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working conditions in the USA
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working conditions in the USA - May 2, 2005 6:26:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
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Hi there everyone,
I was wondering what conditions are like in private musculoskeletal practice in America?
-Are employees paid in percentages or salary? Are they expected to meet targets to justify their salary? Do they get holiday and sick leave?
-What is the average wage for PT's?
-In general, is the labour market in a good state for employees?
In my town, Perth, Western Australia, conditions are very poor. A lot of people, myself included, leave or are leaving the profession due to dissatisfaction with working conditions. The major obstacles we face are;
-rampant overservicing
-lack of an award rate in private practice
-lack of autonomy in practice/financial disencentives for practicing ethically.
Is this trend a new phenomenon? (I've only been working for 4 years) Has anyone made an attempt at addressing these issues?
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Re: working conditions in the USA - June 10, 2005 9:42:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Tim-
Situations here vary greatly about your questions. Standard of living in the area where you work is key to determining salary.
PT autonomy is determined by individual state law. You can make a very good living as a private practitioner in the States, but of course, up-front cost is an issue.
Any non-private practice position that I have ever seen is salary based.
I can't give you any specifics, since I work for the US government and am rather insulated from a lot of those concerns....for now.
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"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,PT
**I no longer post on RehabEdge**
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Re: working conditions in the USA - July 2, 2005 1:19:00 AM
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cadenza2
Posts: 17
Joined: June 22, 2005
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Hi Tim.
About Australian conditions.... I too am getting disillusioned with the system. I agree with the rampant overservicing, minimal pay rate (percentage sometimes without a base rate), not getting paid for paperwork time and no holiday or sick leave. Really, it sucks.
I am wondering if there is anything better out there in the world of physio or is this as good as it is going to get??
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Re: working conditions in the USA - July 4, 2005 7:23:00 PM
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Randy Dixon
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Quick answer with a lot of generalizing. A PT with 4 yrs. experience should get about 65K, two weeks off a year, insurance and 401k(an employee/employer matched retirement fund). With jobs available just about anywhere a person wants.
On the downside I think there are production pressures, some lack of autonomy, no reward for more education/good results. Burnout seems fairly common.
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Re: working conditions in the USA - July 4, 2005 7:25:00 PM
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Randy Dixon
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I think that the model to run a PT business should be like a doctor's group or law practice. With a shared building, equipment and administration but with each PT acting as a private practitioner. They schedule their own patients, work as hard as they want and are responsible to themselves.
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Re: working conditions in the USA - July 4, 2005 10:04:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
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65K in US dollars is a lot for 4 years experience. In Australia, I was struggling to earn over 40K Australian per annum after 4 years experience. Like everyone else, we are subject to market forces and where I live profiteering corporate physiotherapy clinics and universities have flooded the local market. There are several physiotherapy clinics in every suburb.
One interesting statistic that is commonly kept by physiotherapy managers in private practice in my city, Perth, is the ratio of new episodes of treatment to total consults in a week. My average used to be about 5.5, and I was told that this was quite under acceptable levels. Incidentally, that was with roughly 60% of patients with private health insurance or no cover and 40% under workers compensation or funded treatment from a MVA.
Of course, there are many physios out there with similar levels of experience out there who were earning far more.
Has anyone, especially in the US, tracked that statistic? If so, what are acceptable levels of service in your opinion? What are the benchmarks?
Personally, I think the whole thing is quite ridiculous anyway.
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Re: working conditions in the USA - July 4, 2005 10:10:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
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Jason, I understand you work for the army. Is that right?
What is that like? I have pondered doing that myself, mainly to get out of the private practice ratrace. I understand there would still be pressures, but hopefully the pressure would be to get people back in action quickly-not to create a therapy dependancy.
How do your medical colleagues view your empirical, EBP approach? Does it create any conflict?
The reason that I ask is that I could envisage there would be some reduced level of autonomy in the military, with prescriptive treatments being delivered from Doctors?
Does the 'intensive treatment' mantra raise its head? ie. that physio twice a day is bound to help you recover more quickly etc etc
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Re: working conditions in the USA - July 14, 2005 1:53:00 PM
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piedbushchat
Posts: 2
Joined: July 13, 2005
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Hi there,
I am new to US. I've done 3 & half years physical therapy degree from India.
1. where can i do the remaining credits in pennsylvania?
2. how much would be the cost?
can somebody please help me?
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Re: working conditions in the USA - July 22, 2005 10:48:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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I think Randy's vision is the way to go.
Keep in mind, once you cut the third party umbilical cord of government or insurance reimbursement, your patients pay you what you both agree you're worth.
I can't imagine doing anything but private practice, cash based when I get out of the military.
Tim-
To answer your question, I LOVE being a PT in the military. We are granted credentials in military hospital systems as a "Healthcare Provider" -just like every other independent professional, from physicians to podiatrists to optometrists.
I am not bound in any way, shape, or form to do anything any physician asks of me. We have a great relationship with the many excellent physicians in the Army, and there is a very high level of mutual respect. Our medical colleagues have been uniformly impressed at the level of competence and use of EBM we display. We have privileges to order Xrays, CT studies, sometimes MRIs, prescribe basic medications, and give work excusals. It very much is the future of where PT is going, at least in the US (except maybe the meds, which I very rarely prescribe anyway, and don't find terribly helpful overall).
I do know the Australian Army has no active duty physios, but they are government employees who work hand-in-hand with the physical training instructors the Army has.
Good luck.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"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,PT
**I no longer post on RehabEdge**
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Re: working conditions in the USA - July 22, 2005 9:07:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
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Can anyone answer my post about meeting treatment quotas/ratios (about 4 above)?
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Re: working conditions in the USA - July 23, 2005 12:06:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Timothy,
The job market ebbs and flows here just like anywhere else. A few years back, the Universities were graduating too many PT's and the market was flooded (when I entered PT school). Now, after many schools have switched to the DPT and begun admitting smaller numbers of students, it has become a PT market. We can't find people to hire right now.
I work for a hospital-based clinic and we do have quotas (10 patients in an 8 hour day) and the productivity is part of the budget for the clinic (to get raises, etc.) Typically quotas will be smaller at larger clinics. When I worked in private practice we saw closer to 25 patients in 8 hours. The benefits tend to be better in larger systems vs private practice, but not always. (I have four weeks vacation, health insurance and 401K). The pay is average and PTs are salaried. Check out salary.com for specific salary averages in different states. Hope this helps!
Sarah
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Re: working conditions in the USA - August 3, 2005 1:34:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
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Thanks Sarah.
It's great that you have publicly funded musculoskeletal PT. In Oz, we do have this to a small extent but if you work in a hospital you will be doing rotations and probably get outpatients for 25% of the time. The rest of the time you will be in the 'spit pit' as it's called! (Slight exaggeration...) I have heard the UK is similar, lots of my physio friends are over there now. I'm working as a 'lifite' at The Remarkables ski resort in Queenstown, NZ. So, I can't complain really, free skiing and riding!
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Re: working conditions in the USA - August 3, 2005 1:39:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
Status: offline
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As a quick aside...still really interested if anyone can produce actual figures by which performance is measured in p. practice in the US.
Cheers,
Tim
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Re: working conditions in the USA - August 4, 2005 8:03:00 AM
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Sean Weatherston
Posts: 102
Joined: August 3, 2005
From: Idaho
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Tim,
The hospital outpatient clinic I used to work for used a "manhours per stat" calculation. Take the number of hours worked in a day, and divide that by the number of modalities (15 minute charges) performed. Say you charged for 24 modalties in an 8 hour day...your manhours per stat would be .33. At our facility, a PT was expected to be at or below .40 each day.
Another means of figuring productivity is taking the number of mods performed divided by the number of 15 min. segments worked to get a percentage. A lot of places around here expect 80-90% productivity using that calculation.
Hope this helps,
Sean, PT, OCS
_____________________________
Sean Weatherston, PT, OCS, CSCS
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Re: working conditions in the USA - August 4, 2005 1:00:00 PM
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Timothy
Posts: 31
Joined: April 20, 2005
From: Australia
Status: offline
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Sean,
Thanks for that. Your situation seems like you had lots of patients waiting and that it was a matter of ensuring the PT's were working quickly enough to get through them. Am I right?
The situation where I have worked is that there is a shortage of new patients, so that you were very rarely fully booked. Productivity rates weren't really an issue-more so 'utilisation' rates ie. how many sessions you were generating per new patient. I guess if the clinic is flooded with patients you need to ensure the PT's are not wasting time but if their is a shortage of work you need to make sure current patients are being 'utilised' effectively. Awfully 'utilitarian' to say the least. Pun not intended...
What kind of marketing are employees expected to do in the US? I understand there is probably a great deal of variation between clinics. One of the clinics I worked at expected us to do a followup call for each patient. I didn't have much of a problem with that however as it was more about establishing a relationship than soliciting for further sessions. It did feel kind of wierd sometimes...calling someone you had seen for maybe two sessions and they felt like you were putting on the hard sell. It also felt bad calling someone to whom you had been forced to provide inferior service due to double-booking...
Anyhow, any more info. would be much appreciated.
Tim
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Re: working conditions in the USA - August 4, 2005 1:20:00 PM
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Randy Dixon
Posts: 744
Joined: August 6, 2004
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Well, everyone here seems to be talking about Outpatient clinics, since that seems to be the setting most PT's on this forum work in, there is also home health, in patient hospital,
SNIF's and nursing homes, all of which employ a lot of PT's and which generally track productivity differently and imo less stringently.
In the OP department we track by units of service (15 min) with 32/day being expected. This means with Medicare patients you are fully booked with no down time. There are also other measures Full time employee min. to unit charged etc. In other words, someone will be checking to make sure you are making money for them. How much pressure their is to do this varies. Usually, PT owned facilities impose less pressure on this and more on patient outcomes.
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