Two Competent Physical Therapists Talking Shop

Oh man, where do I begin.

Scoot and I are buds from the travel PT days in Aspen. We talk often, it usually digresses in some PT shop talk.

We got on Zoom and talked for over two and a half hours recently. I was able to trim it down to about a 30 min recording. We think we’re hilarious. We think we have good ideas about PT. Give us a try – I think you’ll be entertained and maybe informed too.

If you’re into cable, we’re better than anything on there… and maybe half of Netflix. Play us in the background while you do dishes or something, but try us out. If you like it, we’ll do more in shorter format.

Travel PT in COVID – Part 1

I’m not one of those people who writes, stops, crumples up a ball of paper, and starts over. Usually, I sit down at the computer, write whatever comes to mind and move on with a few edits later. This time, I just can’t get this blog going. I’ve started, stopped, started-over, and re-started over.
There’s so many obstacles to writing this blog. The biggest barrier is that while many of us are finding ourselves with additional free time, we are so all-consumed with this virus that we can’t seem to get anything done – like writing this blog. Another huge barrier has been the speed things are moving at, every time I think I have a handle on what’s happening in healthcare and with the virus, it changes. Finally, I think I’ve been trying to fit too many ideas in one blog that truly contradict with each other.

Contradictions, that seems to be the hallmark of this crisis. While some facilities are laying off all their staff from lack of work, others are overloaded and woefully understaffed. One minute I’m convinced we’re all doomed to big, big trouble, the next I know we’ll be fine, then I swing back the other way. Should my last few remaining patients be scared of what I could spread to them, or should I be scared of what they will spread to me? I worry and I’ve had to quickly learn to manage that.

All those contradictions are why this has now become at least 2 separate blogs, maybe more if this isolation drags on. In this first one, I’d like to lay out the challenges that many travelers are facing in this crisis and some of the resources that are out there to help those challenges. In the sequel to this blog, I’d like to take a more positive note and look at some of the opportunities for change this crisis will bring. But I can’t write that piece without first writing this one that expresses the true graveness of this situation.

We’ll see if I get through writing this. Things will undoubtedly change before I can push that “publish” button. So please grant me some grace in knowing that what I write today may be outdated or completely inappropriate by tomorrow.

This thing is moving very fast. A few weeks ago, I was finishing up a paternity leave in Hawaii. The impetus for the trip was the wedding of an old travel PT friend. At that time in the beginning of March, the COVID-19 concern had started to build, but wasn’t doing much to affect every day life. The wedding went off without a hitch, was awesome, and was full of international guests and current/former Travel PTs and OTs from all over the country. I haven’t heard of a single illness from that wedding. Phew.

The next Monday, still in Hawaii, I had a meeting with some colleagues to decide whether to hold or cancel a PT event. While most of us agreed on a wait-and-see method, one colleague was not happy with the decision and had somehow anticipated or learned of the seriousness of this virus. Only 24 hours later, I would share his opinion that we absolutely had to call off the event (of course now, this is commonsense). In that one day, things had started to fall apart back in Colorado, and I had realized the gravity of what was happening.

All of a sudden, the Govenor was closing down everything in the state. Our county and town had also taken aggressive actions to stop large groups of people from congregating – first no more than 50, then 25, then 10, now 5. From a place of relative comfort in Hawaii where very little was happening COVID-wise, these seemed like drastic measures. Was our Governor OK? Or some kind of germaphobic lunatic?

Because of the craziness in Colorado, we decided to stay a few extra days in Hawaii. There were about 3 extra good beach days in Hawaii before the gravity of COVID-19 hit – then it became time for us to get out. Our flights all started getting cancelled, there were protests to shut down the local airport, quarantines for all arrivals were put in effect. As much as I love Hawaii, I didn’t want to get stuck there. Following many hours on the phone and internet with United and Hawaiian Air, we eventually ended up on a red-eye direct to Denver with a newborn and toddler. We safely made it home in time for me to return to work the next day.

I share this story to say that COVID has an interesting effect of people thinking they’re OK until they aren’t. That original colleague who wanted to cancel our event KNEW already, then the Colorado Governor KNEW, I didn’t know until a full week later. If you’re still out there thinking we don’t need to be social distancing yet, your time is coming. You too will KNOW soon. Please be safe.

Aspen Mountain. Normally people are getting their last slushy turns of the season in and the final mountain parties are happening. Instead, Closed. Shut. Done for the season. Much of the summer activities already cancelled as well.

Running parallel to my timeline in Hawaii, watching Colorado respond from afar, an interesting story was playing out back home in Aspen. A group of Australians had visited and brought COVID with them – even a month later, we only have 30-something confirmed cases in our county, 10 of them are those dang Aussies. Two of these patient-zero-Australians decided to quarantine-in-place at their 5-star slopeside hotel on Aspen Mountain, with the knowledge and agreement of the hotel staff. BUT, they did something no one could have anticipated – those awful, awful people snuck out and went skiing with the general public, putting everyone at risk.

It’s my understanding that their indiscretions is what closed down our city, county, and ultimately the state very early in this pandemic. Those arrogant jerks may just have saved us. Time will tell.

At work, I continue to be gainfully employed – at least as I write this, but nothing is certain. We have trimmed down to “essential” patients only, basically anyone who will be permanently disable if they don’t see a Physical Therapist right now, mostly post-ops. I have about 1-2 patients each day and am managing to stay impressively busy with projects. Administration indicates that they are keeping everyone they possibly can working in whatever capacity they can so that if a “surge” comes, our workforce is immediately ready. Hopefully that surge never comes. I have heard our anticipated peak is April 17th. So, the moment of truth draws near.

Our hospital held onto our travel PTs as long as they could until they finally had to cut them loose this week. In talking with the travelers, no one seemed to be surprised, they were happy to be kept on as long as they were. They were let go with a couple weeks of pay and free housing for a few weeks. It was nice to see the hospital treating the travelers well despite having to make some tough decisions at their expense. Which finally brings us to the point of this post.

This is an awful, awful time for many workers in this country, Physical Therapists included. I don’t have any hard numbers, but casually, it seems like 50% of PTs have been cut from their jobs. If you are a traveler and have had your contract cut short, you are not alone, there are many out there just like you. From what I hear, there are some jobs out there that still have openings, particularly in home health, acute, and SNFs. So don’t forget to open yourself up to the possibility of a new opportunity – just in case you can find one.

If you have suddenly found yourself without a job, I hope your agency or your employer is treating you well to the best of their ability. This time is putting a strain on everyone, and I think we all need to embrace a piece of the sacrifice, employers included. Some clinics will not re-open, many PTs will not return to the clinics that laid them off, PT practice and our society will be forever changed. We are living through a historic event the likes of which very few people have ever seen in their lifetime and hopefully we will not see again. This period in time will go down with the Spanish Flu of 1918, both World Wars, and 9/11 – it’s going to be rough, but it will pass. And some of those events of the past have been defining for our profession.

In talking about Aspen and WWII in the same breath, I must mention the 10th Mountain Division that had its roots in this area. A very fascinating history if you are finding yourself with time to read.

When this is all behind us, people’s knees will still hurt, their backs will still hurt, and they will still suffer strokes and heart attacks. Lots of people will need PT when this is all over! I hope for a very quick rebound, particularly in the realm of clinics needing temporary staffing. When people feel safe coming out of their homes, they will need our services. Hopefully that happens sooner rather than later.

In the Meantime… here are some opportunities to ease the pain.

Emergency License Waivers/PT Compact

There are still some employment opportunities out there. Many hospitals are overwhelmed at this time. It makes sense that as many thousands of people recover from the novel Corona Virus, they will require inpatient rehab needs in a SNF, or the will need home health. If you’re looking for work, it is these setting I would be looking in right now.

I’ve heard some people talking about a possible Federal mandate to open licenses across borders. The main challenge to this happening is that professional licensure is a state protected right by The Constitution. We are far more likely to see more state waivers on licensure like we are seeing emerge now.

The link below from FSBPT is tracking the measures states are taking to allow healthcare workers to come into their state to help in this crisis. There is a huge variation of waivers state-to-state, so your best bet is to click on the link below and see where you might qualify for temporary practice.

A couple examples of what is going on out there:

  • California – allowing people with inactive and expired CA licenses to re-activate within a matter of days.
  • Delaware – Allowing graduated, but not licensed PT and PTA students to practice under a licensed clinician.
  • New Hampshire – Specifically allowing out of state licensed professionals to practice telehealth.
  • Check out the many other waivers:

https://www.fsbpt.org/Portals/0/documents/news-events/Jurisdiction_Licensure_Exemptions_Requirements_Waivers_during_COVID-19.pdf

Volunteer

There are a lot of people out there advocating for our role in this global emergency. Our profession evolved to resemble what it is today out of Reconstruction Aides during the first World War and from needs presented during the Polio Epidemic. Our success or failure in responding to this crisis will shape our profession in the future. If we want to be an essential service in the future, we better demonstrate the uniqueness and importance of our skills NOW.

There will be no one else mobilizing and strengthening the thousands of patients who recover from COVID-19 with significant lung damage that needs our skills. All the people that are sitting sedentary at home right now are going to need us badly when they try to leave their homes again. There will be major societal repercussions from this time of solitary confinement. Don’t be mistaken, if you don’t see our essential need yet, you will – it’s coming.

APTA has collaborated with others to develop a volunteer pool matching available professionals and students with needs for volunteers. If you are available, please consider signing up at the link below – while it might be a little scary, this is a great opportunity to be a part of the heroic response and gain some new skills along the way.

https://engage.apta.org/volunteerresources/volunteer-opportunity-details?VolunteerOpportunityKey=10a21004-24c0-43b5-bbd5-3086687a6288

Free Education

There is a tremendous amount of information available for free these days. There are existing resources and new ones that have been recently opened up. If you are finding yourself with extra time to occupy, here are just a handful of ways to expand your mind, but I encourage you to search for more. There’s a ton of stuff out there.

  • The Academy of Orthopaedic Physical Therapy has release a reading list that was previously a part of a paid course. This reading list is a greatest hits of Orthopaedic Physical Therapy literature and long enough to keep you occupied for months: ow.ly/Z4bT50x2xHT. AOPT has also decreased the price on many of it’s archived courses. You won’t receive official CEUs for these courses, but I’ve taken several of them and they are very meaningful learning opportunities produced by the absolute experts in our field. For $10 or $20 you can get some great education: https://www.orthopt.org/content/education/independent-study-courses/browse-archived-courses
  • Meditate. Headspace is a online service focusing on guided meditations. Now, they are offering their premium service for free to healthcare workers through 2020. This may be the single most valuable resource on this list. Whether you are under-worked or over-worked, some meditation could probably do you some good in this time. Mental health is so important in a time like this.
  • Many universities offer free courses on a regular basis including Harvard. I’ve always wanted to check out what they have to offer, now might be that chance.
  • Audio Books – Audible has over 1,000 titles available for free. With school being out, they have added a whole bunch of children’s books which includes many of the classic. Might be time to review some Mark Twain or Hemingway.
  • Learn a language. If you are, or live with, a student of any level, both Rosetta Stone and Babbel are offering 3 free months of courses in a lot of languages.

Unemployment

If you have been laid off, furloughed, or have had to step away from work to care for a loved one, you are eligible for unemployment benefits. Who is available has been expanded by Congress and they are supplementing the weekly benefit by up to $600. I’m not so polished on the details, but this APTA page explains some of the details and links to the Department of Labor who is ultimately in charge of implementing the changes.

Congress included the gig-economy and contract workers in this expansion. I have to imagine there are Unemployment Benefits that extend to travelers given those two area of focus. It is also likely further expansions of unemployment will come.


That’s all I have in me for now. I have the intention to write the second piece to examine what positive changes our profession and our society can take from this experience… we’ll see what comes of that as the next couple weeks progress.

This is a grave time, historic in all the worst ways. I hope our profession can pivot to meet this time’s needs and come out stronger on the other side. Stay safe out there. Take care of yourself. Take care of each other. We’re going to get through this, and PTs will be VERY busy in a couple months.

COVID in PT (A hastily written mini-blog)

via GIPHY

Well things have certainly escalated quickly.

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.

Be kind to each other out there. Aloha.

Know Your Role

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.

Me (far right) and several other Colorado APTA Members had the chance in early April to meet with my Congressional Representative (center). Central to our discussion was PTs’ Unique Role in the Opioid Crisis.

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?

The whole group from Colorado at FAF. We divided and conquered to chat with as many of our Representatives and Senators as possible. #choosePT

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.

#APTAHOD
A portion of the ballroom at House of Delegates. I have yet to take a picture of this room that gives you the feeling of how big it really is. Walking into that room gives me tingles.

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.

Links to info on all House of Delegates motions including gun control, House of Delegates motion discussions, and Federal Advocacy Forum. If these kinds of topics interest you, you should probably give to PT-PAC and contact me to get involved in this kind of stuff. Our profession needs more, opinionated clinicians who want to drive the future of PT.

4 Island Travel PT Assignments

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.

Hawaii

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….

Martha’s Vineyard

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.

St. Thomas

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.

Alaskan Islands

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.

 

When Will the PT Compact be Active?

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:

  1. 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.
  2. 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!

What’s Your Price?

If you went into rehab to get rich, you’ve made some questionable decisions.

Traveling Physical TherapistPhysical 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.