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Re: mad as hell and not going to take it anymore!!!
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 1:16:00 AM
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clydesdale6
Posts: 65
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oh, by the way. "I am mad as hell and not going to take it anymore" is one of the most famous lines in Hollywood. But I guess nobody got that. Anyway, my original post asked for ideas. I have heard the apta idea. What else? Is my T.V. ad idea crazy?
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 2:28:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Clydes-
No is "hating on" you, as jay put it. I just read the thread and I see a lot of support for you and a lot of positive suggestions, most of which you spurn, and then you claim those here aren't interested in financial advancement. I don't believe that is true.
Randy is right in that we could use some direct-to-consumer marketing, but insurance reimbursement and DA laws need to progress as well.
If anyone is out there and doesn't think the APTA does anything for us, they are simply misinformed. I sat next to an APTA government affairs person on the plane to CSM a couple years back, and was AMAZED at all they do.
Nurse organizations don't have commercials. Medical equipment companies such as Johnson&Johnson's stands to lose money if there are fewer nurses and fewer customers for their products, so THEY are the ones with the commercials.
Last I read our unemployment rate was 1%. I've never found one of those 35hr per week jobs Ben mentions, but hey anything's possible. Overall, if everything else is good but the money, then your business needs to expand into revenue-producing areas. Ben has probably the best advice b/c he's been there, done that.
You asked what to do? Let me repost some of your suggestions from the field so far:
-Get INVOLVED with APTA, don't just send them your money. Get involved via your state chapter or get a local study group of PT clinics going.
-Write letters to your congresspeople and encourage your patients to do the same
-Write newspaper articles for local papers about PT and your practice, TV ads are too expensive, IMO
-Improve the marketing of your clinic by visiting referral sources or appearing in local areas and describing your skills. Have you tried a spinal screening in a mall or Walmart? Whoops, wrong profession! :)
Try those.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 2:32:00 AM
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tr6454
Posts: 60
Joined: March 6, 2004
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If you want to run TV ads then the $4500 may not be out of line. Have you seen what it costs for an ad in USA today, or a 15 second TV promo? The APTA developed a 1 minute ad to be used by PTs, "moments like these". Has anyone seen it? used it? Cost the APTA about 100K to produce.
Clydesdale, realize that there are places where you can work in a private practice, have direct access, and practice collegially with MD's. It can be very satisfying professionally. It still may not provide you with the type of income you are looking for but - then you could always cut your salary in half, double your responsibility, and get a vacation in the desert - join the Army!
_____________________________
Terry
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 3:20:00 AM
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SJBird55
Posts: 2242
Joined: May 10, 2004
From: Michigan
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The APTA, in a way, has done some things that help members to see what the APTA has done and does do. In particular the last 2-3 years, the APTA has been more diligent at communicating what the government affairs department has been actively involved in accomplishing. (The improved sharing of what the APTA does/has done began some time after Justin Elliot came on board.) For all physical therapists, the APTA has been involved at a state level - for MI - we've had issues with a new law to eliminate PTs from performing EMG services. Athletic trainers are attempting to do what we do and be paid for it. Of course the APTA has been involved with disagreeing with the Medicare cap. The APTA was involved in MI with not allowing the chiropractic scope of practice to infringe into the PT territory of physical medicine and rehabilitation. There's some crap going on now in regard to orthotics and prosthetics. The APTA has been active in attempting to reduce referral for profit situations. I'm not sure how helpful the APTA was for Michael Teston when he got into his situation in Arkansas though. It does give one pause to think - the issues the APTA tackles are those that affect each and every one of us that are PTs, whether we are members or not.
Not participating with insurance companies is a good idea. To make it successful, I would tend to believe that rallying all the independent clinics to not participate would make a very strong impression on the public in the local geographic area. My goal in 3-4 years, IF I can gain a great reputation, is going to be to not participate. Third party payers are more of a headache than I ever imagined they would be. Right now though, I won't run the risk of people not wanting to pay... I also think in 3-4 years that potentially health saving accounts may be somewhat common and that mentality of "having to pay" will be more prominent and not such a hurdle for the public as a whole.
In regard to the $17/treatment, I ask one question, why? From a business perspective, why agree to something like that? Just say no. There are two views on reimbursement. 1) a PT company can participate with every policy possible to make it easy on patients and make it easy on referral sources. In making it easy, that means some contracts will be $17/treatment... or 2) a PT company can review various contracts and only participate in contracts that meet business plan expectations. It is a business. If the reimbursement scheme doesn't mesh well with a business plan and the cost of doing business, well, say no. Why sign a contract like that?? So, from a reimbursement perspective, we've kind of done it to ourselves. In the "how low will PTs go" financial game, we've screwed ourselves and apparently we'll go pretty low - $17 does not fit in my business plan and I'd politely say "no thank you."
I don't think that we can stop referral for profit situations. We might be able to potentially convince third party payers of the conflict of interest that exists, but stop referral for profit, no. They could just as easily as we could not participate with any third party payers. But what we could do... educate the public. The freedom to choose. In my area, the physician owned practices play a lot more fairly than the hospital owned practices. In my area, the physician owned practices have an 8 1/2 by 11 referral form that has a lot of PT clinics listed by location. The hospital owned practices only leave their referral pads with only their locations on those pads. But... if one were to spend the time educating the public in one's geographical area about the freedom of choice and what to expect during the provision of physical therapy services and how to choose providers - we might be able to move business away from referral for profit situations.
Generally, if a physician orders something that is ineffective, I tend to make a phone call to that office and speak to either the triage nurse, medical assistant, physician assistant or nurse practitioner. Instead of slamming the use of the ineffective approach, I instead communicate my game plan with a time period of when I anticipate seeing outcomes and the degree of the outcomes I'm anticipating to achieve. I generally toss in that I'd prefer to try my game plan first for X amount of time and then if there is not a response then I'll go ahead and switch to whatever ineffective game plan was outlined for me. That tends to work pretty well for me - it eliminates the pissing match and headbutting. The person at the other end of the phone conversation always tends to agree with whatever I propose.
clydsdale, we do have a lot of frustration in this field. In a way, we've done it to ourselves. To move forward, will take learning from the mistakes of the past and not making them in the future. To move forward will take our voice to be heard.... both money and that "squeaky wheel" saying will be key factors. The future does have a potential of being bright.
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 3:27:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Awesome, SJ. Couldn't have said it better.
I was hoping you'd chime in.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 5:50:00 AM
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karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
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[QUOTE]Howard Beale: 'I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!' I want you to get up right now, sit up, go to your windows, open them and stick your head out and yell - 'I'm as mad as hell and I'm not going to take this anymore!' Things have got to change. But first, you've gotta get mad!... You've got to say, 'I'm as mad as hell, and I'm not going to take this anymore!' Then we'll figure out what to do about the depression and the inflation and the oil crisis (and insurance reimbursement). But first get up out of your chairs, open the window, stick your head out, and yell, and say it:
Howard Beale: [screaming at the top of his lungs] "I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!"
[/QUOTE]
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 6:16:00 AM
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OAK
Posts: 183
Joined: September 1, 2003
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Great post SJ!
The "referal game" is a tough one. The only true way to win is to do the best job possible and ultimately the patients will come to your clinic.
If patients are seeing a Physician owned P.T. clinic with a lousy P.T., the patients will seek a new Physician.
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 7:22:00 AM
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karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
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Hey Terry, don’t make fun of me! I’m one of those poor guys in the Army living off of MREs, sleeping in a GP medium, and ruckmarching 12 miles to work every morning because I can’t afford a bike. And this is in Hawaii where it surprisingly snows to and from work!
Clydes – The majority of private insurance companies use some form of the RVU process to determine their fee schedules. The payment per RVU is set, but the RVU is flexible and represents the “value” of your services compared to a benchmark RVU of 1.0. Now if you believe that your services are being unfairly reimbursed compared to other healthcare providers why don’t you seek to facilitate change in this arena. First find a PT RVS committee – most likely within the APTA. Then determine which codes should be changed and compare those codes to 15-25 other services as reference points. Send out surveys to at least 30 respondents. Analyze results and send a recommendation for change to RUC. Piece of cake!
If you don’t like the way APTA operates get involved to make a change.
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 7:41:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Wow, the posts here are almost exactly the same as what I am seeing on the chiro assoc's listserv, with the exception of physician owned practices.
What is the problem? Is it underutilization of conservative care (DC/PT)? I think that is part of it. Who is our enemy? I do not think it is each other, but rather the pharmaceutical industry. If everyone understood the problems with pharmaceutical care, like side effects and inability to address the problem, patients would come to us more frequently. If there was a shift in understanding, PTs and DCs would have more patients than we know what to do with. Then, we could tell MCO's and third parties with low fee schedules to shove it.
So, is it time to take the gloves off? Maybe the chiro and PT association's should run a joint ad campaign exposing the problems with relying on meds and surgery for musculoskeletal pain. We can make them look like those Truth commercials that expose the tobacco industry.
Dont get me wrong, I am not anti-medical in any way, but we need to let the public know the facts. The NEJM certainly doesnt hold back when they try to compare PT and spinal manipulation to a general exercise, a booklet, or whatever other garbage they want to compare it to.
The problem is, the pharmaceutical companies have about a zillion more dollars than all of the DC's and PTs combined.
What we can do is educate one patient at a time. Explain to people what we do and ask them if they know anyone with musculoskeletal problems and suggest they find a PT or DC to help them instead of going the drug and surgical route.
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 8:08:00 AM
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tr6454
Posts: 60
Joined: March 6, 2004
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Zack,
No 'fun'intended. I've been there.. (retired 97). Actually paying tribute to those of you still on active duty, carrying the load for all of us, exemplifying the utmost professionalism, demonstrating clinical excellence, sacrificing personal freedom for God & Country - WITHOUT WHINING about what someone else should do for your situation. Thank you AMSC corps!
_____________________________
Terry
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 8:26:00 AM
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JSPT
Posts: 266
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From: Michigan
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Most PT's in my graduating class treat PT and business like religion and science: they must stay 100 yards from each other at all times.
In general, I think our profession is not very skillful in business. Look at the chiropractic profession. Do they know more than us? Of course not. Do they kick our *** in almost every corner of business? Absolutely.
Direct access is only part of the problem. Until individual practioners take an interest in business, we'll likely stay where we are.
As a sidenote, I wonder what working for a hospital has to do with this. I think that a slight majority of PT's are employed by hospital systems or large clinics. How much do hospital PT's care about making money for the business, excluding patient care issues? Most chiros work for themselves or in partnerships, so I imagine that they are much more highly motivated to keep an eye on the bottom line.
BTW, for you chiros reading, how many patients do you see on a good day?
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JS
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 8:45:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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I am just starting up, but I have seen as much as 17 in one day. On average, I see about 10. I schedule one every half hour and seeing only 10 is a piece of cake. Although, if I could stay at that pace, it is more than enough to pay the bills and myself. The key is keeping overhead very low. Give me a table in a room with some therapy equipment, an open room with theraballs and some therabands, and I am good to go.
Most chiros I have talked to/observed in practice for more than 5 years is at about 20 visits per day. Make that ethical chiros. There are the few that see 50 per day, but that is rack'em and crack'em and cya later.
The ones that see 20 usually have a few assistants to help out with modalities, rehab or soft tissue therapy/massage.
Oh, and overall we suck at business too. We get virtually none of it in school. I am flying by the seat of my pants and thank god it is working out so far. However, for the ones that make it, I guess we eventually become pretty good at it. PTs may not concentrate as much on business because they dont really have to since there are plenty of paid positions out there that are relatively decent. For us good paying positions are far and few in between, hence my decision to struggle and tough it out for a few years and eventually make some good money (I hope).
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 8:58:00 AM
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karmzack
Posts: 181
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From: Hawaii
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Terry, I know you were kidding. Really I wouldn't want to work anywhere else, those insurance issues sound confusing :)
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Zack Solomon MPT, OCS, CSCS
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 12:59:00 PM
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clydesdale6
Posts: 65
Joined: January 2, 2006
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JSPT - Great response and that is one of our major problems. Many of us are martyrs and think the quest to accel financially is immoral. Just read back and look at some of the posts and one of the other threads i responded to. Did I insult anybody? No, but a few have made me out to be money hungry or maybe I don't like being a P.T. and should leave the field. Or that maybe I am whining. I think I even got a suggestion to join the army. I respect the military greatly, but that is not a current option.
I simply voiced some dissatisfaction and asked what can be done, besides joining the APTA. That is all. I am getting the impression some can't tolerate any negativity toward the profession. I am pro P.T. or I would not have bothered with writing in this forum. But I must say, some of the responses remind me of some of the anal retentive students that used to be in my class. Is this the way you usually handle someone who is asking what they can do? Granted, the title was used to get attention but was designed to be humorous if anything. I hope some of you are a little more humble when dealing with your patients.
Anybody have a list of legislators for NY or a contact list that will cut my time down?
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 1:17:00 PM
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SJBird55
Posts: 2242
Joined: May 10, 2004
From: Michigan
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Use your zip code to find your representative(s):
http://www.house.gov/
Click on your state to find your senators:
http://www.senate.gov/
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 2:26:00 PM
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clydesdale6
Posts: 65
Joined: January 2, 2006
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Thank you kind sir. Do we have any form letters? I can write my own of course, but wonder if there has already been a good letter campaign that has all the pertinent issues. I appreciate the links for the officials.
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 3:32:00 PM
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karmzack
Posts: 181
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From: Hawaii
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[QUOTE]a few have made me out to be money hungry or maybe I don't like being a P.T. and should leave the field. Or that maybe I am whining. [/QUOTE]Clydes, Lets look at some of your quotes:
“It appears to me that this profession is going no where.”
“I didnt go to school for 7 yrs to max out at 65k.”
“I couldn't possibly recommend this profession to anyone.”
“I have waited for things to get better for the last 5 years, they have only gotten worse.”
“The pay is not there.”
“The money is not here.”
“As far as the APTA goes, I will not give them a dime.”
“I wish someone told me in school what it would be like. I would have saved myself some money.”
“I am considering Law school and teaching.”
I don’t think you insulted anyone, but it would appear that you dislike what you do for a living. Don’t take my question “Do you enjoy being a PT?” as an attack against you, I was just curious if there was any reason for you to stay in this profession and it sounds like there is! First take a step back and be thankful that you found something you enjoy doing (and you’re not out digging ditches). I understand your concern about the pay, you need to be able to support your family. Now go out there and demand change!
…..and stop whining ;)
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: mad as hell and not going to take it anymore!!! - January 4, 2006 4:07:00 PM
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clydesdale6
Posts: 65
Joined: January 2, 2006
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Nope dont dislike what I do, just dislike the pay and my apparent earning potential, or lack there of.
I know I am not alone in that. Hopefully things will change. But as a guy with kids and a mortgage, I would probably have made another career choice years ago. But it would strictly be for financial reasons. At least I don't hate what I do and hate the pay at the same time. This would be the PERFECT JOB if we just earned a little more. Thanks
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Re: mad as hell and not going to take it anymore!!! - January 5, 2006 12:58:00 AM
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SJBird55
Posts: 2242
Joined: May 10, 2004
From: Michigan
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clydesdale - yep, there are already letters for a letter campaign. I'm going to mumble this and then walk away kind of quick before you slug me - for "members only" at the APTA site are all the political advocacy issues. I don't have time right now to assist you with that matter, but if no one else does, I'll see if I can help. What issues (legislative bills) did you want to address?
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Re: mad as hell and not going to take it anymore!!! - January 5, 2006 2:26:00 AM
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clydesdale6
Posts: 65
Joined: January 2, 2006
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physician owned practices, in my area it has PROVEN deadly. Yes, there are ethical physicians that will give a list of clinics to their patients. But the ones that I have experience with have the power to open up a practice today, make it successful and shut down other therpist or hospital owned practices. Physicians are more business minded than us and they have more power. There power is something that is very difficult to overcome. In my state of NY, I would like to start with that.
By the way, no slugs from here. If I thought the APTA would help a non-member, I would have called them. Thanks for your help.
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