Tag Archives: physical therapy

Flexibility is key. And I’m not talking muscle length.

5 Jul

As my first travel assignment was coming to the end of its term, I finalized my next assignment: an extension for thirteen more weeks here in Tucson. Yup, no trip to Colorado for now!

An underlying theme to travel PT is flexibility. I had every intention to spend my summer in Colorado Springs, Denver, Boulder, Grand Junction… certainly not the desert heat of Tucson! But with a dry job market in my desired areas and a dry climate sadly setting Colorado a-blaze, my plan became flexible. With all the recent changes to find the right “fit” within the RV’ing lifestyle, staying put now grants me more time to explore all the things still left to discover in Arizona. I also had to use my week between assignments for the not so fun task of driving to/from Austin just to register my vehicle and RV I purchased here in Arizona. Quite the headache, but yet another exercise in flexibility.

I find it best to approach travel PT with a global plan because without thinking about life panned out in a few thirteen week intervals, it’s easy to lose grasp on how few travel assignments actually suck up a whole year. But the best laid plans need to be flexible. Here are some questions I have asked myself during this assignment transition:

• What is the back up plan if an assignment is ended early?
• What if your goal destination doesn’t have available positions in the time frame you need?
• What other state PT licenses do you hold as options, and is there such a thing as maintaining too many?
• How far away can you go while not breaking the bank with unpaid travel time and the expenses to get to your assignment?
• Can you take time in between for a road tripping adventure?
• What changes can you make to the plan to squeeze in those unexpected “taking care of business” hassles?

If you consider traveling as an RVer, also be sure your primary and secondary plans take into account seasonal differences. Driving conditions, freezing hoses/pipes, tornadoes/hurricanes are all examples of Mother Nature’s impact on the plans of a RVing travel PT. These regional and climate considerations are also key when building your potential travel route across several assignments.

Give me your tired, your poor, your huddled masses, and your illegal border crossers…

26 May

With this post, I am bringing back into focus one of the key themes of this blog: exploring new professional practice. Although I have written posts on learning the logistics of travel PT, this is my first to catalog new perspectives I’ve gained from my clinical/professional experiences. Although this post focuses on my experiences with healthcare and illegal border crossers, I love my work and I respect those I provide my services to– regardless of their circumstances, social status, origin, etc.

Despite my years living in central Texas, my first professional exposure to the issues of the U.S.-Mexico border has been here in Tucson. Seeing the dark green clad Border Patrol trolling the hallways and parked beside hospital beds has become nothing out of the ordinary. But with growing experiences and conversations, I feel more and more like a five year old whose reply to every statement is, “But why?” On any given day, the glaring perplexity makes me want to give America an open-palmed slap on the forehead and say, “Are you for real?! This is crazy!”

So let’s get a few things straight about the lingo. When I interviewed for my travel assignment, I was delicately told I would work with a significant population of “undocumented immigrants” to primarily assist with discharge planning. Okay, an interesting choice of nomenclature, I thought. Up on the hospital floors, you hear “border crossers” mostly. Without sounding too insensitive, I don’t understand why we must mince words. These folks are illegal immigrants. (As a side note: Not all border crossers are Mexican. People from many countries attempt to use the U.S.-Mexico border as an illegal gateway.) They are crossing the border with no respect for a (failing) immigration system or the laws/regulations of our society. Although my opinion is a common one, the public’s opinion is quite varied. There is a mix of distain (of the “free ride”), frustration (with a flawed U.S. system), and sympathy (for those who “surely are fleeing a place where they can’t get the care they need—how sad!”). I can understand and have personally experienced each of these feelings during my time here. But, instead, let’s look more closely at the ass backward approach to healthcare for those injured during their ill-fated border cross.

While attempting to cross the border, many get injured. Most often these injuries occur by trying to scale the fence (I mean, really, how likely is that plan to be successful anyway?) or when running away from Border Patrol. Frequently we see spiral fractures of the tibia, trimalleolar fractures, etc. So these folks are brought to our hospital and receive all kinds of diagnostic testing and medical consults for their injury. They occupy our hospital rooms, watch cable, and receive good care. Then they get orthopedic surgery. Some with external fixators placed, some with internal fixation, almost all with a weight bearing restriction. Who pays for these services? America does. Then comes the “PT eval and treat” order. We provide our skilled services for evaluation, assessment, patient education and discharge recommendations for durable medical equipment. Who pays for these services? America does. We communicate with the physician, the case manager, the social worker. They want to know our recommendations for mobility to be able to cross back to Mexico. But in the next breath we are told, “Well, they are a border crosser, no funding, so we can’t get them anything.” Crutches are usually the only guarantee. They want to know what type of vehicle they can mobilize into for transport back to the border, and if they can safely walk (or hop) back into Mexico’s custody since U.S.’s Border Patrol cannot physically cross the border with them to assist. The orthopedic surgeon gives the patient discharge instructions. Some state a follow up is required in a few weeks—a follow up for which some patients have in fact attempted to re-cross the border. It’s a bitch when this time your external fixator gets caught in the fence (true story). This last bit makes me want to slap some ortho docs in the forehead. Where is the awareness to their patient’s situation? Where is the responsibility to the patient to make reasonable recommendations for follow up? Where is the social responsibility to the U.S. to not encourage abuse of our systems?

Given this scenario, the greatest frustration amongst the physical therapists I work with is this: Why is it that a U.S. and/or hospital system will pay for thousands of dollars of medical and surgical care for illegal immigrant (who choose to climb the fence, who are running away from being caught for something illegal) but then refuses to see it through and provide assistive devices that cost less than $100 to ensure their safe mobility?

I, along with many of my PT colleagues, will tell you that it doesn’t take an Oprah “a-ha!” moment to see that this is a ridiculous system and misappropriation of U.S. / healthcare dollars, physical resources, and clinician time. A fellow PT posed a novel concept: As military personnel are frequently trained in medical care and triaging, why isn’t Border Patrol utilizing a medical triage where these injured folks can be stabilized with essential care and returned to their country of origin for further medical intervention? We can provide care to meet the emergent, basic needs all humans deserve. But must we provide medical care that many of our own American citizens cannot afford or do not receive?

Get your ducks in a row before a travel assignment

26 Mar

Before embarking on your travel therapist adventure, the list of “Things to Do” is overwhelming. What I found to be the most daunting was planning ahead for those things that come up scattered throughout the year.  Although traveling within the US means anything you may forget to pack is likely accessible while you’re away from home base (or maybe you can just go without it!), there are things that are better not to be stuck without. Depending on how long you will be away from your home area, you can prioritize what needs to be handled in advance, what may come up on the road, and what can wait ’til you’re return.

These are the “big ones” I came up with before I got on the road for the next 7 months:

Vehicle inspections, registrations, maintenance:  For inspections, you may have to get them done early if you’re not going to be in your home state when they are due.  If your registration is due while away, can you renew online?  If not, be sure our mail is being forwarded appropriately.  Finally, if you have a relationship with a good car repair shop, like I do, assess what routine maintenance items are essential to be done prior to your trip and those that can be put off til your return. A long road trip may mean wanting to invest in some of those services beforehand to prevent problems on the road.

License renewals: For professional licenses, make sure you bring them and any other paperwork you may need if your renewals will come up while you’re traveling. Also, do you know when your driver’s license expires? For me, that was one that almost slipped through the cracks! Check to see if you can do it in advance or from afar. (For example: I could renew my Texas driver’s license months in advance of its expiration, and it still keeps its original renewal month for next time.)

Medical needs: Flex when you take care of routine medical needs. If follow ups or lab work is needed on the road, discuss with your doctor how to get the necessary results to their office or plan to use a provider on the road.

Prescriptions, etc: Use a pharmacy that is national, as your scripts will be accessible through their system no matter your location. Wear contact lenses? Make sure you have enough sets to make it until you’re back.  That way you don’t need to coordinate (or pay for) having them sent by mail.

Bills:  I was slow to move to paperless statements and online bill pay.  Then, I was hesitant to have any electronic fund transfers or recurrent payments. It felt too out of my control. But now with being way from home, both were the way to go! No need to have someone else manage your bills or money and no worries about the sometime time-insensitive mail forwarding.  I learned that some companies will give you incentives (aka discounts) to set up an EFT.

Mail: Decide whether having the post office forward it or a person you know (neighbor, family, friend, house sitter) forward it is right for you.  I prefer to have my housesitters forward it so that they can screen for junk mail and to ensure my mail gets to me at the correct address.  Sometime the postal service can have a lag, which can be a glitch if you’re transitioning to new housing or a new city.

Mission (almost) accomplished!

1 Mar

A lot has happened in the past week plus.  I’ve had several phone interviews for possible assignments, and finally the stars have aligned for location and start date.  An assignment in my desired location of Tucson was secured; and therefore, my anticipated start date has moved up a bit.  I knew I had to jump on the opportunity!  Wow, things happen fast from that point!  Once the assignment was confirmed with the facility, I began (and continue) feverishly working to complete paperwork, drug screens, finger printing, compliance modules, more paperwork.  Once these steps and the final agreement are signed, sealed, and delivered… I’m yours, Tucson!

Not only is one a PT as a traveler, but also a juggler!  It is overwhelming to think of all the things I need to accomplish from the “business” side of it, but also to be prepared for my housesitters’ fast-approaching arrival, my departure to live out of a 23 ft box for seven months, my road trip, and my living arrangements once in Tucson.  … Deep breaths…  It’s amazing  how many things you don’t realize need to be done when you’ll be away from your home base for an extended period.  Some helpful hints of things to consider for both personal and professional “To Do” lists prior based on my current experiences will follow soon.  For now, I’m doing my best to focus and chip away at those daunting checklists while trying to scoop up any work I can in the meantime.

Things I’ll ask before accepting my next assignment…

25 Feb

Starting travel work is certainly a learning process!  I have been fortunate to pick the brains of a few seasoned PT travelers and a PT traveling newbie like myself throughout this experience.  As I undergo the process to find an assignment in Arizona, these are some questions I ask during the client phone interview.  Many of these questions are applicable across practice settings.  Do you have any suggestions to add to the list?

Get specific about productivity standards.  Are the standards different from assistants versus therapists? Are the standards different between contractors versus full time employees?

Daily caseload expectations.  How many patients is each therapist expected to see in a workday?  Is documentation time allotted?   How many patients are you expected to see in one hour, and how much 1:1 time do you have with each patient within that hour?

Supervisory roles.  How many PTA’s will you be supervising (whether at one or multiple facilities)?   This is important to maintain compliance with state practice act rules.  Every state can be different.  Additionally, Medicare has rules for supervision.   If the state’s rules are stricter than Medicare’s, or vice versa, follow the most stringent rule.   It is also important to have an expectation for the volume of supervisory tasks you will have.  Cosigning, conferencing with your PTAs, updating plans of care, recertifications and discharges typically aren’t considered “productive” time (even though we, as clinicians, know these are certainly productive uses of our work hours).

Overtime.  What is the facility/clinic’s policy on overtime?  How is work load adjusted to ensure a contractor does not go into overtime?  If the facility/clinic will not pay for overtime, will your staffing company do so if it is nominal?

Location hopping.  Is there the possibility of traveling between locations?  If so, travel time should be paid (and thus included within your 8 hour work day, for example).  Is mileage also paid (if not, you may be able to keep track of it for your taxes)?  How far are sister facilities or satellite clinics from your primary location?  If there is the possibility to travel between sites and you are open to it, have it included in your contract.

So life just handed me a lemon. Now how to make lemonade…?

20 Feb

I planned to write my next post around the halfway mark of my current assignment (there’s nothing “travel” about it, really, except my daily commute 20+ miles from home).  Unfortunately, it turns out this first assignment has been cancelled after 7 weeks.  Now I am scrambling to come up with a short-term “Plan B”.  Based on the projected 13 week contract, I should have been hitting the road the first couple of weeks in April.  Now I feel back in the holding pattern I was in this fall, uncertain about the plan, stressed about my budget.  But, like when I’ve been hit in the face with a tennis-, soft-, basket- ball (I blame this recurrence on my large, easily-targeted head size), I have to shake it off and focus on the game.  Here is the back-up game plan I suggest when faced with a bump in the travel therapist road:

Maintain a few bridges, avoid burning them.  This is particularly applicable if you are in your home area.  Departing on your adventure as a travel therapist is a whole new direction and life experience.  Sure, there may be factors at a current position that catalyze your drive to seek a new experience; however, becoming a traveler is different than heading to the facility across town.  If you could see yourself returning to a current position in some way, make sure you get that point across.  Establish when you may be available to provide your services again, and keep contact with these connections sporadically while on your assignments.  If possible, have a few options in your back pocket.   As I’m learning currently, established staffing ratios or actual needs can change at your former workplaces.  It’s also easier to fill your work week if you have a few options simultaneously.

Embrace that it is difficult to plan ahead.  This one is especially hard for me.  When I worked as a PRN/per diem therapist, floating between facilities to maintain a full work week, I would schedule myself out on my calendar as far in advance as I could.  Not knowing when you may be called with the “We’re good to go!” on your next assignment makes this challenging.  Having a few employers with which you have a good rapport and are understanding and flexible for your situation is helpful, but know that the sometimes last-minute nature of getting an assignment may limit your ability to commit to days they need coverage further out on the calendar.

Be proactive.  Cast a wide net.  I learned from this first assignment that seeming desperate can lead to perhaps settling for less worthwhile opportunities.  You lose some negotiation power.   You feel pressured to rush your acceptance of an offer.  However, it’s a double edged sword.  You may seem desperate because you do, in fact, feel desperate.  That was my situation in the fall: little activity and few leads from the staffing company and a lot of time tick-tocking away.  My friend, Hindsight, has taught me that it is important to work with more than one company on finding an assignment (I waited too long to do this back in the fall).  If not only to decide which company you feel best about, but also to have more people working for you to find a position.  I have also learned there is a benefit to showcasing your proactivity yet downplaying the desperation that you needed to have an assignment way before now and you just need something, anything, please!  A  PT friend of mine who used to travel advised me recently:  “You need to think of yourself as a small business owner, and you are the small business.”  This is true.  The ball is in your court.  You are the business, you have the skills, you bring in the dough.   Without you signing a contract, the company doesn’t make money from their work with you.  Avoid being overeager, make them work for your business.  It is common for travelers to work with more than one company when still learning what best meets their needs or when looking for a particular area for an assignment.  I’ve been told to be honest about having contact with multiple companies, but don’t feel overly loyal to just one until your experiences lead to earned loyalty.

Casting a wide net is not only important for companies, but also for practice settings and locales.  I have practice settings that I prefer, but am I open to new ones?  It can offer the opportunity for new skills and also improve the possibility of clinching an assignment more quickly.  But, be honest with yourself and in your interviews with what you feel comfortable and capable. Most clients expect you to hit the ground running, be effective, and productive.  There are also particular travel destinations in which I am interested.  If you’re having difficulty getting placed in a timely fashion, are you open to widening your radius?  There may need to be creative approaches to reaching your ideal location.  Could you live in that place, but commute to an assignment from there?  Could you be placed close enough for day trips or weekends?  Maybe work in a less preferable practice setting if it is in your targeted region?

How fast can you make it happen?  With this assignment ending unexpectedly, the first call I made was to my aforementioned “bridges” to find immediate work.  My second call was to my housesitters to update them on the changes.  Luckily, they are flexible, willing and able to arrive here sooner.  Although my list of “Things to Do” to be prepared for being on the road 7-ish months and to have housesitters live in my house is incredibly daunting, I will have to ramp up my productivity.  Reevaluate your initial timeline.  Could you get your affairs in order and get on the road to a travel assignment sooner?

Yes, I can hold a steady job. But I don’t want to, thank you very much.

29 Jan

My passion for being a physical therapist remains strong, but finding the balance between life and work has been a daunting task. I have been a full-time employee, but the whisper inside to be a travel P.T. was ever present. The whisper became more like a bug in my ear when, in 2007, I met a fantastic PT (now friend, too) who had experienced life as a PT traveler and matter-of-factly told me within the first few weeks of knowing me, “It would be perfect for you, and you’d be great at it.” Sadly, it felt like too big of a “risk” for me at the time, so I pushed away that nagging voice in my head and carried on my established path. That road, however, was riddled with flashy billboards proclaiming, “Travel, PT! You know you want to!”

It was true. I wanted to find a way to do what I loved (both travel more and be a PT) while staying balanced (read: not overly invested, overly stressed, overly consumed by my work). I love challenging work, and from the beginning, I’ve been drawn to clinical practice (particularly inpatient neurologic rehab) that is hard work on multiple levels but holds the potential for monumental stepping stones toward the reward of the patient’s recovery. The multifactorial intensity of these practice settings can make maintaining my “balance” another (less welcomed) challenge. When I wanted to recalibrate my life/work balance without taking the plunge into travel PT, I dipped my toes in the waters of being a wandering P.T. by filling a “full-time” schedule floating between several facilities PRN (“as needed”). Ironically, I then missed the continuity and contributions made from start-to-finish of a patient’s care. My gypsy soul was in a tug-of-war with my professional preferences. Where was the middle ground between the heavy commitment of full-time placement and the freedom (yet, little sense of investment) of PRN work? To me, the happy medium could be Travel PT. No other employment status offers the “pseudo full-time employee” feel (for 13 weeks) by allowing you to contribute your unique insights and skills, leave a positive footprint, but then move on to the next!

As I certainly don’t live in an idealistic fairytale, I know that every situation has its potential pitfalls. Sure, some travel contracts are to cover a maternity leave or a leave of absence. But to paraphrase conversations I’ve had with many therapists experienced in travel/contract work— many places that will pay for a contractor are desperate for a reason. So, with new freedom and travel adventures comes a tradeoff. It is likely that I will encounter places with staffing troubles, management issues, morale dips, and/or obscure locales. This brings to mind another recurring pearl imparted to me by fellow travelers: “You can do anything for 13 weeks [within the realm of your professional ethics and values].” For the many perks, I think it will be worth it.

So, the Southwest, you say?

21 Jan

How could I possibly narrow down the 50 glorious states to Arizona and Colorado?  Well, here’s what I considered:

1.)    Timing is everything.  Things pretty much aligned with the culmination of my Argentina trip.  I was able to give my employer 4 weeks’ notice in advance of my 2 week trip that, upon my return, I would transition to PRN (or “as needed”) status.  My plan was to begin a local “travel” PT contract (which is typically 13 weeks) at the end of November to get my feet wet, then hit the road.  Two out-of-state assignments in a row, plus travel time, would equate to approximately 7 months away.  I also wanted to be home before the holidays and any on-the-road winter weather.

2.)    I had a “feeling”.  Not much more to it than that.  My gut said, “Go west, young (wo)man!”  As I described in my last post, I haven’t experienced many states since my pre-teen days.  Plus, the opportunity to explore natural landscapes I haven’t yet seen was alluring.  My gut also told me that my next round of PT travels (should I enjoy this lifestyle for a bit longer) will take me back toward my homeland of the northeast.   But, I’m getting ahead of myself…

3.)    ‘Tis the season. Based on the aforementioned “timing”, I hoped to be headed to my first destination roughly mid to late February.   Although I love cold weather and snow, managing to drive and live in the motor home (named “MH”— creative, I know) while worrying about frozen water lines/pipes and icy roads was not something I intended to take on during my first outing.  As much as I adore seeing my breath on a brisk day, I equally detest scalding hot weather (a bit ironic that my home base is central Texas where we saw 70+ triple digit days in 2011).  Therefore, I hoped to escape the torrid temperatures for my second contract (theoretically, to start mid/late May).

4.)    Family ties.  Although Arizona was always in the running, it sealed its place in the final two when my mom and stepdad relocated from Texas to the Grand Canyon State.  I frequently live apart from my scattered family, but being close enough to them for visits (and pet sitting) seemed appealing. Also, they are full time RVers themselves and will likely have to field a few SOS calls regarding MH. This #4 consideration is also a strong influence on my second round of travel hopefully taking me north, to bridge the geographical gap between me and my family up there.

5.)    It’s not about the destination but the journey.  What can I see and do while en route to my job?  Initially, New Mexico had been in the mix of travel assignment possibilities, but the areas in which I was interested had a high probability of snow (refer back to #1 and #3 considerations).  So, highlights of New Mexico moved to the list of “places to stop along the way”.  Additionally, what locations could I incorporate on my journey from first assignment to second?  I also needed to be realistic about the distance of my trip, not only for my two final destinations but for the time I would take to go from point A to point B.  I’m not a good long-distance driver (again, a bit ironic) and so I needed to be cognizant of the length of time I would be on the road each day.   Another consideration:  driving MH plus tow dolly plus car also limits the speed at which I can travel safely.  Finally, time is money.  As fun as it would be, I can’t afford to be too leisurely on my trek to each assignment.  Time between each assignment is without pay (other than a travel allowance from my company, which will only put a dent in the gas expenses of my fleet).

Given all my considerations, how has it all panned out?  Well, my timing wasn’t that great.  I got cold feet on my plan to be 3-ish hours away from home (so I could take advantage of some tax-free benefits) and be able to come home occasionally for weekends.  It just felt too fast for my MH preparedness, and I was without a decent cat-sitting option.  So, I narrowed my window to seeking an assignment that was commutable from my home.  This bit me in the ass, and I was contract-less for many weeks longer than I thought.  Until my January start date, I treaded water working PRN at my former full-time gig and dabbled in a bit more contract home health.

Looking forward, I selected Arizona and Colorado for my assignment destinations.  My delay in getting to Arizona would actually work to my advantage if I wanted to be near Sedona or Flagstaff (potentially snowy earlier) but would make for a hot time if I wanted to be near Phoenix or Tucson.  If fate landed me in the sweltering desert, I knew I could look forward to blissful weather in Colorado for the summer/early fall.  I would hit New Mexico sites on the way to Arizona and catch the Grand Canyon on the way to the big CO.  I lined up a great couple, who fulfill their love of travel and new experiences by house sitting, to take care of my home and kitty while I’m away.  Luckily, the flexibility of their lifestyle meshes well with that of a travel PT (as you don’t know exactly when or where you’re going start an assignment until just weeks before).   Sure, it’s an unpredictable and ambiguous career path… but it sounds exciting, doesn’t it?