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Great teachers build students to be great

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

I have had many students over the course of my career as a PT.

It is not hidden that I practice with a base of MDT (Mechanical Diagnosis and Therapy). This is the base from which I begin every new patient evaluation. It allows me to keep information in an order that makes sense to me and keeps me thinking systematically.

When I take students, I don’t dictate how they practice. I want for them to learn about what is their passion within this profession.

Everyone has to follow his/her own dreams and goals.

I frequently get students that ask me how did I get to where I am at in this profession.

I tell them about reading textbooks, thousands of pages, two to three times in order to understand the words. The students go from feeling great about the energy that I bring and the mentoring and teaching that I have done through the clinical to telling me that they don’t think they can do it.

I DON’T CARE!

You do you. Don’t try to do the things I’ve done in my career. Becoming better at anything takes work. I can feed you my information and this can put you a little further in your quest for information, but you will never own the information in the same way that I own the information. It takes time and work to own the topics.

I only hope that the students can take from me an inspiration that this profession has a lot to offer. Each professional could be great at any one niche AND there would still be enough information, topics, niches for everyone to be great at something.

In the end, the responsibility is on the person…the student.

It is not on the teacher, for the teacher has already paved his/her own way.

The student must choose the path and forge forward.

What path have you taken as a student…professional?

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Training for game day…everyday

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

There is so much to unpack here.

First, don’t do as I do because you may have different goals than I.

When I worked at Sams Club, I could have two conversations: gym stuff and Sams stuff. I was so single minded. I would go to school in undergrad and read Ironmind, Flex, Powerlifting USA and books by authors such as the great Mel Siff, Mike Menzter, Fred Hatfield and others.

I wanted to make myself better at the things I enjoyed and school was just something I had to do in order to eventually make money.

I became employee of the year at Sams Club in 2003 and quit the same year to go work at a gym making half that money and to start PT school.

Once in PT school, I still devoted my time to learning about lifting. I went deeper into methodologies and theories of exercise.

Once I graduated from PT school, I devoted all of my free time to becoming a better physical therapist. I want to be the best (warrior) at this craft (physical therapy) that I could attain.

This is not necessarily healthy. I want to start by saying this because it’s been told to me my entire career.

I studied research between sets at the gym. I read textbooks multiple times over. I sacrificed personal relationships to become better…I won’t even say good, but better than the day before.

I’m glad I put all of that time in during those first ten years.

This does not conform to the thought of work-life balance. Again, I’ve heard this my entire career.

When looking at balance, it has to be what makes you happy. Not everyone has the same definition of happiness. When I go to work, I’m sure my patients are grateful that I sacrificed a decade of my life to get better at my craft. When I believe in something I give it my attention. In giving it my attention, I give my time. In giving my time, I am giving my life.

I understand that not everyone is devoted to their craft, but I would hope those depending on that craft can see the difference between those who do and those who don’t.

Medicare for all

Are you paying attention?

Medicare for all would not be a great option, since we can barely sustain Medicare for some.

Government has to get more and more creative in order to make the 💰 last longer.

Part of that creativity is to reduce output.

Another part of that will be to increase revenue to this system.

Reducing output is easy. They are simply paying less for services and taking less risk than previous years.

For instance, ACO (hospitals and other entities) are seeing less reimbursement than previous years for the same procedure.

Less income means that the hospitals have to find other ways to generate income or to become “leaner” in their operations. This may mean less one-one time for PTs.

What do you think the solution should be?

See some of the comments to understand why we are running into problems.

Patients with Medicare using PT

“Services were required because the individual needed therapy services”

For a person to need therapy services, they must have a plan of care certified as necessary by a physician or other referring professional.

“A plan for furnishing such services has been established by a physician/NPP or by a therapist providing such services and is Eperiodically reviewed by a physician/NPP”

A PT is allowed to establish a plan of care for patients, but the insurance doesn’t necessarily have to pay for it. In order for Medicare to pay for a plan of care that is established by a physical therapist, a physician or other referring provider must sign off on that plan of care.

“Services are or were furnished while the individual is or was under the care of a physician…In certifying an outpatient plan of care for therapy a physician/NPP is certifying that the above conditions are met. Certification is required for coverage and payment of a therapy claim.”

If a physician/NPP provides a referral at the time of evaluation, this ensures that the patient was under the care of a referral source at the time of the evaluation. This becomes important because there are patients that will wait to start therapy for months or years after a referral was issued. There is not guarantee that the referral source will certify the POC at this later date. If this POC is not certified, then the treatment will not be covered by Medicare.

“Claims submitted for outpatient PT, OT, and SLP services must contain the National Provider (NPI) of the certifying physician identified for a PT, OT, and SLP plan of care”

Although this is a technicality, this may cause a denial of payment if the NPI number, of the referring professional, is not included on claims.

“Although there is no Medicare requirement for an order, when documented in the medical record, an order provided evidence that the patient both needs therapy services and is under the care of a physician. The certification requirements are met when the physician certifies the plan of care”

Again, this needs to be reiterated over and and over, the patient needs to be under the care of a physician when in physical therapy. The referral can serve to show that the patient was under the care of a physician at the time of the initial evaluation. In the end, the only thing that matters is that the physician/NPP signs off on the plan of care established by the PT.

“Payment is dependent on the certification of the plan of care rather than the order, but the use of an order is prudent to determine that a physician is involved in care and available to certify the plan”

Have you had enough of this yet.

Do you think that there is a reason this is spelled out so frequently in the documentation?

Some don’t follow the rules of the game.

“The services must relate relate directly and specifically to a written treatment plan as described…must be established before treatment is begun…written or dictated.”

We all know that a plan is required.

Some don’t know how to write frequency and duration.

Some don’t know how to write interventions, or some perform interventions not written.

They must be written and signed off on in order to perform.

“The signature and professional identity of the person who established the plan, and date it was established must be recorded with the plan”

No brainer…or is it?

Stamped signatures are not signatures according to CMS, and stamps are not approved.

“Outpatient therapy services shall be furnished under a plan established by:

A physician/NPP

The physical therapist who will provide the physical therapy services”

This is critical. A therapist doesn’t need to have a POC signed if the physician/NPP creates the plan and it is abided by the PT verbatim.

Also, the PT doesn’t need to be licensed if practicing under a physician.

“The plan may be entered into the patient’s therapy record either by the person who established the plan or by the provider’s or supplier’s staff when they make a written record of that person’s oral orders before treatment is begun.”

This is a formality, but it has to do with dictating a note. Treatment can not be started by anyone other than the PT or immediately supervised by the PT that created the plan, before it is entered into record.

“The evaluation and treatment may occur and are both billable either on the same day or at subsequent visits.”

I tend to do one billable unit on the days of an evaluation. This is based on how much time you spend with the patient covering an intervention, or if an untamed intervention is performed.

“Therapy may be initiated by qualified professionals or qualified personnel based on a dictated plan. Treatment may begin before the plan is committed to writing only if the treatment is performed or supervised by the same clinician who established the plan”

This means that the PT or PTA can start treatment on the initial visit. The PT must be in the office supervising the PTA at this point.

Some people, like Anthony Maritato, use this method to establish a relationship between the treating therapist and the patient.

Others, like Rick Gawenda, find this to be a less efficient use of time.

“It is acceptable to treat under two separate plans of care when different physicians/NPP refer a patient for different conditions. It is also acceptable to combine the plans of care into one plan covering both conditions if one or the other referring physician/NPP is willing to certify the plan for both conditions”

I’ve seen some clinic totally prefer to treat the patient 2x/week for one ailment and 2x/week for another ailment.

Take a guess why…it sure ain’t for the patient’s benefit.

Medicare limits how many units can be charged in a session (essentially how much money can be paid in a session). If there is a way around this, you can bet that money hungry clinics will find this workaround.

“The plan of care shall contain, at minimum, the following information as required by regulation:

Diagnosis

Long term goals

Type amount and frequency of therapy services”

The evaluation doesn’t need much. It would be great if it established medical necessity, but is it required…NOPE!

The diagnosis can either be ICD codes or the written diagnosis since it is not spelled out.

“Long term treatment goals should be developed for the entire episode of care in the current setting”

This is something new to many therapists. Medicare doesn’t specifically require short term goals. If they are not required, do they need to be done? In school it is taught to set short term goals as a step towards the long term goal. In reality, every minute counts. The time spent creating and typing short term goals could be used elsewhere. Creating short term goals is literally robbing Peter to pay Paul, but Paul doesn’t need the money.

“…long term goals may be specific to the part of the episode that is being certified. Goals should be measurable and pertain to identified functional impairments”

Goals should be measurable and timely. They should relate to function. There is a lot of grey area in this portion. Subjective measurements are not the most reliable and maybe shouldn’t be used in goal writing.

I see frequently “to increase hip abduction strength to 4/5”

This goal is measurable, albeit loosely and has no tie to function.

I personally like to use outcome measures and specific functional testing in my goal writing. For instance, the patient will improve the (TUG, Tinetti, Berg, chair rise, single leg stance, lower/upper extremity functional scale, yellow flag risk form) in order to …

“…documentation should state the clinical reasons progress cannot be shown”

This is built into many EMRs now.

Sometimes I will write that the symptoms are not reducible through movement or modulation. Other times, I will write that the patient is not consistent with the HEP. Sometimes, it’s that it is a maintenance case and the patient is unsafe to perform exercises with an untrained professional due to fall risk, BP fluctuations or rapidly changing SpO2.

This is where it really pays off to have read some of the textbooks that were recommended in PT school. I particularly recommend the ACSM handbook.

“The amount of treatment refers to the number of times in a day the type of treatment will be provide…one treatment session a day is assumed”

In an outpatient setting, this is typically one. In an acute or subacute setting it may be BID (twice in a day) or even TID (thrice in a day).

“The frequency refers to the number of times in a week the type of treatment is provided”

I struggle with this one. Many therapists are putting 3 times per week for 4 weeks on all their plans. This isn’t being done because they believe it’s what is best for the patient, but because there is a corporate policy to get as many visits in per week as able.

I get frustrated with this type of plan. If you are a therapist and working in this setting, but only putting this plan down to keep from rocking the boat…you are abusing Medicare and should call CMS to report this activity.

Please and thank you.

“The duration is the number of weeks, or the number of treatment sessions, for THIS plan of care.”

This question is asked frequently. I will typically put down the number of weeks if I know that the surgeon only wants so many weeks of PT per a protocol. If it is not protocol based, the. I will typically put down the total number of visits expected for the episode.

Many of my patients (>80%) require an authorization and are typically given 12 visits to start. In this case, I will make the plan for 12 visits or 90 days, whichever comes sooner. I know that I have to do a progress note and get a recertification and ask for more visits at this time anyways.

“It may be appropriate for therapists to taper the frequency of visits as the patient progresses toward and independent or caregiver assisted self-management program with the intent of improving outcomes and limiting treatment time.”

Again, I frequently get 12 visits to start. I try to make these visits as worthwhile for the patient as possible. For some cases I will see 3 times per week, but for many I will see 1 visit per week or 2 per 10 days. This way we are able to see the patient for the timeline of change that is expected. For instance, strength usually occurs in the first 6 weeks due to neuromuscular changes and hypertrophy happens after this timeframe. If we are seeing the patient for 12 visits in 4 weeks, then we may have exhausted the benefits before noting the change.

To me, that is a waste. Many patients agree with me on this because we make the POC together based on their finances (copays need to be paid each day regardless of how many times you are seen per week), work schedules and need/expectation to change over a given time period.

Again…PTs, if you don’t have this autonomy to create your own Plan of Care, are you truly an autonomous practitioner or are you simply a technician that is doing what a higher figure is telling you to do?

“When tapered frequency is planned, the exact Number of treatments per frequency level is not required to be projected in the plan, because the changes should be made based on assessment of daily progress”

This is one of the aspects that I take advantage of in the plan. At this point, I will write 12 visits over 12 weeks or 12 visits over 6 weeks. This way I may start at 3 visits and taper down to one visit per week.

“The clinician should consider any comorbidities, tissue healing, the ability of the patient and/or caregiver to do more independent self-management as treatment progresses, and any other factors related to frequency and duration of treatment”

I had a patient that hadn’t walked in years. The person had fluctuating blood pressures with activity and at times therapy was halted due to elevated BP. This patient was not safe to perform gait training independently due to fall risk and intermittent cardiac crises. This patient was treated 1-2 times per week with gait training and performed a Nu Step at home. The interventions that were skilled were performed in the clinic and the unskilled interventions were issued for HEP.

“…optional elements: short term goals, goals and duration for the current episode of care, specific treatment interventions, procedures, modalities or techniques and the amount of each.”

As much as this says “optional”, I’m not sure it is fully optional. For instance, this report notes that a therapist did not have the type of intervention in his POC as one of many reasons for repayment.

“Changes to procedures and modalities do not require physician signature when they represent adjustments to the plan that result from a normal progression in the patient’s disease or condition or adjustments to the plan due to the lack of expected response unchanged. Only when the patient’s condition changes significantly, making revision of term goals necessary, is a physician/NPP’s signature required on the change.”

For me personally, when there is a major change in status that requires a change in goals and expectations, I phone the physician and alert the medical team to the change in status. I feel that it is important to relay this information to the physician personally, in addition to writing a progress note or re-evaluation.

“Certification requires a dated signature on the plan of care or some other document that indicates approval of the plan of care… The date of the certification is signed is important to determine if it is timely or delayed”

This small detail is important. Although the physician may sign it, it also must be dated. I’ve had to send many evaluations back for a date.

“The physician/NPP’s certification of the plan satisfies all of the certification requirements noted above in (section) 220.1 for the duration of the plan of care, or 90 calendar days from the date of the initial evaluation, whichever is less.”

This is where things get confusing. If you set your plan for 90 days, then everything is good and no confusion.

If you set your plan for 6 weeks, then you would need to get another certification past 6 weeks.

I’ve seen some therapists just write the plan for 90 days on each evaluation in order to check the 90 day box. Don’t be that person. Put thought into your plan and don’t just set up your plan for 90 days because it’s the maximal allowable in one episode.

My duration varies from 4 weeks for acute back pain, 6 weeks for vestibular dizziness up to 12 weeks for neurological disorders. The only downside of doing this is that there is paperwork more frequently. The upside is that it forces a reassessment, which indicates whether or not a patient is responding to care.

“…the physician/NPP shall certify the initial plan as soon as it is obtained, or within 30 days of the initial therapy treatment.”

At my clinic, we have a spreadsheet that has the evaluation name, date and signature (yes/no). Once the signature is obtained, the name is removed from the spreadsheet.

Also, when discharging a chart we have a checklist of items that are expected to be in the chart. The signed evaluation is one of these items on the checklist.

“Evidence of diligence in providing the plan to the physician may be considered by the Medicare contractor during review in the event of a delayed certification”

Again, this is more of a standard operating procedure. When a note is faxed to a physician, the fax cover letter becomes a part of the record. This is done to demonstrate that due diligence was performed in attempting to get a note signed.

“Payment and coverage conditions require that the plan must be reviewed, as often as necessary but at least whenever it is certified or re-certified to complete the certification requirements. It is not required that the same physician/NPP who participated initially in recommending and planning the patient care certify and/or re-certify the plans”

This is also an opportunity for PTs. If a patient has a better relationship with the PCP compared to the orthopedic surgeon, it may be prudent to have the patient get the PCP to sign off on the recertification.

“If the physician wishes to restrict the patient’s treatment beyond a certain date when a visit is required, the physician should certify a plan only until the date of the visit.”

The evaluation template that we use from Theraoffice provides an area for the physician to change the plan if deemed appropriate.

“Certifications and recertification’s by Doctors of podiatric medicine must be consistent with the scope of the professional services provided by a doctor of podiatric medicine as authorized by applicable state law… Chiropractors may not certify or recertify plans of care for therapy services.”

This is huge. For instance, a podiatrist physician is only allowed to write a referral for their scope of practice. Seeing a patient from a podiatrist for an ailment that is outside of the scope of practice may result in a sticky situation, like Seinfeld encountered.

Also, Chiropractic physicians are not allowed to certify plans of care for PT. This applies to Medicare. You must be aware of the patient’s insurance in order to determine if other insurances have the same regulations.

“… The provider is precluded from charging the beneficiary for services denied as a result of missing certification”

This means that the provider or company that the provider work for will hound the physician’s office to get the evaluation or progress report signed. Otherwise, the amount paid was not approved to be performed.

The clinics are not allowed to charge the patient due to a lack of certification.

This is not meant to be legal advice, as this is my take on the Important passages from This manual regarding our profession.

If in need of more information on Medicare compliance, check out Nancy Beckley or Rick Gawenda

Life purpose and changes

“If you want to change the world, you have to enroll others in your plans and vision.”

Adam Robinson

About 2 years ago I started a blog. It was just for fun and the premise behind the blog is this “the only knowledge wasted is the knowledge not shared”. I saw this quote on a t-shirt; a blog was born.

My goal is to provide high quality content to readers through this blog in order to assist them with making decisions regarding choosing a health care practitioner. The secondary goal is to educate physical therapists at least up to the point of at patients. It sounds cynical that I believe that some patients have more knowledge than the PT, but I also believe that the patient has more to lose and more at stake than the PT.

The PT only has a paycheck at stake, maybe a reputation. The patient has life limitations and issues that may prevent them from truly experiencing life. That way more at stake than the PT has on the line. In this fashion, I have seen patients becoming smarter over the years through forums, FB groups, reading blogs and watching videos.

The reason why I say high quality content is because there are a lot of lies and misinformation on the World Wide Web (internet). Healthcare professionals prey on the weak and ignorant to take their money using scare tactics and unrealistic hype.

I ain’t got nothing to sell you other than making you a better human through work. Nothing ventured, nothing gained.

I have increasing demands on my time with a family, managing multiple clinics, treating patients and community involvement.

My posts will become fewer and fewer as I try to fit them into my life instead of fitting my life around my work.

Love your life or change it

Dr. Vince Gutierrez, PT

Second opinion

How many people will choose to get a second opinion before going in for a major surgery?

I would hope 💯%!

I had an awesome conversation about 10 years ago when I was visiting Canada. There was a guy that traveled to Canada in order to get an opinion regarding back surgery. He was from San Diego. That’s a pretty far trip to see if he needs back surgery.

I asked him why travel that far for an opinion and he said that he wanted to reduce any bias on the doctor’s part regarding whether he was a candidate. For instance, the doctor in Canada would not be performing the surgery and it was unlikely that the doctor giving the opinion would be able to benefit from recommending surgery, since the patient would have surgery in California.

He avoided going for the opinion in California because the hospital system would profit from the surgery. The surgeon may have an arrangement with the hospital to ensure that the hospital gets a percentage of the money. We know that the hospital will make money during a surgery. Many people stand to profit from a surgery and the patient would do well to get an opinion from someone that doesn’t stand to benefit.

This brings me to my rant for now. 👇

Why don’t patients get a second opinion regarding physical therapy?

1. It’s not a huge expense

Physical therapy, on average will cost the insurance company about $1200 per episode of care. If the patient is paying 20% for the coinsurance, then it will only cost the patient $240/episode. This works out to about $50/week.

That’s relatively inexpensive compared to a large surgery. The question is: why not spend an extra $25 to see if a second therapist agrees with the first? If there is a disagreement in how treatment should be performed, then the cost may not be the chief factor.

This leads us to 👇

2. All therapists do the same thing

Not all PTs are trained the same! Don’t let a non-PT (such as surgeon or family doctor) tell you that it’s all alike.

Not all surgeons have the same reputation and skills. Not all PTs have the same reputation and skills. The only way that you, as a patient, will know about other’s skills and reputation is to ask and try.

If you are absolutely in love with your PT or MD, then so be it. Sing from the rooftops so that the reputation gets built. If you’re not…try someone different.

Sometimes the grass IS greener.

3. Convenience

I get it. A drive around the corner is much easier than a drive for an hour. It makes sense.

If we believe that not all therapists have the same training or passion for treating a specific issue, then we must also believe that these therapists are worth the drive.

Follow this example:

1. Patient A decided to go to a therapist close to home or work (we know that regarding gyms most people won’t drive more than 15 minutes from work/home). The therapy session costs the patient $240 out of pocket and the insurance pays $1000.

Let’s also say that the patient is being seen for low back pain or sciatica, since this is the number one reason to seek PT. The patient is seen in a clinic in which the therapist is there to punch a clock and see as many patients as possible because that’s how 💰 is made.

The patient doesn’t get much better and then returns to the doctor for a series of shots (more money and time). The shots are a 50/50 chance of working.

Half of the patients will then still have pain and now be shuffled to the next step, either pain management or surgical consult.

2. Patient B spent a little time to search for the therapist in a 20 mile area that best treats low back pain or sciatica. The patient makes an extra 20 minute drive. The therapist decides that the patient would ben for from 8 visits of PT over 6 weeks and the patient gets better because the therapist enjoys the job and works well with patients having this diagnosis.

The patient made a little more of an effort up front, but saved 💵 and ⏳ by choosing the right therapist instead of moving further along in the medical system.

Want a second opinion, send me a message.

Efficient and Effective Care

“Proliferation of these staffing models (increasing the use of PTA’s and aides) has been driven by managed care organizations, the introduction of prospective payment systems, and low reimbursement rates, as well as workforce shortages in allied health.”

For those that are unfamiliar with physical therapy and what the titles mean lets do a quick refresher:

PTA = licensed physical therapist assistant (high school + 2 years)

PT = licensed physical therapist (Bachelor’s or Bachelor’s + years)

aide = no required degree with on the job training (no degree needed)

MPT = Master of physical therapy degree (Bachelor’s plus 27 months)

DPT = Doctor of physical therapy degree (Bachelor’s plus 33 months)

Based on the above, one can see that the aide would be paid less than the PTA.  The PTA would get paid less than the PT based on education level alone and all other things are equal.

When insurance companies cut pay to professionals, companies have to decrease their costs in order to continue to make margin.  One way to cut costs is to have fewer PT’s and more PTA’s or aides.  The ethics/legalities of the decision are for a different day.

Some insurance companies are refusing to pay for services provided by PTA’s.

The reason that I bothered to look at this research was a large discussion that took place on a professional FB page in which PTA’s were arguing that the care shouldn’t change from PTA to PT, seeing as PTA’s can perform most treatments that a PT can perform.

I decided to look into this to see if there was a difference and I was shocked by what I found, based on my own experience working in a hospital system.  On the same note, I wasn’t shocked based on some of the reports that I hear from patients and others in the profession.

“Use of support personnel in outpatient therapy settings can double the number of patient visits a therapist can manage per day, thus increasing clinical productivity.”

If I am a PT making $50/hour (using round numbers to keep it simple) and in a typical day I could treat 10 patients with an average reimbursement rate of $95 (please go watch all the videos from Dr. Ben Fung ), then I would cost the company $400 dollars, but make the company $950 dollars.  A gross profit, with the removal of only the PT salary, of $550 dollars per day.

Now, if we have that same PT making $50/hour and a PTA making $30/hour (again round numbers to keep it simple), with each therapist seeing 10 patients per day, then the following numbers are the result.  The salaries would cost $640, but the therapists would generate $1900/day.  A gross profit, with salaries of the therapists removed, of $1260/day.

As you can see, the company would be able to generate more money by hiring PTA’s instead of a second PT.  The question then becomes is it cost effective to have the PTA compared to the second PT.  The answer at a glance is “of course”!, but looking a little deeper may force a company to weigh values (i.e. profit or outcomes) before making that second hire.

“While some advocate use of support personnel to increase productivity without loss of quality, others warn that an over reliance on support personnel can negatively affect outcomes and compromise quality.”

This is essentially the discussion that occurred on FB.  Some people say that PTA’s provide the same quality of care as PT’s and others state that PTA’s offer less quality care than PT’s.

I’ve worked with rockstar PTA’s (plus my wife is a PTA so I am already a little biased) and I’ve worked with some PT’s that I would never refer a patient to (no offense if you think that this is you).

“Three dependent variables were analyzed: high PTA utilization, number of visits per treatment episode, and patients FHS (functional health status) at discharge…high PTA utilization, defined as a patient seen by a PTA 50 percent or more of the treatment time”

High PTA utilization, in this study, meant that the PTA was seen by the PTA for over 50% of the visits.

Again, I have worked in locations in which this was true and locations in which we had no PTA’s, so I have seen the results from both.

Looking at treatments per episode is a means of measuring efficiency of treatment.  It may not be the best measurement, but is one way of looking at treatment efficiency.

Looking at outcomes is one way of looking at effectiveness of treatment.  Again, it may not be the best way, but it is one way.

“…less than 2 percent of patients were treated by the PTA for more than 75% of the treatment time, and 8 percent were treated by the PTA 50% of the time or more.”

I’ve been in clinics without PTA’s and with PTA’s.  This stat will be correlated with the amount of PT’s/PTA’s in the clinic.

In private practice, it was 0 PTA’s.  In the hospital we had 1.5 PTA’s for 4 PT’s.  Currently, in my practice there are 2 PTA’s for 1.5 PT’s.

“The second dependent variable, number of visits per treatment episode…We believed that fewer visits per treatment episode were a marker of greater efficiency of care”

This is debatable by people.  I’ve actually been involved in these on-line debates.  Some people will fight that more visits equals better, but more is not always better.

If we can get patients better in shorter visits, then this seems to be ideal to me.  If additional visits would correlate with increased function, then I would be all for increased visits if the patient is willing and able to pay for increased visits (time and money).

“The majority of physical therapy care was delivered by PTs with no reported assistance from PTAs.”

Again, in a clinic without PTA’s, there will be no reported assistance from PTA’s.  This study used data from FOTO, which included private practices and hospital based practices.

“PTAs were involved in the care of patients only 35% of the time. High PTA utilization was relatively uncommon, with only 7.7 percent of the patients seen by PTAs more than 50% of the time.”

This is interesting.  It is becoming more and more common to find clinics advertising/marketing that the patient will only be seen by a PT, or even a step further a Doctor of Physical Therapy.  I don’t know how well this marketing is going.

When seeing it, it subconsciously implies that a DPT is better than a PTA.  I think that this is very individualized.  For example, a PTA that has continued to improve over the years through independent study may be a better clinician than a PT that never sees patients (administration/teacher/manager).

“Medicare patients who were seen in private practice were 48 percent less likely to have had high PTA utilization.”

Some insurance companies require that a patient be seen by a PT and prohibit PTA’s from treating patients.  This will skew numbers towards the PT in private practice.

“Treatment with a therapy aide for 1-25 percent time and greater than 25 percent compared with 0 percent, and high utilization of the PTA were associated with 1.8, 2.6 and 2.0 more visits, respectively.”

Lets break this down.

Being treated by a therapy aide for 1-25% of the time resulted in 1.8 more patient visits per episode.

Being treated by a therapy aide for > 25% of the time resulted in 2.6 more visits per episode.

Being treated by a PTA for greater than 50% of the time resulted in 2.0 more visits.

Remember, an aide is someone that may not have any college experience or degrees.  The aide is not legally able to treat patients that are payed by the government.

Utilizing an aide only results in slightly more visits than using a PTA! Why is this?!

An aide is paid much less on average than a PTA.  For example, the aide may only cost the employer $12.50/hour.  The PTA will cost the employer $30.00/hour.

I see employers trying to cut costs by hiring more aides (not ethical to call it physical therapy if it is not provided by a licensed physical therapy professional IMO).

If it doesn’t change the outcomes though, who’s to argue against it?

I can see both sides of the coin.  Margins (profits) in physical therapy is small, so cutting costs is a business decision.

Providing quality care is something that IMO we should all strive for.

“Greater than 50% time spent with the PTA was predictive of lower discharge scores as was time spent with a therapy aide.”

This part may be the most important statistic in the article.  Seeing someone other than the PT led to worse outcomes.

This is the statistic that I was looking for because of the original question asked.

In other words, the PT will get a patient better than a non-PT and do it faster in an outpatient setting.

Strong words for businesses and people looking to go to PT school.

What is the future of PTA’s?  I don’t know.  Medicare just announced that they will be reducing reimbursement rates for PTA’s in an outpatient setting.  Pair this with the small margins in physical therapy and the question becomes is it profitable to hire PTA’s in an outpatient setting, seeing patients according to Medicare rules?

“…our analysis shows that Medicare regulations for continuous in-room supervision of PTA’s in private practice are associated with a decreased likelihood of high PTA utilization.”

 

“High utilization of PTA’s, and use of therapy aides were each independently associated with more visits per treatment episode, and lower functional health. Thus our findings suggest that use of care extenders such as PTA’s and therapy aides in place of PT’s is associated with more costly and lower quality care delivery in outpatient rehabilitation.”

 

I advise all people to look to the source:

link to article

 

Ways to mitigate burnout

“Burnout…is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment leading to decreased effectiveness at work…primarily affected those in ‘helping’ professions”

Hey!…  Hey!…  You!… PT’s!…Are you listening?!….

Does this sound like someone you know?

“The high prevalence of burnout among physicians results in lowss of engagement and commitment…5 out of every 10 physicians affected by burnout”

Loss of engagement and commitment with patients.  Hmmm? How many therapists do you know that are “punching the clock”?

I have a problem with a lack of engagement.  It just isn’t something that I tend to do often and I have a short attention span.  Maybe not as short as the new average of 9 seconds, but pretty darn short.  I just shift the engagement to something different.

A therapist that isn’t engaged with the patient is problematic.  Patients are coming to us for our professional opinion and placing trust in us to help them along their journey of pain or functional restoration.  To have loss of engagement places that trust at risk.

Not only is trust lost between the patient and the physical therapist, but also between the patient and the profession of physical therapy.

Remember young Jedi, YOU REPRESENT THE FORCE (by force I mean the PT workforce).  Your burnout makes me look bad.  Not that it’s all about me, but really…it’s all about me.

50% of physicians are affected by burnout?!

I haven’t seen any studies on prevalence in our profession, but I hope it’s not that high.

“Many factors contribute to burnout, including high workloads; an inefficient environment; problems with work-life integration; lack of flexibility, autonomy, and control; and loss of meaning in work.”

I’ve seen research showing that treating 20 patients per day may lead to burnout.  I don’t know if it’s the 20 patients or the notes that come along with the 20 patients, but….20 patients!!! REALLY?

At my busiest time, I was only seeing about 15 per day.  This may be why I have yet to experience burnout from treating patients.

An inefficient environment.  I have experienced this multiple times.  Sometimes people and companies are just set in their ways and don’t see a good enough reason to change.

Problems with work-life integration: this is what I am struggling with right now.  Is the juice worth the squeeze?  This is a phrase that I am thinking of more and more currently.  When I think of how many hours that I am away from my kids and wife, I have to think (or my wife makes me think) about where do I want to be in life 5 years from now.  Managing a clinic takes a ton of time.  If you have never tried to build a “brand”, it takes a lot of time and work in order to get a personal brand out to the community.

Autonomy and control: I haven’t personally experienced a loss of control in the clinic,  but I hear from PT’s all over the country that their boos/manager/director almost dictates the care in order to create a “comprehensive care plan”. Now this sounds all good and nice and all, but in the end the question has to be asked…Why? Why does the boss want a comprehensive plan?

The reason is no different than any other business and it has to do with money.  Clinics make more money by doing multiple different treatments than providing one treatment that may have the best outcomes.  It’s sad…but I hear it frequently.

“Physicians who suffer from burnout are impaired and they and their organizations are at risk of having higher rates of medical errors, less professionalism, lower patient satisfaction, and lower productivity, as well as more turnover and suicidal ideation”

Does burnout sound good?

Not like the burnout that I would do on my BMX bike as a kid or in my F-150 as a teenager.

Burnout leads to major issues at a personal and corporate level.  I wonder though if the companies care about burnout.  Turnover happens in physical therapy.  Although it costs money to train a new therapist, it may not matter since many companies see a PT as a widget instead of as an autonomous practitioner.  If one therapist can easily be swapped out for another, is burnout an issue at the corporate level?

Rhetorical questions of course.

“Organizations that make investments in leadership development experience substantially higher returns than those that do not.”

This is a great quote. Invest in your people, more so than seeing your people as an investment.

For instance, when you put money into an IRA, it sits there and you hope it grows (at least matches the 10% historical APR). You are passive in this role. Hopefully money makes money. This is what typically happens in a company. The employee is expected to go out and grow individually, which benefits the company, although the company may not take part in that individual investment.

I would like to see it more as owning a home. This is an investment also. It averages about a 2% gain per year, but the individual living in the home has to actively care for the investment in order for it to keep growing. I would love for more businesses to see employees as an investment for which they should foster care. High tides raise all ships. When the employee is successful both on an individual and business sense, everyone wins.

“Clinician engagement is empirically linked to more effective organizations, with outcomes including lower turnover rates, superior clinical outcomes, better patient experience, and superior financial performance”

Does this sound like a positive experience for clinicians and patients alike?

If the clinician is engaged in not only treating patients but also regarding the health of the business everyone wins.

Some therapists don’t see themselves as business people, which is a shame because if we don’t get the patient in the door, then we can’t help that person. We have to feel confident in attracting our customer (someone with functional complaints that may or may not relate to pain), educating our customer, selling to our customer and then accepting their money. Sales doesn’t have to be a bad thing. I have been reading Rabbi Daniel Lapin and have learned that money is just as much a show of appreciation and gratitude as it is a financial transaction.

“Physicians experience highest levels of engagement when they have a degree of control over their work environment. Engage Physicians tend to receive higher patient satisfaction ratings.”

This is an indication of autonomous practice. When a clinician gets to dictate care, instead of having care dictated to the clinician, then everyone wins again.

“Combating physician burnout is a twofold process that involves 1. mitigating the structural and functional drivers of burnout and 2. bolstering individual resiliency.”

This is the Mayo Model to try to reduce burnout in physicians. This appears useful for many other health professionals also.

Quick Link to the article here

Healthcare fraud and abuse

“During Fiscal Year (FY) 2017, the Federal Government won or negotiated over $2.4B in health care fraud judgments and settlements…$2.6B was returned to the Federal Government or paid to private persons.”

Put this into perspective.  If you were born today and started counting one…two…three…four, you would get to 2B right around retirement age.  This is of course assuming that you don’t sleep.

That’s a lot of money!

What’s important is to read that the money was returned to the government or paid to private persons.  This means that the Government is at least paying this much out to health care providers in order to recover the money at a later date.

There is a saying in health care…”it’s not about how much you make, but how much you keep that matters”.

“In FY 2017, the Department of Justice (DOJ) opened 967 new criminal health care fraud investigations…filed criminal charges in 439 cases.”

Again, I’d love to say that health care is a field full of altruistic people, we we know that some people suck!  They just suck. They take advantage of people.  They may have been bullied as a child and feel the need to get payback.  They may have been the bullies and just continue to try to take advantage of others.  It doesn’t matter the why, but they can’t be trusted to do the right thing when placed in a situation in which personal gain is an option.

“HHS-OIG also excluded 3,244 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.”

When a health care provider attempts to defraud a federally funded program, the health care provider can be excluded from seeing any patients that participate in these programs.  For instance, if I were to be a shady individual and overbill or bill for services that I didn’t actually provide, the government can then say that I am no longer allowed to see these patients.  The government could also enter into a corporate integrity agreement with the person or company and allow them to see patients, but the company would have to prove that steps are being taken in order to minimize abusing the system.

“Under the joint direction of the Attorney General and the Secretary, the Program’s (Health Care Fraud and Abuse Control Program) goals are:

  1. To coordinate federal, state and local law enforcement efforts relating to health care fraud and abuse with respect to health plans;
  2. To conduct investigations, audits, inspections, and evaluations relating to the delivery of and payment for health care in the United States;
  3. To facilitate enforcement of all applicable remedies for such fraud; and
  4. To provide education and guidance regarding complying with current health care law. “

Imagine that you have the full force of the Federal Government tracking you as a health care professional.  How confident are you that you are doing everything correctly? We are responsible for complying with health care laws and regulations.

It’s unfortunate, but there are many therapists that still struggle with how to bill appropriately and will just take the word of another health care provider instead of looking up the rules and regulations.

“Relators’ Payments: $262,095,000…are funds awarded to private persons who file suits on behalf of the Federal Government under the qui tam (whistleblower) provisions of the False Clams Act”

In my opinion, this is where it gets interesting.  If anyone sees an injustice of abuse or fraud and reports it to the government, the government may pay that person(s) a percentage of what is recovered from the abusing person or company.

About 10% of what was recovered was paid out to individuals and groups that reported this fraud.

Someone is hitting the lottery by doing the right thing and reporting on those that are taking advantage of the system or are ignorant of the rules of the system.

“The return on investment (ROI) of the HCFAC program over the last three years is $4.20 returned for every $1.00 expended.”

If you are the federal government, “would you put more or less money into trying to recover more money from those committing fraud or abuse?”

I don’t see these recovery attempts to slow down over the years.

“Health Care Fraud Prevention and Enforcement Action Team (HEAT)…The Medicare Fraud Strike Force teams are a key component of Heat.  The mission of Heat is:

  1. To marshal significant resources across government to prevent waste, fraud, and abuse in the Medicare and Medicaid  programs and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars.
  2. To reduce health care costs and improve the quality of care by riding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries.
  3. To highlight best practices by providers and public sector employees who are dedicated to ending waste, fraud, and abuse in Medicare.
  4. To build upon existing partnerships between DOJ and HHS, such as our Medicare Fraud Strike force Teams, to reduce fraud and recover taxpayer dollars. “

If you are in healthcare…are you listening?!

Does this sound personal?

This is to crack down on perpetrators costing us billions of Dollars.

“DOJ and HHS have expanded data sharing and improved information sharing procedures in order to get critical data and information into the hands of law enforcement to track patterns of fraud an database and increase efficiency in investigating and prosecuting complex health care fraud cases…enables the DOJ and HHS to efficiently identify and target the worst actors in the system.”

As a therapist, you should be shaking in your boots…if you are breaking the rules.  When the DOJ gets involved, it gets serious.

If you aren’t sure if you are one of the “worst actors in the system” you should check out the statistics.

Scary statistics for some

“In January and February 2017, 4 defendants pled guilty…conspiracy to commit health care fraud and conspiracy to commit money laundering…submit false claims to Medicare and Medicaid for among other things, fraudulent physical and occupational therapy services…patients received medically unnecessary services that were later falsely billed to Medicare and Medicaid…totaling over $55 million were submitted to Medicare and Medicaid in connection with the scheme”

This may be more than most people can perceive regarding fraud, but it doesn’t always start this way.  I’ve heard that it starts with overcharging by a couple of minutes and when a person doesn’t get caught, then the billing becomes more and more unethical.  Before you know it, the person is billing for thousands of dollars of services that weren’t actually performed.

“In March 2017, an owner of several physical and occupational therapy clinics in the Central District of California was sentenced to 5 years and 3 months in prison after pleading guilty to health care fraud conspiracy…ordered to pay more than $2.4 million in restitution to Medicare…instructed therapists and others to bill Medicare for physical and occupational therapy services that were medically unnecessary and not provided”

This is unfortunately all to common.  I received calls just in the past year from PT;s in Minneapolis, Houston, NYC, and San Diego describing similar situations.  This is happening all across the country, but very few people are saying anything about it.  It is much easier to ask opinions of others that have no vested interest in the topic than it is to actually call the compliance officer for the company or call the office of inspector general.

“In July 2017…a 2-count indictment against 5 high-billing medical professionals who worked at a network of Brooklyn-area clinics where patients were paid illegal kickbacks in return for subjecting themselves to purported physical and occupational therapy, diagnostic testing and other medical services.”

Kickbacks are illegal.  Kickbacks come in many forms.  Money is the easy one, but there are others.  I’ve heard of free sports tickets, free trips to medical conferences, paying patients to show up for sessions, waiving co-pays for all patients in order to keep them in the clinic, etc. etc. etc.

If you are a patient, this is illegal and needs to be reported.  If you are a therapist, this is illegal and needs to be reported.

“In October 2016, the owner and medical director of Christian Home Health Agency in New Orleans were sentenced to 8 years and 6 years in prison, respectively, after being convicted of health care fraud for billing Medicare for home health services that were not medically necessary or were not provided.”

People go to prison.  Some worry about whether they will be shunned by their job, so they don’t report the wrongs noted in the clinic.  Some people worry about whether they will lose their job, so they don’t report it.  People are going to prison.  Jobs come and go, but time served isn’t something that one can just walk away from.  Walk away from a negative situation while you still have time…or you may find yourself doing time.

To see the report in whole click here

To learn more click here.

Burnout in Canadian physios

This post may be the most important post that I have done in the past year.  This topic has piqued my interest since a person on a PT FaceBook page wrote about regretting becoming a PT.

My passion for this profession has grown in the 11 years since starting the profession.  I never…ever…thought that I would be able to impact people from all over the world with my content, but it is happening.  I never thought that I would be voted among the most influential therapists, but it is happening.  I laughed the first time that someone told me that they follow my content, but it is happening more and more.

This profession is awesome…if you let it be.  This profession can be very destructive to those in the profession…if you let it be.

Today’s post will cover burnout and will take quotes from the paper “Burnout Among Alberta Physiotherapists”.

“Burnout is defines as ‘…a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'”

Is this the healthcare practitioner that you want as a patient?

Is this the healthcare practitioner that you signed up to be when you graduated from PT school?

No?  Well then what are you going to do about it?

If you don’t make a change in your life situation, then life situations won’t change around you.

I have more zeal for my profession now than I did 10 years ago, 5 years ago and even 2 months ago.  I am meeting new people on social media and engaging in meaningful conversations with the “big dawgs” of the profession.  You know what…so can you!  You just have to take that first step from behind the keyboard or phone and just reach out.  Everyone that I have interacted with, from across the world, has been very awesome to talk to and at no point did I ever feel like I was a burden or a vampire on their energy or time.

These relationships help to prevent emotional exhaustion for me.

I love people! Really, I do…most of the time at least.  I don’t understand the depersonalization portion of burnout, because we signed up for working with people.  This is an inherent part of the job.

Reduced personal accomplishment….hmmm…what do I say about this?

This is inherent.  I don’t understand how an external force can allow for reduced personal accomplishment.  Each day we have choices to make.  One choice could be to stay in the situation that you are in, but another could be to just make a different decision.  I have worked with many people that weren’t satisfied with their job or their career, but when asking them why don’t do something different, the answer was always the same…I can’t afford to.

When the money becomes to good to leave, there is a problem.  When the money over rides personal accomplishment and satisfaction, there is a problem.  The problem is that the person may no longer recognize the person looking back at him in the mirror.  I’ve made 6 figures in this profession.  I took a major pay cut and essentially started over.  I have to work multiple jobs in order to try to accomplish a goal of being my own boss and creating an army of PT’s that have similar goals and wants in the profession.  I will try to keep this dream alive as long as possible.  This is what I am trying to accomplish.

“The concept of work engagement is also relevant and is considered the opposite of burnout. Individuals may demonstrate a high degree of burnout if they report high levels of emotional exhaustion and depersonalization and low levels of personal achievement.”

here is so much that I struggle with in these papers.  I come from a blue collar family.  My dad served as a Medic in the 101st Airborne during the Vietnam War.  When he returned home, he went to work as a laborer putting in water and sewer lines.  He nearly died multiple times at his job and he showed up he next day.  He had multiple broken bones from accidents and he showed up the next day.  Work ethic seems to be a lost trait.  For years, I just put my head down and worked.  I made my first boss look good.  I made my second boss look good.  At not time did I ever worry about making myself look good.  I always assumed that if I made the organization look good that I would reap the benefits.

I had to leave my last job because there was too much of a gap between the highest producer and the lowest producer not only in terms of productivity, but also in terms of patient satisfaction and outcomes.  That’s when I realized that I could no longer continue to work for the same company and decided it was time to put my work ethic to use for my family and my community.

This is work engagement.  When I realized that I needed to shift places of employment, I really learned about professional engagement.  In the year of deciding to leave the comfort of a fairly high paying hospital, I since became one of the most influential people of 2017, simply by putting my head down and working.  I am hosting my first CEU course in the next month and I have found a way to piece together enough hours through other opportunities to cover the lost income from leaving the high paying cushy job.  I will continue to put my head down and work.   I feel like I am accomplishing more at this point in my career than I did during the previous decade.

“Research has demonstrated that burnout and work engagement are negatively correlated”

This is not earth shattering information, but serves to demonstrate that loving your job and actively engaging your work can combat depersonalization and emotional exhaustion.  My previous cushy job had me working from 9:30-6 M-F without any forced weekends or need for overtime.  I was paid higher than the median salary, but I realized that the company as a whole was full of donkeys.  This is a Dave Ramsey reference.  Don’t get me wrong, my immediate team had some thoroughbreds, but they were definitely outnumbered by… you guessed it!

I saw myself climbing the ladder at this location and when I got near the top rung, there was no place left to grab onto.  Some of the people that had the position that I was gunning for had no intention of retiring.  At that point, I knew that if I stayed it would only have been for the $$$$$.

“37.3% of survey respondents were estimated to demonstrate a high degree of burnout based on thier EE (emotional exhaustion) subscale sore.”

Overall, the scores for burnout were average to low, but there were some aspects of the survey that demonstrated high burnout levels.  Being emotionally exhausted is a topic that was recently discussed in a FB post.  One PT posted that he was emotionally drained from the treatment of patients.  This is an issue and should throw up a flag for some employers.  When looking at work engagement and burnout being negatively correlated, there is research that states that high burnout rates may lead to compromised care.  Hopefully, this is actually a concern, but in reality I’ve learned that many corporate based therapy clinics care more about the Benjamins than patient outcomes.

“Respondents 61 years of age and older reported statistically significantly lower mean EE (emotional exhaustion) scores than respondents in other age categories…there was a decreasing trend in depersonalization scores with increasing experience”

There is a light at the end of the tunnel…and it’s not an oncoming train! If you can make it in this field for at least 30 years, then you will no longer let it get to you.  (I’m trying to make a funny).  Why should we have to wait until almost retirement age before we experience less emotional exhaustion and depersonalization.  I have personally seen this in practice, but from my experience, it is due to the therapist just not caring as much.  It’s like some of them have started counting down the days to retirement.  I’ve seen therapists that are more focused on the upcoming vacation than they are on the patient in the present.  They anticipate the vacation for weeks and then leave for a week or two and when they return they talk about it for two months until they start to anticipate the next vacation.  Work is just a way to pass the time while waiting for vacation.  Nothing wrong with that if it’s your style, but that’s not the Doctor that I want treating me!

We have to do better, otherwise the newbies in the profession won’t last until they can reach the age in which they can stop caring about the stresses of the profession.

There were some flow sheets from the paper that I will put in at the end.  I highly recommend reading this paper as a whole if you are interested in burnout.

“The most commonly reported symptoms of burnout related to fatigue and exhaustion”

It’s not uncommon to hear that therapists are staying after hours to complete documentation.  If you are a patient and you have read this far…kudos to you.  After your visit with a PT, the note may take anywhere from 5 minutes to 30 minutes to complete.  If the therapist is spending 100% of the time with you, then the note will have to be completed after you leave.  If the therapist is seeing 12 patients per day, then there could be as much as 2-3 hours of paperwork left at the end of the day.  In many places, this time is unpaid since it is part of the salary.  If it is paid, then it may count against the therapist because the time is “unproductive”, which means that the company is not making any money although they are paying a therapist to work for that time period.  This is a no-win for the therapist…unless they are over 61 years-old, of course.

“Respondents identified many perceived work-related causes of burnout including work overload, unrealistic expectations, lack of recognition from management and client demands.”

Ours is a profession that is consistently ranked in the top 10 professions in the country.  Why would there be people feeling burned out?

We get into this profession with dreams of helping people and fixing the world.  Those dreams are quickly crushed when corporate greed takes precedence over patient care.  It’s not uncommon to see a therapist trying to manage the circus of “treating” (I use that term loosely here) multiple patients at once.  I have talked to therapist that take pride in “treating” 30 patients per day.  I don’t know how much “treatment” actually gets accomplished when there are three patients in the clinic at the same time.  They actually wear it like a  badge of honor.  sometimes these therapists don’t understand that specific insurance companies require that a patient be treated one-on-one.  This means that the therapist is legally required to only charge the patient for the time that the therapist is actually working with the patient.  We are not allowed to charge insurance companies for having a technician (usually a high school or college that wants to be a therapist).

Patients: If you are unsure if the person treating you should be treating you, simply ask if the person has a license

Therapists: if you are allowing technicians to treat patients…why? Does it benefit you, corporate PT or the patient? If you can answer the patient, I follow with one more question…Is there ever a time in which you believe that the patient is in better hands with an unlicensed professional than with you?

Unrealistic expectations? Never!

I’ve seen therapist that are expected to do their paperwork at home for 2-3 hours per night.  I used to be one of those therapists.  You essentially are working 60 hour weeks for 40 hour pay.

If a patient is doing well and is ready for discharge, good luck with that.  There is pressure from some supervisors to keep patients longer than they need to be in therapy.  This too is illegal, but I hear about it on a monthly basis from therapists all over the country.

Client demands! The client is the boss.  There are very few demands from the client that we shouldn’t attempt to accommodate. The chief demand is accessibility.  Patients want access to therapists essentially around the clock.  This is to be expected in a social driven by social media and access to news/information and advice.

“…burnout prevention…maintaining a healthy lifestyle, and the importance of social relationships.  Within the work environment, flexible hours, career change, positive workplace relationships and continuing education were perceived to help prevent burnout”

All you new grads………

Re-read that paragraph!

Get out there an move! Be an example that your patients can follow.  It will not only give you more authority with your patients, but it may save you from burning out in the long term.

Flexible hours are a plus, but the positive workplace relationships is what kept me in a position for 10 years.  I was able to work with the thoroughbreds for a majority of my career.  I started at that location taking a pay cut from the previous job because I was impressed with some of the people with whom I would be working side-by-side.

Recommendations for employers:

identify burnout early

improve communitcation

address flexible work hours

provide recognition

provide professional development

These are paraphrased from the article and I find some of them overkill.  Zig Ziglar repeatedly stated that people would quit jobs because they were underappreciated.  I have never felt this way in my over a decade long career.  I have always been the work horse in the company, whichever company I worked for, and have never felt unappreciated.

Work hours are important for family and life balance, but goals have to be determined.  If work-life balance is the chief goal, then the flexible hours are extremely beneficial.  If work and learning your craft is important then so be it and make your choice from there.

This is by far and away the most important post that I have done in the previous 2 years of posting.

I hope that all those that read this learn from this and don’t allow themselves to get eaten up by this profession and fall to the wayside due to burnout.

Excerpts from:

Bainbridge L, Davidson K, Loranger L. Burnout Among Alberta Physiotherapists: A White Paper. Physiotherapy Alberta. 2017: