When I was offered my first job out of PT school, I actually turned it down at the last second, due to location alone. I had thought I was ready to move back to my home state of TX, but I just could not bear to leave California yet.
The supervisor was understanding and kind, but in a last attempt to sway me into taking the job, she mentioned the absurdly low (76%, I believe) level of productivity required. Honestly, in the moment, that meant nothing to me. Nothing. I nodded emphatically and said, “wow!” But I had not been exposed at all, whatsoever, to the idea of productivity during my clinical rotations. So I humbly thanked the woman for the offer and got to work searching for jobs in California.
Fast-forward to 3 years later, and every job I had held was rife with talk of productivity. Billable units, patients per hour, individual versus departmental productivity…. each important staff meeting and annual review seemed to boil down to numbers. How many patients can the therapists see, and how much can they charge per session?
Well, that’s complicated, isn’t it? What, exactly, constitutes working? It depends who you ask, and what their standards are.
As PTs, our daily tasks are varied. We educate patients, and we educate families. We provide hands on treatments and prescribe exercise programs. We recommend equipment. We confer with physicians and nurses. Depending on where we work, we submit insurance claims, we answer phones, and we schedule patients. We attend staff meetings. Depending on where you work, much of this non-billable time is considered non-productive. While conferring with a physician falls into a gray area, answering phones, scheduling patients, calling nurses and preparing supplies for a treatment are decidedly non-billable.
This is why my would-be supervisor was jubilantly proud of her ace-in the hole: a low productivity expectation.
The harsh reality of productivity for a new physical therapist
Soon, I would find out that my first employer (a rather good large hospital system that I quite enjoyed) required 100% departmental productivity. 100%?! My supervisor explained that one therapist could get over 100% and another could get under, but as long as the department hits an average of 100%, all is good and the sun is shining. The department occasionally fell below this standard, but the managers would then help coach us, gently reminding us that we were doing our best.
At another hospital where I worked, productivity was measured by individuals, who were required to fill out what one of my coworkers coined “the log of shame” every day. If you did not reach your productivity for the day, you had to state why, which ended up taking even more precious time. Most therapists stayed off the clock to ensure they fully explained their perceived failures to management. This was in addition to simply staying off the clock to document, as every second of time at work had to be treatment time, to ensure they got their units.
I worked in an outpatient facility that had shared departmental responsibility of 100% productivity, but a very poor attendance rate by patients (many did not own cars). Part of my decision to leave that job was the pressure to use e-stim on as many patients as possible, regardless of whether it was indicated or safe, simply to allow more billable time units per patient.
At another outpatient clinic, productivity was never even mentioned. However, we would occasionally receive emails from the owner, reminding us to bill 3 units of treatment along with every evaluation. I also spent 2-3 hours of unpaid documentation time almost every night after work.
In extreme cases, my coworkers were called in by management and made to sign agreements to raise their productivity, or risk losing their jobs. I have read some horror stories online where therapists were actually terminated for their low productivity. I have spoken with therapists who regularly tack on extra units of treatment for each session, effectively creating a fraudulent billing scenario.
What does this mean for the new grad physical therapist?
While increasing focus on productivity may sound like a death knell for good PT practice, the APTA is listening to concerns. In June, 2014, the House of Delegates swiftly voted to establish resources for PTs and PTAs as they struggle to balance productivity with quality care.
Therapists are writing articles to address the problem and have come up with some viable solutions to measuring physical therapist productivity over the years. Montero Therapy Services wrote an excellent article about physical therapy productivity. Please take the time to read it!
As a new graduate, it is vital not to let productivity expectations dictate your practice. Your managers exist to provide you with the training tools needed to ensure you are productive, yet compassionate. Efficient without sacrificing safety or your own well-being. If you feel that you are in an unethical situation, approach your manager and explain your concerns.
While it can be tempting to resort to "padding units" or billing for unbillable time, you are surely not the only therapist in your shoes within the workplace. If you find that you are inclined to cut corners during chart review, remember that patient safety can suffer. Open a dialog within your facility, in a professional manner. Remember that, while you can be reprimanded for having low productivity, compromising patient safety and/or having your PT license revoked is much worse! Maintain your integrity and do what you can!
We shall all be awaiting the changes promised by the APTA, which should be coming around any time now :)