It Is Not Always Roses
From employee to owner back to employee
By Christine Taylor, PT, DPT
Remember that surge of excitement when you accepted your first position as a physical therapist? The feeling you were going to heal everyone and change the world.
I remember signing my first employment agreement and thinking this is more money than my parents ever made.
Those first few years as a physical therapist were filled with many learning experiences. Five years into my career, my skillset and knowledge were such that I could work anywhere. I wanted to advance, and considered working in therapy management, but the job market was starting to get tight with fewer high-paying positions available. Additionally, the shift to managed care made patient care more difficult with payer cuts to therapy becoming prevalent. Driven by the demands to increase efficiency and reduce expenditures, therapy management positions became more complicated and less desirable.
Although the career outlook for physical therapists was positive, the complexity of the healthcare market made every job seem more like a job than the career I sought as a new graduate. As I interviewed for new positions, I realized patient care was taking a backseat to efficiency and productivity. Frustrated, I knew if I could create my own set of rules, it would be less complicated than dealing with the hierarchy established by someone else.
MAKING THE LEAP
I made the leap to private practice in October 2003. I built the business from the ground up, physically, and financially. I didn’t want to be at the mercy of anyone for anything I could do myself. I learned everything I possibly could about the business of therapy. I became laser-focused on establishing policies, and procedures, negotiating contracts, purchasing, and making decisions on documentation systems, billing systems, and so much more.
The practice grew rapidly, and we did very well for many years. Being self-employed gave me the autonomy to provide therapy the way it was meant to be — with patients’ needs coming first. I was proud of what I had accomplished and the reputation for being the go-to clinic in the region. The financial rewards were great, and we were able to donate money to many worthy causes.
The downside was I typically worked 60 hours per week and still struggled to meet all of the demands with compliance standards, claims issues, taxes, human resource issues, repairs, maintenance, and keeping up with the financials.
We had been open for 15 years and I was completely exhausted. I needed to take a step back. After 18 months of diligent contemplation, I decided to close the practice. I couldn’t imagine anyone else taking over what I had painstakingly built. People came to rely upon my expertise, and I didn’t want to compromise my reputation if another company took over.
TALK ABOUT BITTERSWEET
The decision to close was the hardest decision I ever made. But by that point, I wasn’t sure if I wanted to be a therapist anymore. Talk about bittersweet. After 15 years of achieving my dream, the dichotomy of emotions was unbearable. Today, I have the comfort of knowing I truly changed lives, and I am still in contact with many of the families I served.
I took an 18-month hiatus before I started investigating the job market. I quickly learned the interview and hiring process was excruciating. Employers had made a shift to behavior-based interviewing and EQ was all the rage. I can’t count the number of interviews I bombed because of freezing and bumbling questions. I also learned I was over-qualified but under-experienced, and as a “seasoned” therapist (a nice way of saying you’re old), many companies didn’t want to hire me. I settled on some PRN work and eventually cycled through four full-time positions working as a staff physical therapist for an orthopedic surgeon and a manager for skilled nursing and assisted living communities.
Along the way, I encountered working environments fraught with problems. From fraudulent practices to personnel issues, volumes of policies and procedures, expectations over productivity and efficiency, and the rules — don’t get me started. The process made me feel overworked and underappreciated.
BACK AS AN EMPLOYEE
The transition back to being employed was bumpy. I struggled to learn how to be an employee. It was tough working under someone almost half my age and with less experience. I couldn’t make the rules, set my own schedule, or take time off when I wanted. The plus side was I had a regular paycheck, health insurance, and I could go home every day and not worry about the business.
Five years later, I found a position that offered a lot of autonomy. The role is like having my own practice, but with a lot of support. I have no regrets about making the change to being an employed therapist but there are still a lot of challenges. As an employed therapist, I have the comfort of knowing there is a regular paycheck and perks such as bonuses, health insurance, and paid time off. The best part is, when I am off work, I am off work. No one is texting, calling, or sending emails. I feel like a valued part of a team.
The shift from being an employed therapist to a self-employed therapist is a transition offering many risks and rewards. Conversely, for those who want to transition from being self-employed to being employed, the transition is just as difficult, if not more so. Anyone considering either one of these decisions should take time to evaluate all their options. Consider the motivation for the change. Will a change satisfy the motivation behind your desire to change? What do you see yourself doing? What working environment best suits your experience? Are there options you may not be aware of? How much longer do you anticipate working as a therapist?
The beauty of a career as a physical therapist is that there are many options. Few careers offer the flexibility, autonomy, and financial rewards that working as a physical therapist does.
Christine Taylor, PT, DPT, , is an APTA Private Practice member with over 25 years of experience. She is the former owner of a specialty private practice in middle Tennessee. Dr. Taylor is currently the owner of Wellness Worx Group and is employed as a Clinic Director for a national outpatient therapy corporation. You can contact Dr. Taylor at firstname.lastname@example.org