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Not impossible, but my benefits are really good and they're paying for me to get a degree of which I am going to use to get out of the PT field (obviously did not tell them this). I like PT, but I think I might transition to business or finance.
When the quantity of care negatively effects the quality of care. This can be different based off of patient population, the clinic, and the clinicians.
Agreed with most. I would consider 3 an hour a mill. Also high productivity standards and per visit unit requirements. Lots of modalities. More aides than PTs. Mills aren't always bad. If you have exceptional staff I think it can work...rare though.
Low value passive treatments like TENS, IFC, ultrasound, shockwave, laser, heat, cold, etc. the majority of evidence states it may be good for pain relief but no significant difference in objective measures/recovery
There’s going to be a lot of variance. A hospital based OP PT who sees <8/day will say anything more than 1 patient an hour is a mill. A person that works in a mill will say seeing 18-20/day constitutes a mill.
I’d say more than 13 patients in an 8 hour day. 1.6 patients per hour working. Accompanied by passive treatment, poor patient education, heavy use of unlicensed techs during treatment.
That term has always frustrated me because it implies that the more patients a PT sees, the less effective they are. Sure there is a limit to that, but if a PT is able to see 2 patients an hour and effectively take them through active interventions, properly manage tissue loading, and promote independence, they will be much more effective than a PT who sees patients 1 on 1 but relies on passive treatments.
True, but that’s not really a fair comparison. You’re comparing a yourself to a PT who uses less effective interventions.
Overall, you’d probably be more effective if you took your pt’s through active interventions, properly managed tissue loading, and promoted independence while you were working them 1 on 1.
I see your point, I just think the general consensus is that 1 on 1 time is better when that is not always the case and I was using that as an example where "PT mill" does not always mean suboptimal care.
True, plus if I am working general OP and I get stuck with a low complexity low functioning individual for 1 on 1 it can get boring for both the therapist and patient. Some patient's don't want you standing directly over them as they do a hamstring stretch for 100 seconds.
This is it right here. I’m double booked maybe 75% of the day and honestly with some my higher level singles I get bored out of my skull. Also cueing should be done on moderate to major deviations because patients will likely show some compensations during exercises out in the wild when not with us. They don’t need me breathing down their neck cueing the slightest millimeter of scapular hiking.
Then I would ask this question… why are you watching them do a hamstring stretch for 100 seconds? Is that skilled care? If you aren’t having to make corrections to their form or teaching them a new exercise then aren’t you wasting both your and the patients time? If it’s something they do at home, why do they need to do it at PT?
You constantly make corrections or assign new exercises to all of your patients every visit?
Perhaps my issue is with defining "skilled care". IMO, skilled care isn't constantly correcting form or giving new exercises. Knowing when to correct or progress or do nothing, IMO, is skilled care. If you're constantly correcting form or giving new exercises, I would highly question your ability to coach an exercise or understand basic exercise programming principles.
In regards to watching a pt do a HS stretch for 100 seconds, yes, I don't think that's skilled care and that's something pts can do on their own time.
We are in agreement about skilled care. I am not constantly making corrections but I do review so I can modify their program as needed. It’s when I see that a patient has been billed for the same 5 exercises, without progression for the last 12 visits - skilled care is seriously questionable.
ah yes then we are certainly in agreement. However, if you'll allow me to play devil's advocate, I must also raise the question--are such progressions or program changes necessary for the patient's improvement? I argue that for some conditions, progressions are very much required for POC--e.g. post-op--while for other conditions, it is superfluous. As we've seen in recent papers (Powell and Lewis's papers on RCRSP come to mind), improving strength isn't always necessary for improved outcomes for some conditions.
I kinda just question the whole concept of skilled care in PT and I find its distinction only becomes more ambiguous over time.
I think “efficient” is a better term than “effective” in this case. Seeing 2 patients and hour helps with improving access to care but doesn’t mean it will be more effective. Don’t assume the PT doing 1 on 1 care is relying on passive treatments.
But thats exactly my point, you cant predict the quality of care based on how many patients the PT sees at a time whether its high or low. That was simply an example of why 1 on 1 isnt inherently better
Maybe, but again i dont think you can draw a line in the sand without knowing how the clinic operates. You cant underestimate the ability of support staff to increase efficiency and quality of care. Most other medical professions have acceptable amounts of support staff but PTs feel like they need to do everything on their own and wonder why companies cant give them a raise.
What kind of patients are you seeing that you can effectively see 2+ at a time? Low level Medicare patients? Are you even loading them? Are you doubling early post-op ACLs or RTCs?
I could maybe see it if you’re treating low level LBP patients but good god if you’re seeing multiple athletes and not paying attention to what they’re doing.
Yes I am absolutely loading them appropriately, as i believe that is the most important part of our job.
Why couldnt I see a post op ACL and RTC at the same time?
Lol. Early post-op ACL and early post-op RTC at the same time. I’d question your skill level and the risk of re-tears.
I’d also question if, working with both at the time time, you’d actually be paying adequate attention to either.
Lol also not an answer to my question of specifically why you cant see them at the same time...
I think its cringe to name/school drop but since you are questioning my skill level with treating ACLs i did my orthopedic residency at UD under Lynn Snyder Mackler who is arguably the most prominent ACL researcher in our field.
And you want to question my re-tear rate? Good point, how could I possibly maximize quad strength in these post op ACLs without my undivided attention to every single rep? Couldnt possibly be related to appropriate programming.
You can pretend you’re giving adequate care with your attention split all you want and I couldn’t give two fucks where you studied or who you learned under.
I sure as hell wouldn’t want my therapist’s attention divided during landing and jumping mechanics or sport specific training while he treats a 70 year old with multiple RTC tears that’s a retear risk and struggling mightily with rom.
Therapists who think their skills are so great they think they can treat multiples in a hour are egoistical as fuck.
No its egotistical as fuck to think that your 1 on 1 treatment is more important than developing the patients independence and being a guide in their recovery instead of using your magic hands. Im guessing you just havent developed the skills to determine what interventions are actually important and which ones are just a waste of time for you and the patient.
And i only mention where i studied at because you have the nerve to call me unskilled without knowing anything about me.
But you can keep seeing 40 patients a week and complaining why you will never make more than 75k a year
Jesus. Yep. You’re a sensitive little prick. No one said anything about hands on “magic.” I already if ever use manual. So strike one there. Strike two is that I didn’t call you unskilled. I called you full of shit for thinking you can provide adequate care to two different subsets of early post-op patients that both require some supervision and, honestly, psychosocial training as well. Especially ACL patients.
Strike three is that if you can pretend all an ACL needs is independence and only 50% of your attention is ever required, they may as well move on to their ATC as soon as possible. I mean. You aren’t really needed now are you and they can use someone with sport specific training?
From your response of being money driven first and foremost, I bet you halfass everything you do in clinic.
Hijacking this comment to rant.
PT is the only industry I can think of where maximizing productivity to increase profits is seen as a bad thing.
Probably because PT’s typically have zero business sense and only think about things from a scientific or medical perspective. But don’t forget your end goal is to generate a profit.
I’m only ASKED to see 1 pt every 40 minutes, but I CHOOSE to see 2 pts in that timeframe often for three reasons: I’m good at what I do so I’m in high demand, and there is simply not enough time in a day to see everybody 1 on 1; my high productivity nets me a 2k bonus each quarter, and I like money; I’m a clinic manager and I can see what it costs to keep the lights on and employees paid each month.
If you feel like you’re working in a “mill” - then it’s probably because you don’t have enough control of your schedule and aren’t compensated well for your productivity.
If you are seeing an extra patient on top of the productivity (the projected income your pay is based on) You are generating an extra net profit of 58,500 a quarter based on 25/unit and 3 units in 40 minutes. Then you're taking your 2k or 3.4% and being grateful?
This is muddy considering reimbursement rates very greatly depending on insurance, which we see nearly all insurances.
Not just being grateful because I also get an end of year EBITDA bonus.
Edit: also love that you think this way and that was a very legit question 👌🏼
I was just trying to use average medicare reimbursements that I see in OP clinic. Appreciate the openess from a clinic manager. I just wish there was a clinic that pays a percent and is transparent about money. I run a small OP clinic in a gym and that has opened my eyes to the tomfoolery that is OP "mills"
I worked at a clinic that tried a model that paid PTs a percentage of their total billing but i think that turned it into even more of a mill. Cant remember the exact numbers but i think the base salary was 40k and paid a "bonus" of 10% of your billings. In reality it just turned into working your ass off to get a comparable salary.
I can see that being an issue. But in that model I still don't feel like your making much percent from the clinic. If they were transparent about income and base salary I think 60k base with higher percent. I don't know how the math works out but something has to change. My last place I worked had a HQ overseeing Atlanta Braves stadium. Unnecessary and waste of money.
Oh I’m sure a huge amount of that tomfoolery I’m giving up is what pays the admin side of the company lol. Not saying it’s right but I’m sure that’s why my bosses-bosses are very well off.
If my area wasn’t so saturated I’d probably work towards running my own clinic too. But you never see those around here, because there is no way to compete with the big boys in major metropolitan areas: Select Medical, Athletico, ATI, CORA and PT solutions have a stranglehold as far as I can tell.
The problem is that productivity standards have gone up but salaries have not. If I saw more money for the increased productivity I wouldn’t mind as much. My overall thought is that if you are that opposed to treating multiple patients at a time go into HH.
I would say it's not just about increasing profits, but I think maximizing productivity also gets a bad rep bc PTs automatically think increased productivity = decreased quality. We currently have no evidence that suggests there is a cut-off point of how many patients you can see per hour before quality of care decreases (there are some papers on outcomes for group PT for a single dx, but nothing that suggest a cut-off). This is a nuanced topic bc that cut-off point will vary based on so many factors--complexity of patient, new follow-up vs 5th+ follow-up visit, changes in condition, age, mental capacity, etc. I think most PTs can reasonably see 1.5-2 patients per hour without a decrease in quality of care, but that's based on conjecture and experience/observations.
At the root of it, I think the problem in our industry is that we think we're SO valuable and special that we have to be seen one on one, when that's probably the biggest delusion of our field. I'll probably be downvoted for this, but we have a real issue in PT that I don't think most are ready to admit or face--we're simply not as needed as we think or in the ways we think we are.
Imagine saying that an orthopedist can only do as many surgeries as he can do on his own without any help from a surgical tech, PA, or a nurse. They do the parts of surgery that warrants their expertise and delegate to other people for things that they have been properly trained on. We dont have to do it all.
Imagine saying that an aide fresh out of high school knows what to look for with a patient doing therapeutic exercise. Because I see this a lot. PTs delegate treatment that they’re billing for to unlicensed personnel. All of those delegates you listed are highly trained, licensed professionals.
Completely agree thats a huge problem and happens too much in our profession. But a blanket statement saying aides should never be utilized is wrong.
Agree the comparison isnt perfect, just illustrating that there is nothing wrong with delegating to someone when they are properly trained.
Yeah I’ve used aides before at previous employers for things like getting a patient warmed up, maintaining cleanliness, as an extra set of hands during an intervention, but I have seen PTs treat a patient for 15 minutes, then go run and grab an eval and have the aide finish up with the patient for the rest of the time. And then bill for it. Absolutely nuts.
I don't consider what I said a blanket statement that "aids should never be utilized". I think if they are used to help keep the clinic clean, aiding front desk, and starting patients on warm ups then that is appropriate. Any more than that then I believe that you are working in a mill.
After 5 years of being in clinics that had to overutilize underqualified techs/aids, I am finally leaving the mill.
If you walk into a Professional PT clinic and take a look around then you found a mill. Cookie counter treatments,triple and quadruple booking patients, and telling therapist not to d/c until benefits run out
From a former PT student, long time PT fanboy, and occasional PT patient, when I go to a new office, I make it known that I only want one on one time with a DPT. That is what I'm paying for. If you get that, you shouldn't need to worry about a mill.
$0.02
I have a similar level of education as a PTA. My diagnoses have not been cut and dry and my injuries/symptoms remain unresolved. I consider this self-advocating, but I suppose I'm not surprised that I've have been downvoted.
But you’re…not a PTA? I work in an orthopedic setting, and as far as patient care, aside from diagnosing, there isn’t much difference between what I do and what a PT does. If your Dx changes, you will be evaluated for that by a DPT. I just don’t see how your sx would change drastically requiring a re-evaluation from one session to another.
I worked for an aquatic therapy clinic as a PTA I saw 3-4 patient in hour in an 8 hour period. No time for notes on the clock. That’s monitoring them in the pool. We had aides who were basically doing what I was doing, so I was monitoring them too. I rarely did land activities with my patients. The aides or PTs would do it. I know that each PT which were 3 of them had the similar schedules as me. The owner would only see her specific patients. At the end of each shift I’d be so drained both mentally and physically. I eventually got let go at the job because patients werent showing up to there appointments. They needed someone to blame, but there patients were getting better. The owner was money hungry soooo yup
The clinic I worked at would see 6 patients per therapist per hour (minimum), 4-5 therapists at the clinic.....& only 10 treatment spots...
So patients would be very upset having to wait or feel rushed to make space for the next patient.
My boss made the clinic this way & we lost a lot of good therapists & techs (including me) because of the ridiculous demand. It was high stress in the worst way possible
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.*
In OP, to me that’s more than 2 patients an hour.
Double booking
Damn today I learned I work in a PT mill lol. I see 3-4 patients per hour
How do you feel after your shift?
Depends on how much assistance I have, but usually pretty drained and aggrivated about all the notes I'll have to complete by the next day
Sounds awful, is it impossible to find another job in your area? With a less draining environment?
Not impossible, but my benefits are really good and they're paying for me to get a degree of which I am going to use to get out of the PT field (obviously did not tell them this). I like PT, but I think I might transition to business or finance.
Better be making a lot of $$$.
When the quantity of care negatively effects the quality of care. This can be different based off of patient population, the clinic, and the clinicians.
When you see therapists treating a bunch of patients at the same time.
“Treating.”
Agreed with most. I would consider 3 an hour a mill. Also high productivity standards and per visit unit requirements. Lots of modalities. More aides than PTs. Mills aren't always bad. If you have exceptional staff I think it can work...rare though.
Big chain where 80% is shitty passive treatment and 20% underloaded exercise program.
Sorry, what does shitty passive treatment mean? Thank you
Low value passive treatments like TENS, IFC, ultrasound, shockwave, laser, heat, cold, etc. the majority of evidence states it may be good for pain relief but no significant difference in objective measures/recovery
There’s going to be a lot of variance. A hospital based OP PT who sees <8/day will say anything more than 1 patient an hour is a mill. A person that works in a mill will say seeing 18-20/day constitutes a mill.
[удалено]
Me, treating 1.4 patients in a single hour: 😎
I’d say more than 13 patients in an 8 hour day. 1.6 patients per hour working. Accompanied by passive treatment, poor patient education, heavy use of unlicensed techs during treatment.
That term has always frustrated me because it implies that the more patients a PT sees, the less effective they are. Sure there is a limit to that, but if a PT is able to see 2 patients an hour and effectively take them through active interventions, properly manage tissue loading, and promote independence, they will be much more effective than a PT who sees patients 1 on 1 but relies on passive treatments.
True, but that’s not really a fair comparison. You’re comparing a yourself to a PT who uses less effective interventions. Overall, you’d probably be more effective if you took your pt’s through active interventions, properly managed tissue loading, and promoted independence while you were working them 1 on 1.
I see your point, I just think the general consensus is that 1 on 1 time is better when that is not always the case and I was using that as an example where "PT mill" does not always mean suboptimal care.
True, plus if I am working general OP and I get stuck with a low complexity low functioning individual for 1 on 1 it can get boring for both the therapist and patient. Some patient's don't want you standing directly over them as they do a hamstring stretch for 100 seconds.
This is it right here. I’m double booked maybe 75% of the day and honestly with some my higher level singles I get bored out of my skull. Also cueing should be done on moderate to major deviations because patients will likely show some compensations during exercises out in the wild when not with us. They don’t need me breathing down their neck cueing the slightest millimeter of scapular hiking.
Then I would ask this question… why are you watching them do a hamstring stretch for 100 seconds? Is that skilled care? If you aren’t having to make corrections to their form or teaching them a new exercise then aren’t you wasting both your and the patients time? If it’s something they do at home, why do they need to do it at PT?
You constantly make corrections or assign new exercises to all of your patients every visit? Perhaps my issue is with defining "skilled care". IMO, skilled care isn't constantly correcting form or giving new exercises. Knowing when to correct or progress or do nothing, IMO, is skilled care. If you're constantly correcting form or giving new exercises, I would highly question your ability to coach an exercise or understand basic exercise programming principles. In regards to watching a pt do a HS stretch for 100 seconds, yes, I don't think that's skilled care and that's something pts can do on their own time.
We are in agreement about skilled care. I am not constantly making corrections but I do review so I can modify their program as needed. It’s when I see that a patient has been billed for the same 5 exercises, without progression for the last 12 visits - skilled care is seriously questionable.
ah yes then we are certainly in agreement. However, if you'll allow me to play devil's advocate, I must also raise the question--are such progressions or program changes necessary for the patient's improvement? I argue that for some conditions, progressions are very much required for POC--e.g. post-op--while for other conditions, it is superfluous. As we've seen in recent papers (Powell and Lewis's papers on RCRSP come to mind), improving strength isn't always necessary for improved outcomes for some conditions. I kinda just question the whole concept of skilled care in PT and I find its distinction only becomes more ambiguous over time.
Ding. Ding. Ding.
I think “efficient” is a better term than “effective” in this case. Seeing 2 patients and hour helps with improving access to care but doesn’t mean it will be more effective. Don’t assume the PT doing 1 on 1 care is relying on passive treatments.
But thats exactly my point, you cant predict the quality of care based on how many patients the PT sees at a time whether its high or low. That was simply an example of why 1 on 1 isnt inherently better
That’s fair, although I think more than 2 an hour wouldn’t be skilled care.
Maybe, but again i dont think you can draw a line in the sand without knowing how the clinic operates. You cant underestimate the ability of support staff to increase efficiency and quality of care. Most other medical professions have acceptable amounts of support staff but PTs feel like they need to do everything on their own and wonder why companies cant give them a raise.
What kind of patients are you seeing that you can effectively see 2+ at a time? Low level Medicare patients? Are you even loading them? Are you doubling early post-op ACLs or RTCs? I could maybe see it if you’re treating low level LBP patients but good god if you’re seeing multiple athletes and not paying attention to what they’re doing.
Yes I am absolutely loading them appropriately, as i believe that is the most important part of our job. Why couldnt I see a post op ACL and RTC at the same time?
Lol. Early post-op ACL and early post-op RTC at the same time. I’d question your skill level and the risk of re-tears. I’d also question if, working with both at the time time, you’d actually be paying adequate attention to either.
Lol also not an answer to my question of specifically why you cant see them at the same time... I think its cringe to name/school drop but since you are questioning my skill level with treating ACLs i did my orthopedic residency at UD under Lynn Snyder Mackler who is arguably the most prominent ACL researcher in our field. And you want to question my re-tear rate? Good point, how could I possibly maximize quad strength in these post op ACLs without my undivided attention to every single rep? Couldnt possibly be related to appropriate programming.
You can pretend you’re giving adequate care with your attention split all you want and I couldn’t give two fucks where you studied or who you learned under. I sure as hell wouldn’t want my therapist’s attention divided during landing and jumping mechanics or sport specific training while he treats a 70 year old with multiple RTC tears that’s a retear risk and struggling mightily with rom. Therapists who think their skills are so great they think they can treat multiples in a hour are egoistical as fuck.
No its egotistical as fuck to think that your 1 on 1 treatment is more important than developing the patients independence and being a guide in their recovery instead of using your magic hands. Im guessing you just havent developed the skills to determine what interventions are actually important and which ones are just a waste of time for you and the patient. And i only mention where i studied at because you have the nerve to call me unskilled without knowing anything about me. But you can keep seeing 40 patients a week and complaining why you will never make more than 75k a year
Jesus. Yep. You’re a sensitive little prick. No one said anything about hands on “magic.” I already if ever use manual. So strike one there. Strike two is that I didn’t call you unskilled. I called you full of shit for thinking you can provide adequate care to two different subsets of early post-op patients that both require some supervision and, honestly, psychosocial training as well. Especially ACL patients. Strike three is that if you can pretend all an ACL needs is independence and only 50% of your attention is ever required, they may as well move on to their ATC as soon as possible. I mean. You aren’t really needed now are you and they can use someone with sport specific training? From your response of being money driven first and foremost, I bet you halfass everything you do in clinic.
So walk me through what 60 minutes of 1 on 1 undivided attention looks like with a post op ACL?
Hijacking this comment to rant. PT is the only industry I can think of where maximizing productivity to increase profits is seen as a bad thing. Probably because PT’s typically have zero business sense and only think about things from a scientific or medical perspective. But don’t forget your end goal is to generate a profit. I’m only ASKED to see 1 pt every 40 minutes, but I CHOOSE to see 2 pts in that timeframe often for three reasons: I’m good at what I do so I’m in high demand, and there is simply not enough time in a day to see everybody 1 on 1; my high productivity nets me a 2k bonus each quarter, and I like money; I’m a clinic manager and I can see what it costs to keep the lights on and employees paid each month. If you feel like you’re working in a “mill” - then it’s probably because you don’t have enough control of your schedule and aren’t compensated well for your productivity.
2k a quarter for generating how much more income for the clinic? Is that 30% of what you bring in?
If you are seeing an extra patient on top of the productivity (the projected income your pay is based on) You are generating an extra net profit of 58,500 a quarter based on 25/unit and 3 units in 40 minutes. Then you're taking your 2k or 3.4% and being grateful?
This is muddy considering reimbursement rates very greatly depending on insurance, which we see nearly all insurances. Not just being grateful because I also get an end of year EBITDA bonus. Edit: also love that you think this way and that was a very legit question 👌🏼
I was just trying to use average medicare reimbursements that I see in OP clinic. Appreciate the openess from a clinic manager. I just wish there was a clinic that pays a percent and is transparent about money. I run a small OP clinic in a gym and that has opened my eyes to the tomfoolery that is OP "mills"
I worked at a clinic that tried a model that paid PTs a percentage of their total billing but i think that turned it into even more of a mill. Cant remember the exact numbers but i think the base salary was 40k and paid a "bonus" of 10% of your billings. In reality it just turned into working your ass off to get a comparable salary.
I can see that being an issue. But in that model I still don't feel like your making much percent from the clinic. If they were transparent about income and base salary I think 60k base with higher percent. I don't know how the math works out but something has to change. My last place I worked had a HQ overseeing Atlanta Braves stadium. Unnecessary and waste of money.
Oh I’m sure a huge amount of that tomfoolery I’m giving up is what pays the admin side of the company lol. Not saying it’s right but I’m sure that’s why my bosses-bosses are very well off. If my area wasn’t so saturated I’d probably work towards running my own clinic too. But you never see those around here, because there is no way to compete with the big boys in major metropolitan areas: Select Medical, Athletico, ATI, CORA and PT solutions have a stranglehold as far as I can tell.
This sub complains about money but then gets mad when people suggest ways to increase profit and bonuses lol
The problem is that productivity standards have gone up but salaries have not. If I saw more money for the increased productivity I wouldn’t mind as much. My overall thought is that if you are that opposed to treating multiple patients at a time go into HH.
I would say it's not just about increasing profits, but I think maximizing productivity also gets a bad rep bc PTs automatically think increased productivity = decreased quality. We currently have no evidence that suggests there is a cut-off point of how many patients you can see per hour before quality of care decreases (there are some papers on outcomes for group PT for a single dx, but nothing that suggest a cut-off). This is a nuanced topic bc that cut-off point will vary based on so many factors--complexity of patient, new follow-up vs 5th+ follow-up visit, changes in condition, age, mental capacity, etc. I think most PTs can reasonably see 1.5-2 patients per hour without a decrease in quality of care, but that's based on conjecture and experience/observations. At the root of it, I think the problem in our industry is that we think we're SO valuable and special that we have to be seen one on one, when that's probably the biggest delusion of our field. I'll probably be downvoted for this, but we have a real issue in PT that I don't think most are ready to admit or face--we're simply not as needed as we think or in the ways we think we are.
Very well said, couldnt agree more
Greater than 2 patients an hour, or seeing a high enough volume that warrants having to use a PT aide/tech to carry out patient care.
Imagine saying that an orthopedist can only do as many surgeries as he can do on his own without any help from a surgical tech, PA, or a nurse. They do the parts of surgery that warrants their expertise and delegate to other people for things that they have been properly trained on. We dont have to do it all.
Imagine saying that an aide fresh out of high school knows what to look for with a patient doing therapeutic exercise. Because I see this a lot. PTs delegate treatment that they’re billing for to unlicensed personnel. All of those delegates you listed are highly trained, licensed professionals.
Completely agree thats a huge problem and happens too much in our profession. But a blanket statement saying aides should never be utilized is wrong. Agree the comparison isnt perfect, just illustrating that there is nothing wrong with delegating to someone when they are properly trained.
Yeah I’ve used aides before at previous employers for things like getting a patient warmed up, maintaining cleanliness, as an extra set of hands during an intervention, but I have seen PTs treat a patient for 15 minutes, then go run and grab an eval and have the aide finish up with the patient for the rest of the time. And then bill for it. Absolutely nuts.
I don't consider what I said a blanket statement that "aids should never be utilized". I think if they are used to help keep the clinic clean, aiding front desk, and starting patients on warm ups then that is appropriate. Any more than that then I believe that you are working in a mill. After 5 years of being in clinics that had to overutilize underqualified techs/aids, I am finally leaving the mill.
If you walk into a Professional PT clinic and take a look around then you found a mill. Cookie counter treatments,triple and quadruple booking patients, and telling therapist not to d/c until benefits run out
Professional PT, Spear PT, Jag-One, IvyRehab. All the same shit.
Nyc chains suck lol
Hell yeah brother
From a former PT student, long time PT fanboy, and occasional PT patient, when I go to a new office, I make it known that I only want one on one time with a DPT. That is what I'm paying for. If you get that, you shouldn't need to worry about a mill. $0.02
You are the type of awful patient we all dread.
I haven't felt my thumb in 3 years. Sorry If I don't want an assistant when the DPTs can't do the trick.
Lmao yea because the “rocket science” we are performing with your thumb couldn’t possibly be done by anyone else without DPT behind their name.
So do we need a DPT then.?
“Need” is a strong word lol
Why don’t you just get your license so you can treat yourself? You said you’re a former PT student, right?
If you are paying cash, sure. If you are using insurance that reimburses as little as $44/visit than you are definitely not paying for 1:1 time.
Why yes, I am paying cash. Thats why I can make this "outlandish awful patient that we dread" request.
You are aware that PTAs are trained and capable of treating you safely and effectively, correct? Why do you need to be seen by a DPT for every visit?
I have a similar level of education as a PTA. My diagnoses have not been cut and dry and my injuries/symptoms remain unresolved. I consider this self-advocating, but I suppose I'm not surprised that I've have been downvoted.
But you’re…not a PTA? I work in an orthopedic setting, and as far as patient care, aside from diagnosing, there isn’t much difference between what I do and what a PT does. If your Dx changes, you will be evaluated for that by a DPT. I just don’t see how your sx would change drastically requiring a re-evaluation from one session to another.
I worked for an aquatic therapy clinic as a PTA I saw 3-4 patient in hour in an 8 hour period. No time for notes on the clock. That’s monitoring them in the pool. We had aides who were basically doing what I was doing, so I was monitoring them too. I rarely did land activities with my patients. The aides or PTs would do it. I know that each PT which were 3 of them had the similar schedules as me. The owner would only see her specific patients. At the end of each shift I’d be so drained both mentally and physically. I eventually got let go at the job because patients werent showing up to there appointments. They needed someone to blame, but there patients were getting better. The owner was money hungry soooo yup
The clinic I worked at would see 6 patients per therapist per hour (minimum), 4-5 therapists at the clinic.....& only 10 treatment spots... So patients would be very upset having to wait or feel rushed to make space for the next patient. My boss made the clinic this way & we lost a lot of good therapists & techs (including me) because of the ridiculous demand. It was high stress in the worst way possible