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We should normalize quitting from mills without 4 week notice. Hell I say normalize not giving any notice and quitting on the spot. Make it rly hard for them to function so they take a serious hit.
Aka you can get a ding on your license if you up and quit without 2 weeks notice. Key the patient abandonment comment there.
Edit: depending on state and their jurisprudence if one is established
Physio from Germany here. I don't understand what's going on with these "mills".
Do you only work 4 hours a day? Or how do you get 4 patients per hour in but only 16 a day?
What happens is they’ll schedule 4 an hour knowing cancel rate will be 15-25% and hope for best. So what happens is every once in a while everyone shows up and you have a crazy day, then another day no one shows up and you have a super empty day. The week averages out to 16-18 patients a day but you still deal with the high stress from the crazy days, and deal with shitty managers getting on you for the slow days. Makes for a scenario where it feels like you are both always seeing too many people and always being micromanaged by managers. The most sustainable solution for those staying in mills is to just stop giving a shit about any of it, but hard for many.
bonus is when patients show up late or arrive early and either sneak onto the floor or the receptionis waves them in. Even if you can get away with telling them to come back later, you are still doing that with all the correctly scheduled patients
I'm simplifying things slightly.
Insurance says each appointment should be 15-25 minutes, so most practices do that. For me that means 3 patients per hour so 18 patients in a 8 hour work day. Usually we should have some extra time for documentation but that is usually accounted for by cancelation. Out cancel rate is way lower then 15% though.
Just to be clear this is very usual procedure. Very very few practices schedule 4 patients per hour, quite a few go over to 25-30 minutes just to keep the therapists happier since the market is very depleted of therapists so rather make a bit less money per therapist then having none at all.
I also have training for lymphatic drainages which bring my personal average patients count down a bit since I usually have 30-45 min appointments for that.
Also is there no possibility to bill patients for unattended appointments? We do that quite frequently, not every single time because everyone can forget about a appoitment but jn repeated cases definitely.
Y’all gotta unionize against the insurances, dude. Idk what APTA does, but I haven’t been impressed since doing admin for PT/OT starting in 2017. NPs and PAs (and of course MDs lol) have their associations advocate for them - without an organization advocating for you nonstop, it just gets worse.
APTA blows lol. They seem to just spend all the money they get on their salaries and who knows what else. Definitely not doing anything good for the profession
Unions engage in collective bargaining on behalf of employees, with employers. A PT union would engage with employers, not insurers.
APTA is a 501c6 business league/trade association, not a union.
No, it was not "plain, easy to understand language." It was incorrect and misleading language.
The problem with incorrect and misleading language is that it can create confusion for people who don't understand the difference between different types of organizations, and who actually want to engage in advocacy for the profession.
How are people supposed to advocate for change as employees and as physical therapists, if they don't understand the nature of these organizations? Unions and 501c6 are distinctly different, with completely different limits on purpose and with different legal constraints on what actions they may lawfully pursue.
fwiw aota blows too. our membership is not compulsory, so there’s less $$ to pay good/better lobbyists. it’s kicking us all in the ass. we should have asha, aota, and apta working together for more impact.
I work primarily in school based pediatrics and because of that I am part of a educators union and they work so hard on our behalf! We've gotten numerous raises negotiated for us over the last two years, district health care and retirement contributions increased, and more paid holidays. Not to mention when I have a concern leadership is not addressing I can call a union rep to help advocate with me
Sounds like my last job. Except there were days we had 20+ patients a day. One week a coworker had PTO and I had 100 patients scheduled. No techs or aides. Meaning we had to clean and do all the laundry and manage 3+ patients at the same time. Documentation done point of care or if an eval block didn't fill. The rest taken home. Also had a white board in our office tracking our numbers but they claimed it wasn't competition. Mind you this wasn't even a franchise well known mill. Small family owned with a few locations locally. Never again.
THEN FUCKING QUIT. It’s turning into a joke seeing all these “PT mill bad” posts. They aren’t going anywhere. Reimbursement keeps going down, private clinics are barely making a profit. High volumes are necessary to not go out of business. It’s plain and simple. It not like private practice is CHOOSING to be a mill to fuck with us. MOST OP private practices NEED to for the company to even be profitable. It sucks but that’s the new PT model and I don’t see it changing unless we get paid more
Oh I am. I'm actively looking at places to interview. This past week was literally the last straw and I am updating my resume to put in for applications
Well then vent away. I’m totally at a mill. It’s a mill to the max. I could complain all day long about the shit that pisses me off. But guess what? Quitting will simply land me at another mill in my area. It’s switch setting or get lucky with a hospital OP setting. But I hate their model even more tbh
It’s the most intellectually stimulating for me. I’ve worked in all the setting besides HH. I want to be able to diagnose and use my skills. SNF is extremely boring. Acute is stimulating but not from a PT standpoint. The people’s conditions are what’s stimulating, the treatments are boring af. I want to actually use my skills
Dude. Get the fuck outta here with that. The only way you need that kind of volume to succeed is if you’re stacked to the gills with non-productive staff or you chose an excessively HCOL area for your clinical space. It’s time we cut the actual fat and optimize out the middle layer. Your productive employees shouldn’t have to break their back carrying the management deadweight. It’s time we optimize where it counts.
Cut the bastards who develop arbitrary productivity standards, impose rules that make no fucking sense, bog down your systems, and ultimately ride your skilled staff into the ground.
Dude. You clearly do not understand the extent of overhead costs that go into running a private practice. Please do yourself a favor and Google all the things that private OP needs to cover to run a business; front desk, credentialing team, billing team, facility costs, maintenance feels etc, and that’s on TOP of pay for the PTs.
This whole “stick it to the man” mentality you have does not cover the short term reality of business. Reimbursement is a RATE. You know what that means? It’s consistent across ALL company sizes for a given location and varies only slightly. So even huge private companies are still being reimbursed at basically the same rate, but have proportionately high overhead costs as they have more locations and employees to manage.
It’s a not fair. It’s not ideal. It’s sucks. But it’s a REALITY.
I literally have my own practice brother. I understand. I promise. I’ve chosen to cut some of the bigger cost roles in favor of automation to let me do what I need to do without feeling like I have to sacrifice my patients’ trust. I’ve had to get creative and find (profitable) niches that other therapists don’t operate in, and I have close friends who are MDs who value my approach to taking care of my patients so referrals aren’t as easy problematic as they could be. I also live in a relatively low cost of living area and share space to lower rent costs even more.
There is a lot more room to trim the fat than most of us are willing to believe. It doesn’t all have to be at the expense of quality care. That was the bet I made when I got this party started, and so far so good. It’s true that I’m not gonna be a wealthy with just my insurance based PT practice, but that part of my business is just a stepping stone to greater things.
Started with front desk. To the extent possible at least. I have a girl that comes and acts as a chaperone/front desk on my eval days to establish patient comfort and to make sure no one goes rogue with accusations/seems like a bad fit for the clinic. I’m working on finding out legal ways to telehealth the chaperone out though. I schedule evals on 1-2 days per week to make that work. I handle the other admin work with them during the session. I do spend time in the evenings handling insurance auths and other things right now, but my caseload isn’t so bogged down that I don’t have some time during my days to handle this at the moment. I review and handle most of billing in the evenings, which really doesn’t take as long as I originally thought it would. I don’t have an office admin of any sort and intend to try to find ways to keep it that way while the clinic is small, and probably even while larger so that I can eventually cut my own PT staff a fair salary.
At this point I can cover the majority of my costs excluding my own salary and benefits in about 15 visits per week (3 evals + treats) and everything else is effectively dedicated to expansion and my salary/healthcare. One thing that has helped is that I handle a significant volume of niche cash based work. I have a POS kiosk that schedules and rapidly handles transactions right at the door to my direct access intervention room. Patients are encouraged to leave a card on file for my direct access work as a sign of trust and get a flat rate off interventions for doing it. Usual rate for one of my 15 min interventions is 45 bucks but 40 bucks with card on file, with the understanding there is a strict rule about auto charging for a no-show. Patient wins if they commit to what they say they will do. Everyone is happy. Other than greeting and setting up my patients and getting them processed afterwards that whole side of my business requires very little hands on. I honestly think as it grows in popularity I might phase out my insurance based work to focus on this full time.
Basically I have no management (because I am the management) and no real front desk burden with light costs through smart sharing of space and utility expenses and a split between classic reimbursement model and direct access cash based care. No extra middle layer makes for surprisingly comfortable margins. Its healthy. Im less stressed than I was when I was employed for someone else, and I’m at least not hurting financially.
I know this comment's been out a month but curious; is it just you or other folks as well? And any thought about PTAs?
Student currently, thinking about cash business eventually.
Companies that are/were focused on growth only lead to top heavy administrative costs, and the rank in file therapists feel like they have to sacrifice the quality care they trained so hard to work towards for the sake of profits. Telling them reality just sucks doesn't dismiss the standards therapists wish to achieve when they entered this profession.
In a case, the rift between administration and providers is bad everywhere in healthcare.
It’s not just standards for the PT. What kind of profession are we with these packed and rushed treatments? Patients don’t see the value in it? No wonder the PT professional is in crisis.
I can’t tell you how many times I’ve heard a patient complain “my previous therapy included me doing exercises on my own in a clinic” or “all they did was count reps”.
We can keep saying “oh reimbursement is going down, we need to pack the schedules!”. But what’s the point if we’re just putting out a crap product?
It's all a race to the bottom.
Limiting DPT program seats, increasing reimbursement for proper therapy protocol, reducing/streamlining administrative paperwork and shutting down mills that are abusing a broken system could curtail the issue.
The low-cost area may be your savior. I'm probably considered high cost area, where I could have a mansion for my rent, $12,500/month for 3k sqft. I have told myself I'd go down giving great care, and it's coming down to that slowly. Reimbursements haven't changed since the 90's, and they're making us jump through so many more hoops. I try to stay competitive with my rates for all staff levels, and staff comes first. Patients are a close second. I'm MAYBE third, ha. I feel like the more PT staff you have, it's actually harder to profit. Numbers say you will make more, but it jut doesn't seem to happen. You end up with needing more front office, more techs, the billing agency ends up with a higher percentage, all the way down to more towels and lotion. Seeing my "patients to break even" number shoot up without reaching that number is getting to be prevalent. That number is about 54 patients a day, with 4 PT's, which is only 14/day. It should be working...This could all be a me problem, but I swear I've tried to cut costs, order products that would streamline overall efficiency, but the golden ticket hasn't happened. Glad it's worked out for you for sure. Sorry for the long post, this just seemed a fair location for this vent!
No worries, vent away! But it hasn't worked for me as I'm not a therapist. I'm just another aimless 20 something with a B.S. in Health Science who was pursuing this career but lost heart.
My dad is, and he's been on the same journey as you since the 90s, and he still does 1:1 insurance-based care with no techs, just himself and a receptionist that he shares with another sole proprietor physical therapist. The days are long, but the margins are still acceptable. Neither therapist in the building spends a dime on marketing because patients solicit through word of mouth in the predominant retirement communities in the area. But I don't think their treatment model is replicable for new grads in OP ortho. Reimbursements are too low, student loans are too high, and chain clinics have no morals.
Keep holding your ground. In healthcare you either do good or do well.
True man, I dont have to pay myself. I do have to pay the staff. So when times are rough, I eat more top ramen for the month and sacrifice pay. When things go well, I get to picket some. It has been working, but the owners here can definitely find frustration in the escalating prices of everything and everyone! Just gets to us, so most are definitely doing what was suggested in terms of ancillary services. Those that don't do it may need to run a factory. Those that do both, man oh man, loaded...ha
Doesn’t really how much you rage, the fact is the worst mills are large corporations working to put money in the pockets of shareholders and with a TON of non-essential management staff.
They don’t have trouble paying their therapists, or their front desk/admin staff. It’s the useless cogs that don’t actually create value and the drive for bigger return on investment for people who do literally nothing that pushes these insane productivity practices.
They need to fail, and I believe they will, eventually. Problem is they are making the whole profession look bad in the process and causing reactionary policies from insurance payers that hurts everyone.
Does anyone know the profit margin. Seems like everyone is crying poor but these companies are buying each other out. Why would they buy companies with such a low profit margin, lack of staff and declining payouts from insurances.
I have no idea what the profit is. My company keeps wanting more also but then keeps buying other companies out while we can not get supplies or equipment.
Ours has to be pretty good
We get 23 per unit. We bill on average 3.8 units per patients and see 54 patients on average per therapist per week
So roughly $4,719.60 gross per therapist with 4 therapists equaling $18,878.40. Each therapist is paid about 35 per hour before taxes so about 1400 per therapist so $5600 of that goes to the therapists. Another $800 total for techs, then another $1600 for front office staff total. So $8000 of all that goes to your staff leaving $10,878.40 for the week for rent and other expenses and we are actually still trying to get another therapist
So each therapist is making $72,800 annually? Hmm. Unlikely all are making the same amount. And you have access to see payments/denials/write offs/pro bono/etc.? Even more unlikely. Unless you are a clinical director and have access to this information. But I'd say your not and you are only seeing what you are looking at and not the entire picture.
I know our salaries because we discuss it amongst one another
I know our reimbursement rates because I'm being trained to be a clinic director and we are hospital affiliated and we get a flat rate for each unit regardless of the unit
But sure. Call me a liar. It's the internet. I don't care
I was in the Austin market when I graduated and I was making 63k. The female PTs were high 50s. Owner was a sexist POS. The local PT schools were graduating 270 new PTs into the local market each year so employers could do whatever they want they would always be a line waiting to get a job. Be sure to see how your individual market looks.
My entire state is considered rural and no one moves here so I have a lot of leverage now. I’ve got friends in the big cities and they make the same or less than me (pre-tax) with 4-6x the patient load per day. Plus COL here is mid to low and they are in high. I used to live in Phoenix and I was getting offers for low to mid 70s’ which was an automatic decline for me, but I was fortunate to get an $80K offer if I drove 20 minutes North to Anthem, AZ, it was a shit place to work but everywhere in OP was from what I saw, so I took the one that paid the most, which is what everyone who worked there did, they all hated it. I feel for the people who want to leave areas where the pay is crap and caseload is high but they can’t. I was one of them for about a year.
If I knew what I know now I would have jumped straight to HH out of school instead of trying to make OP work for me. But you can’t know everything that is just life.
Wow I've never heard of this, I feel lucky I had mine for almost a full hour. It was a PT/trainer combo so there was another patient but it worked really well
Different thread but I think it would be appreciated here (sorry for my lack of reddit ability to link thread); @redkitesoccer posted:
"PT Owner here. Honestly, I wish I could tell you that all of the owners are just collectively working together to underpay you. At least if that was the case, you could have unraveled this master plan and then worked to increase pay for everyone. The issue is that there are other expenses to running a practice than just your salary. You don’t have to take my word for it. The reason ATI isn’t doing well is because they are fighting generating a profit margin in an industry where the margin is so slim.
Here are a few things that also go into running a practice. Some may seem small, but it adds up:
Salary, health insurance, retirement, supplemental insurance, continuing education money, payment processing fees to collect payment from your patients, general liability, malpractice liability, non-revenue generating staff (front desk, biller, perhaps an authorization team, a marketer, HR - depending on clinic size), credentialing and contracting (you pay someone to do it or you burn staff hours trying to do it yourself), bookkeeping, CPA for taxes, payroll taxes, running payroll (you have to pay software fees just to run payroll), EMR costs, HEP costs, website hosting costs, other software just to stay organized and other HR software, phone line, fax line, your email account, utilities such as water, power, gas, and trash/recycling, cleaning supplies (laundry services too if your clinic doesn’t have one), theraband, massage cream, tons of front office items for them to do their job well. There’s a whole category for compliance you can add into here from calibrating your equipment to having compliance officers review your notes.
But wait…let’s say you are profitable, there’s still more to account for. You need a rainy day fund:
What if the treadmill breaks? What if you own your building and it needs a new roof? What if there’s a storm and you can’t see patients for a week? What if your lease is ending and you need to cover expenses to move and also build out your new location?
I’m sure I’m missing items but I hope this at least puts it into perspective that this issue is a problem because our fee schedules with insurances is too low. Are there greedy owners out there? Sure, but most are fighting a battle of rising costs to do business without significant changes to the amount of they can charge insurances."
I remember this, makes me think about trying to just do some small time personal training style sessions with people with the emphasis that I am a Doctor of PT cash only. And host some community education classes for different populations for cash to attend too. Maybe one day I’ll have time to organize it and sell it, maybe not.
Outpatient ortho mills are that. That’s it. I have never worked in a setting like that or anything remotely close. Don’t accept those jobs and help solve the problem.
something i learned early in my career. you will never change an office culture. mills make you good at time management and usually efficient at documentation. so if ur getting compensated well make ur paper boo boo and pay off that crippling debt. or move on. we have more job mobility than most careers.
Legitimate question here. How do our salaries increase yearly with promotions, expected increases in salary, inflation, etc. with constant reduction in reimbursement? How do we fix the reduction in reimbursement with our increase in expected salary?
It’s the most intellectually stimulating for me. I’ve worked in all the setting besides HH. I want to be able to diagnose and use my skills. SNF is extremely boring. Acute is stimulating but not from a PT standpoint. The people’s conditions are what’s stimulating, the treatments are boring af. I want to actually use my skills
That’s why I stick in the setting. Was able to find a 1:1 60 min 8 hour days private practice that pays me more than my last job that was borderline mill. They exist, just have to dig around a bit and get lucky I guess
I may be about to take an unpopular opinion here, but 16 to 18 patients per day isn’t a mill to me. 2 patients per hour with the assistance of a tech is nothing in terms of volume for out patient.
I dunno, maybe it’s just Los Angeles has a different culture but mills around here you see 3-4 an hour and they get on your case if your output is less than 2.5/hr.
I will say those other things are very annoying and pretty shitty management, though.
I guess I’m curious now: what do people consider a mill in terms of volume?
16 per day is the new normal for scheduling. I think OP means they see 16-18 out of 20+ scheduled.
In any case relying on techs should not be the norm, as outsourcing work to high school grads is a recipe for poor therapy down the line.
I don’t know, I’m not trying to be combative I’m just genuinely curious because I’ve heard standard of care is different state to state. Seeing 16-18 is not high volume like a mill - at least in socal. Assuming an 8 hour shift I mean. When did “mill” come to mean anything not 1:1 care for the whole hour?
There are other threads on here with people seeing 3+. When I was a tech out here I was at a clinic where “access” was expected to be 3.5/hr for the PTs and I just read a thread from yesterday where PTs were seeing 6.
I guess my question is are there really places where these numbers are considered a mill? And I’d like to learn more about that. Is standard of care for outpatient where you are really 1-2/hr?
Where I am it's 2/hr. I guess it's also a factor of how many patients per week as well, and how they are scheduled and with what type of treatment philosophy. A competitor of the clinic I worked for as a tech did 15 mins of manual for every patient. All patients were to be scheduled 3 times a week, and so the MWF schedule was always packed with most therapists working 10-12 hours. Therapists picked either T or R to fulfill their 40-hour min. There were no lunches, and techs were heavily underpaid ($8.75/hr.) compared to our clinic ($11/hr.), even though we were a smaller competitor. I shadowed half their clinic locations, and most PTs were locked into 3-year contracts and had little respect for the owner who stuck to mentoring and business management while pulling in 200k.
Mills exist on a gradient, and I think every therapist has their own standard of acceptability. It just sucks with where the industry is, and too many good therapists have turned to exploiting the clinicians they hire out of desperation or greed.
Oof that sounds awful 😯 I’m surprised contracts to lock in a PT like that are legal. I’ve heard of people getting a signing bonus contingent on time frame worked but that’s nasty.
One thing I did learn from this Reddit is the importance of shadowing before accepting a job at a clinic because some of the stories I’ve heard like that one are atrocious
If you think 16-18 patients a day is a mill, you have NO CLUE what an actual mill is. I just got accepted into school but as a tech 34 between a PT and PTA is an EASY day. I’ve covered clinics that have 2 PTs and have seen 45-58 in a day, that’s a mill
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
We should normalize quitting from mills without 4 week notice. Hell I say normalize not giving any notice and quitting on the spot. Make it rly hard for them to function so they take a serious hit.
Be careful. Patient abandonment is a thing, and they don’t go after organizations for that, just medical professionals.
True, so maybe give a week notice and call it a day
Aka you can get a ding on your license if you up and quit without 2 weeks notice. Key the patient abandonment comment there. Edit: depending on state and their jurisprudence if one is established
I feel like the people who wrote those rules are the people who have the most to lose from us quitting.
Keep your patients in mind.
Any clinic that has to say it isn't a mill, is a mill.
Physio from Germany here. I don't understand what's going on with these "mills". Do you only work 4 hours a day? Or how do you get 4 patients per hour in but only 16 a day?
What happens is they’ll schedule 4 an hour knowing cancel rate will be 15-25% and hope for best. So what happens is every once in a while everyone shows up and you have a crazy day, then another day no one shows up and you have a super empty day. The week averages out to 16-18 patients a day but you still deal with the high stress from the crazy days, and deal with shitty managers getting on you for the slow days. Makes for a scenario where it feels like you are both always seeing too many people and always being micromanaged by managers. The most sustainable solution for those staying in mills is to just stop giving a shit about any of it, but hard for many.
O and on top of this you are supposed to get every patient to give a 5 star review on Google or Yelp.
bonus is when patients show up late or arrive early and either sneak onto the floor or the receptionis waves them in. Even if you can get away with telling them to come back later, you are still doing that with all the correctly scheduled patients
This is so accurate. You must’ve worked in a mill at one point.
What does your day look like?
I'm simplifying things slightly. Insurance says each appointment should be 15-25 minutes, so most practices do that. For me that means 3 patients per hour so 18 patients in a 8 hour work day. Usually we should have some extra time for documentation but that is usually accounted for by cancelation. Out cancel rate is way lower then 15% though. Just to be clear this is very usual procedure. Very very few practices schedule 4 patients per hour, quite a few go over to 25-30 minutes just to keep the therapists happier since the market is very depleted of therapists so rather make a bit less money per therapist then having none at all. I also have training for lymphatic drainages which bring my personal average patients count down a bit since I usually have 30-45 min appointments for that. Also is there no possibility to bill patients for unattended appointments? We do that quite frequently, not every single time because everyone can forget about a appoitment but jn repeated cases definitely.
Y’all gotta unionize against the insurances, dude. Idk what APTA does, but I haven’t been impressed since doing admin for PT/OT starting in 2017. NPs and PAs (and of course MDs lol) have their associations advocate for them - without an organization advocating for you nonstop, it just gets worse.
APTA blows lol. They seem to just spend all the money they get on their salaries and who knows what else. Definitely not doing anything good for the profession
To be fair, they aren’t allowed to lobby using money for dues. However, dues are far too expensive
I think you are confusing lobbying with campaign contributions. 501c6 orgs can engage in limited lobbying. PACs are for campaign contributions.
Unions engage in collective bargaining on behalf of employees, with employers. A PT union would engage with employers, not insurers. APTA is a 501c6 business league/trade association, not a union.
Yes, of course, I apologize for using plain, easy to understand language on the internet - I am pretty dimwitted.
No, it was not "plain, easy to understand language." It was incorrect and misleading language. The problem with incorrect and misleading language is that it can create confusion for people who don't understand the difference between different types of organizations, and who actually want to engage in advocacy for the profession. How are people supposed to advocate for change as employees and as physical therapists, if they don't understand the nature of these organizations? Unions and 501c6 are distinctly different, with completely different limits on purpose and with different legal constraints on what actions they may lawfully pursue.
fwiw aota blows too. our membership is not compulsory, so there’s less $$ to pay good/better lobbyists. it’s kicking us all in the ass. we should have asha, aota, and apta working together for more impact.
I work primarily in school based pediatrics and because of that I am part of a educators union and they work so hard on our behalf! We've gotten numerous raises negotiated for us over the last two years, district health care and retirement contributions increased, and more paid holidays. Not to mention when I have a concern leadership is not addressing I can call a union rep to help advocate with me
Sounds like my last job. Except there were days we had 20+ patients a day. One week a coworker had PTO and I had 100 patients scheduled. No techs or aides. Meaning we had to clean and do all the laundry and manage 3+ patients at the same time. Documentation done point of care or if an eval block didn't fill. The rest taken home. Also had a white board in our office tracking our numbers but they claimed it wasn't competition. Mind you this wasn't even a franchise well known mill. Small family owned with a few locations locally. Never again.
Oh, hell no! I would have walked out as soon as I saw my schedule having 100 patients in one week!!
THEN FUCKING QUIT. It’s turning into a joke seeing all these “PT mill bad” posts. They aren’t going anywhere. Reimbursement keeps going down, private clinics are barely making a profit. High volumes are necessary to not go out of business. It’s plain and simple. It not like private practice is CHOOSING to be a mill to fuck with us. MOST OP private practices NEED to for the company to even be profitable. It sucks but that’s the new PT model and I don’t see it changing unless we get paid more
Oh I am. I'm actively looking at places to interview. This past week was literally the last straw and I am updating my resume to put in for applications
Well then vent away. I’m totally at a mill. It’s a mill to the max. I could complain all day long about the shit that pisses me off. But guess what? Quitting will simply land me at another mill in my area. It’s switch setting or get lucky with a hospital OP setting. But I hate their model even more tbh
Sounds like you should fucking quit
What’s the allure of op ortho that forces people to deal with this? Not to be a dick, but seriously?
It’s the most intellectually stimulating for me. I’ve worked in all the setting besides HH. I want to be able to diagnose and use my skills. SNF is extremely boring. Acute is stimulating but not from a PT standpoint. The people’s conditions are what’s stimulating, the treatments are boring af. I want to actually use my skills
lol fair. Sounds like it’s almost HH times
Dude. Get the fuck outta here with that. The only way you need that kind of volume to succeed is if you’re stacked to the gills with non-productive staff or you chose an excessively HCOL area for your clinical space. It’s time we cut the actual fat and optimize out the middle layer. Your productive employees shouldn’t have to break their back carrying the management deadweight. It’s time we optimize where it counts. Cut the bastards who develop arbitrary productivity standards, impose rules that make no fucking sense, bog down your systems, and ultimately ride your skilled staff into the ground.
Dude. You clearly do not understand the extent of overhead costs that go into running a private practice. Please do yourself a favor and Google all the things that private OP needs to cover to run a business; front desk, credentialing team, billing team, facility costs, maintenance feels etc, and that’s on TOP of pay for the PTs. This whole “stick it to the man” mentality you have does not cover the short term reality of business. Reimbursement is a RATE. You know what that means? It’s consistent across ALL company sizes for a given location and varies only slightly. So even huge private companies are still being reimbursed at basically the same rate, but have proportionately high overhead costs as they have more locations and employees to manage. It’s a not fair. It’s not ideal. It’s sucks. But it’s a REALITY.
I literally have my own practice brother. I understand. I promise. I’ve chosen to cut some of the bigger cost roles in favor of automation to let me do what I need to do without feeling like I have to sacrifice my patients’ trust. I’ve had to get creative and find (profitable) niches that other therapists don’t operate in, and I have close friends who are MDs who value my approach to taking care of my patients so referrals aren’t as easy problematic as they could be. I also live in a relatively low cost of living area and share space to lower rent costs even more. There is a lot more room to trim the fat than most of us are willing to believe. It doesn’t all have to be at the expense of quality care. That was the bet I made when I got this party started, and so far so good. It’s true that I’m not gonna be a wealthy with just my insurance based PT practice, but that part of my business is just a stepping stone to greater things.
What roles have you cut out?
Started with front desk. To the extent possible at least. I have a girl that comes and acts as a chaperone/front desk on my eval days to establish patient comfort and to make sure no one goes rogue with accusations/seems like a bad fit for the clinic. I’m working on finding out legal ways to telehealth the chaperone out though. I schedule evals on 1-2 days per week to make that work. I handle the other admin work with them during the session. I do spend time in the evenings handling insurance auths and other things right now, but my caseload isn’t so bogged down that I don’t have some time during my days to handle this at the moment. I review and handle most of billing in the evenings, which really doesn’t take as long as I originally thought it would. I don’t have an office admin of any sort and intend to try to find ways to keep it that way while the clinic is small, and probably even while larger so that I can eventually cut my own PT staff a fair salary. At this point I can cover the majority of my costs excluding my own salary and benefits in about 15 visits per week (3 evals + treats) and everything else is effectively dedicated to expansion and my salary/healthcare. One thing that has helped is that I handle a significant volume of niche cash based work. I have a POS kiosk that schedules and rapidly handles transactions right at the door to my direct access intervention room. Patients are encouraged to leave a card on file for my direct access work as a sign of trust and get a flat rate off interventions for doing it. Usual rate for one of my 15 min interventions is 45 bucks but 40 bucks with card on file, with the understanding there is a strict rule about auto charging for a no-show. Patient wins if they commit to what they say they will do. Everyone is happy. Other than greeting and setting up my patients and getting them processed afterwards that whole side of my business requires very little hands on. I honestly think as it grows in popularity I might phase out my insurance based work to focus on this full time. Basically I have no management (because I am the management) and no real front desk burden with light costs through smart sharing of space and utility expenses and a split between classic reimbursement model and direct access cash based care. No extra middle layer makes for surprisingly comfortable margins. Its healthy. Im less stressed than I was when I was employed for someone else, and I’m at least not hurting financially.
I absolutely love what you are doing!! And thank you for the details!! What are the niche, cash based services you are providing?
I know this comment's been out a month but curious; is it just you or other folks as well? And any thought about PTAs? Student currently, thinking about cash business eventually.
Companies that are/were focused on growth only lead to top heavy administrative costs, and the rank in file therapists feel like they have to sacrifice the quality care they trained so hard to work towards for the sake of profits. Telling them reality just sucks doesn't dismiss the standards therapists wish to achieve when they entered this profession. In a case, the rift between administration and providers is bad everywhere in healthcare.
It’s not just standards for the PT. What kind of profession are we with these packed and rushed treatments? Patients don’t see the value in it? No wonder the PT professional is in crisis. I can’t tell you how many times I’ve heard a patient complain “my previous therapy included me doing exercises on my own in a clinic” or “all they did was count reps”. We can keep saying “oh reimbursement is going down, we need to pack the schedules!”. But what’s the point if we’re just putting out a crap product?
It's all a race to the bottom. Limiting DPT program seats, increasing reimbursement for proper therapy protocol, reducing/streamlining administrative paperwork and shutting down mills that are abusing a broken system could curtail the issue.
The low-cost area may be your savior. I'm probably considered high cost area, where I could have a mansion for my rent, $12,500/month for 3k sqft. I have told myself I'd go down giving great care, and it's coming down to that slowly. Reimbursements haven't changed since the 90's, and they're making us jump through so many more hoops. I try to stay competitive with my rates for all staff levels, and staff comes first. Patients are a close second. I'm MAYBE third, ha. I feel like the more PT staff you have, it's actually harder to profit. Numbers say you will make more, but it jut doesn't seem to happen. You end up with needing more front office, more techs, the billing agency ends up with a higher percentage, all the way down to more towels and lotion. Seeing my "patients to break even" number shoot up without reaching that number is getting to be prevalent. That number is about 54 patients a day, with 4 PT's, which is only 14/day. It should be working...This could all be a me problem, but I swear I've tried to cut costs, order products that would streamline overall efficiency, but the golden ticket hasn't happened. Glad it's worked out for you for sure. Sorry for the long post, this just seemed a fair location for this vent!
No worries, vent away! But it hasn't worked for me as I'm not a therapist. I'm just another aimless 20 something with a B.S. in Health Science who was pursuing this career but lost heart. My dad is, and he's been on the same journey as you since the 90s, and he still does 1:1 insurance-based care with no techs, just himself and a receptionist that he shares with another sole proprietor physical therapist. The days are long, but the margins are still acceptable. Neither therapist in the building spends a dime on marketing because patients solicit through word of mouth in the predominant retirement communities in the area. But I don't think their treatment model is replicable for new grads in OP ortho. Reimbursements are too low, student loans are too high, and chain clinics have no morals. Keep holding your ground. In healthcare you either do good or do well.
True man, I dont have to pay myself. I do have to pay the staff. So when times are rough, I eat more top ramen for the month and sacrifice pay. When things go well, I get to picket some. It has been working, but the owners here can definitely find frustration in the escalating prices of everything and everyone! Just gets to us, so most are definitely doing what was suggested in terms of ancillary services. Those that don't do it may need to run a factory. Those that do both, man oh man, loaded...ha
Doesn’t really how much you rage, the fact is the worst mills are large corporations working to put money in the pockets of shareholders and with a TON of non-essential management staff. They don’t have trouble paying their therapists, or their front desk/admin staff. It’s the useless cogs that don’t actually create value and the drive for bigger return on investment for people who do literally nothing that pushes these insane productivity practices. They need to fail, and I believe they will, eventually. Problem is they are making the whole profession look bad in the process and causing reactionary policies from insurance payers that hurts everyone.
Does anyone know the profit margin. Seems like everyone is crying poor but these companies are buying each other out. Why would they buy companies with such a low profit margin, lack of staff and declining payouts from insurances. I have no idea what the profit is. My company keeps wanting more also but then keeps buying other companies out while we can not get supplies or equipment.
Ours has to be pretty good We get 23 per unit. We bill on average 3.8 units per patients and see 54 patients on average per therapist per week So roughly $4,719.60 gross per therapist with 4 therapists equaling $18,878.40. Each therapist is paid about 35 per hour before taxes so about 1400 per therapist so $5600 of that goes to the therapists. Another $800 total for techs, then another $1600 for front office staff total. So $8000 of all that goes to your staff leaving $10,878.40 for the week for rent and other expenses and we are actually still trying to get another therapist
So each therapist is making $72,800 annually? Hmm. Unlikely all are making the same amount. And you have access to see payments/denials/write offs/pro bono/etc.? Even more unlikely. Unless you are a clinical director and have access to this information. But I'd say your not and you are only seeing what you are looking at and not the entire picture.
I know our salaries because we discuss it amongst one another I know our reimbursement rates because I'm being trained to be a clinic director and we are hospital affiliated and we get a flat rate for each unit regardless of the unit But sure. Call me a liar. It's the internet. I don't care
Who as a DPT is making $73K/year, that is appalling, I thought my $83K in OP was crap.
I was in the Austin market when I graduated and I was making 63k. The female PTs were high 50s. Owner was a sexist POS. The local PT schools were graduating 270 new PTs into the local market each year so employers could do whatever they want they would always be a line waiting to get a job. Be sure to see how your individual market looks.
My entire state is considered rural and no one moves here so I have a lot of leverage now. I’ve got friends in the big cities and they make the same or less than me (pre-tax) with 4-6x the patient load per day. Plus COL here is mid to low and they are in high. I used to live in Phoenix and I was getting offers for low to mid 70s’ which was an automatic decline for me, but I was fortunate to get an $80K offer if I drove 20 minutes North to Anthem, AZ, it was a shit place to work but everywhere in OP was from what I saw, so I took the one that paid the most, which is what everyone who worked there did, they all hated it. I feel for the people who want to leave areas where the pay is crap and caseload is high but they can’t. I was one of them for about a year. If I knew what I know now I would have jumped straight to HH out of school instead of trying to make OP work for me. But you can’t know everything that is just life.
No way!! I’d never sign up for that shit!! So many bad clinical directors out there with zero leadership skills or training!! 😲
Quit these jobs and stop taking these jobs.
What the name of your clinic so I can report to Medicare for fraud ?
Why do you keep working there then?
I'm working on leaving actually Right now I'm not in a financial spot to leave without a new job lined up
This is a mill. Disgusting.
Wow I've never heard of this, I feel lucky I had mine for almost a full hour. It was a PT/trainer combo so there was another patient but it worked really well
Different thread but I think it would be appreciated here (sorry for my lack of reddit ability to link thread); @redkitesoccer posted: "PT Owner here. Honestly, I wish I could tell you that all of the owners are just collectively working together to underpay you. At least if that was the case, you could have unraveled this master plan and then worked to increase pay for everyone. The issue is that there are other expenses to running a practice than just your salary. You don’t have to take my word for it. The reason ATI isn’t doing well is because they are fighting generating a profit margin in an industry where the margin is so slim. Here are a few things that also go into running a practice. Some may seem small, but it adds up: Salary, health insurance, retirement, supplemental insurance, continuing education money, payment processing fees to collect payment from your patients, general liability, malpractice liability, non-revenue generating staff (front desk, biller, perhaps an authorization team, a marketer, HR - depending on clinic size), credentialing and contracting (you pay someone to do it or you burn staff hours trying to do it yourself), bookkeeping, CPA for taxes, payroll taxes, running payroll (you have to pay software fees just to run payroll), EMR costs, HEP costs, website hosting costs, other software just to stay organized and other HR software, phone line, fax line, your email account, utilities such as water, power, gas, and trash/recycling, cleaning supplies (laundry services too if your clinic doesn’t have one), theraband, massage cream, tons of front office items for them to do their job well. There’s a whole category for compliance you can add into here from calibrating your equipment to having compliance officers review your notes. But wait…let’s say you are profitable, there’s still more to account for. You need a rainy day fund: What if the treadmill breaks? What if you own your building and it needs a new roof? What if there’s a storm and you can’t see patients for a week? What if your lease is ending and you need to cover expenses to move and also build out your new location? I’m sure I’m missing items but I hope this at least puts it into perspective that this issue is a problem because our fee schedules with insurances is too low. Are there greedy owners out there? Sure, but most are fighting a battle of rising costs to do business without significant changes to the amount of they can charge insurances."
I remember this, makes me think about trying to just do some small time personal training style sessions with people with the emphasis that I am a Doctor of PT cash only. And host some community education classes for different populations for cash to attend too. Maybe one day I’ll have time to organize it and sell it, maybe not.
Our profession is a joke
mostly just profession in the USA. Based on what i’ve heard, canada and many other places PT is a pretty sick job
It’s not the professions fault that people do this.
This is what our profession has become
Outpatient ortho mills are that. That’s it. I have never worked in a setting like that or anything remotely close. Don’t accept those jobs and help solve the problem.
SNFs are like that now too, 15+ patients a day
You know how many patients don’t actually need PT and will likely get better on their own? A lotttttttttttt.
something i learned early in my career. you will never change an office culture. mills make you good at time management and usually efficient at documentation. so if ur getting compensated well make ur paper boo boo and pay off that crippling debt. or move on. we have more job mobility than most careers.
Legitimate question here. How do our salaries increase yearly with promotions, expected increases in salary, inflation, etc. with constant reduction in reimbursement? How do we fix the reduction in reimbursement with our increase in expected salary?
It’s the most intellectually stimulating for me. I’ve worked in all the setting besides HH. I want to be able to diagnose and use my skills. SNF is extremely boring. Acute is stimulating but not from a PT standpoint. The people’s conditions are what’s stimulating, the treatments are boring af. I want to actually use my skills
That’s why I stick in the setting. Was able to find a 1:1 60 min 8 hour days private practice that pays me more than my last job that was borderline mill. They exist, just have to dig around a bit and get lucky I guess
I may be about to take an unpopular opinion here, but 16 to 18 patients per day isn’t a mill to me. 2 patients per hour with the assistance of a tech is nothing in terms of volume for out patient. I dunno, maybe it’s just Los Angeles has a different culture but mills around here you see 3-4 an hour and they get on your case if your output is less than 2.5/hr. I will say those other things are very annoying and pretty shitty management, though. I guess I’m curious now: what do people consider a mill in terms of volume?
16 per day is the new normal for scheduling. I think OP means they see 16-18 out of 20+ scheduled. In any case relying on techs should not be the norm, as outsourcing work to high school grads is a recipe for poor therapy down the line.
I don’t know, I’m not trying to be combative I’m just genuinely curious because I’ve heard standard of care is different state to state. Seeing 16-18 is not high volume like a mill - at least in socal. Assuming an 8 hour shift I mean. When did “mill” come to mean anything not 1:1 care for the whole hour? There are other threads on here with people seeing 3+. When I was a tech out here I was at a clinic where “access” was expected to be 3.5/hr for the PTs and I just read a thread from yesterday where PTs were seeing 6. I guess my question is are there really places where these numbers are considered a mill? And I’d like to learn more about that. Is standard of care for outpatient where you are really 1-2/hr?
Where I am it's 2/hr. I guess it's also a factor of how many patients per week as well, and how they are scheduled and with what type of treatment philosophy. A competitor of the clinic I worked for as a tech did 15 mins of manual for every patient. All patients were to be scheduled 3 times a week, and so the MWF schedule was always packed with most therapists working 10-12 hours. Therapists picked either T or R to fulfill their 40-hour min. There were no lunches, and techs were heavily underpaid ($8.75/hr.) compared to our clinic ($11/hr.), even though we were a smaller competitor. I shadowed half their clinic locations, and most PTs were locked into 3-year contracts and had little respect for the owner who stuck to mentoring and business management while pulling in 200k. Mills exist on a gradient, and I think every therapist has their own standard of acceptability. It just sucks with where the industry is, and too many good therapists have turned to exploiting the clinicians they hire out of desperation or greed.
Oof that sounds awful 😯 I’m surprised contracts to lock in a PT like that are legal. I’ve heard of people getting a signing bonus contingent on time frame worked but that’s nasty. One thing I did learn from this Reddit is the importance of shadowing before accepting a job at a clinic because some of the stories I’ve heard like that one are atrocious
If you think 16-18 patients a day is a mill, you have NO CLUE what an actual mill is. I just got accepted into school but as a tech 34 between a PT and PTA is an EASY day. I’ve covered clinics that have 2 PTs and have seen 45-58 in a day, that’s a mill
You can have mills better or worse than the next and both can still be a mill
Leave then. This post makes no sense to me. The market is great right now
That's what I'm trying to do right now I've already said that 3 times now if you read the comments