front was at this location in the past. Fanuel Hall was Boston’s version of Ellis Island.
Love this dirty water. The Charles Rivah.
Boston City Hall
The ORIGINAL Cheers. The actual pub the TV series Cheers was based on. 5,000 points if you know the name of this pub before they recently changed it to Cheers.
The Hatch Shell and Esplanade
The Holocaust Memorial and the old State House building peeking out.
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?
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?
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.
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.