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PT on the Run

Scheduling Conflict

Published July 16, 2014 3:23 PM by Michael Kelley

I've got a bone to pick with you outpatient therapists! When I first started working at the hospital, our inpatient office was right next door to the front office of our outpatient department. It was pretty easy to listen to some of the phone calls come in, and one of the most frequent things I'd hear that always bothered me was a conversation that went something like this:

Patient: "I need to come in for physical therapy for balance."

Office Staff: "Well we only have two ‘balance therapists' and they are booked out for the next three weeks."

First of all, why are we labeling therapists as "balance" or "neuro" or "ortho?" I can appreciate that specific therapists have areas they like working in or maybe are more proficient at than others, but I've always had a problem with therapists restricting themselves to one diagnosis or problem area. (This is probably one of the reasons I work in inpatient... I get to see a little of everything!)

Secondly, three weeks to get an appointment? Are you kidding me? And sadly, this is common practice, not just at our outpatient facility, but at many throughout the area. It hit me again today as I was trying to assist a patient who had been admitted for BPPV. Typically we like them to follow up with an outpatient therapist within 48 hours, but the first appointment available within our hospital system was almost two weeks out! I ended up having to set him up with a rival company just because they had the availability in their schedule!

Now, I can certainly appreciate that outpatient physical therapy is where the money is at (when compared to inpatient physical therapy at least), so having a full schedule for your therapists is obviously preferred. But what kind of message does it send when you have to tell new patients that they have to wait two or three weeks to get in? And then finding treatment sessions after that, well good luck!

Surely there has to be a better business model than this. One that maximizes therapist efficiency and productivity, while still maintaining a flexible enough schedule to accommodate new patients coming in within a reasonable timeframe!

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I am a neuro therapist and proud of it  Getting my NCS was one of my greatest accomplishments.  Becoming a specialist at anything, particularly within physical therapist requires effort, hard work and determination. That said, those same specialists need to be able to treat other patient diagnoses.  Just because I don't enjoy treating orthopedic patients doesn't mean I can't.

My big pet peeve is therapists who work in an outpatient orthopedic setting and try to treat a neuro patient.  The clinic rarely has the correct equipment.  There are too many distractions and while principles of neuro transfer to ortho the same doesn't apply in the other direction.  Making an exception for that one neuro patient is doing the patient a disservice.  

Toni July 17, 2014 6:51 PM

I have worked in outpatient my entire career of 18 years, and no it is not ridiculous to specialize in one or two areas, especially given the sheer amount of conditions/diagnoses that come in for care. It is no different than the orthopedic surgeons office with each surgeon having his/her area of expertise/specialty. So if you need to have surgery for a torn rotator cuff, would you just see whomever has the earliest available, even if it's with "the knee guy"?  A patient who the best treatment for their condition surely doesn't mind waiting 2-3 weeks for the best person for their problem. The problem I saw in your post was how the receptionist answered and spoke to the patient, not that there are "specialists" at the clinic (oh the horror!). She should have said something more along the lines of "we have two therapists who specialize in your condition, and the next available time for an evaluation is _____. I can set this up for you, but also put you on a cancellation list in case something sooner opens up.

Karen, Physical Therapist July 16, 2014 7:55 PM

I'm a little surprised at someone being admitted for BPPV when that is something I can treat in 30 minutes (if it is truly BPPV) and discharge.

I've worked my butt off for years to be a specialist in falls prevention for older adults. Our colleague Dr Patt has done the same for working with people with stroke. It is not just a "label", it is an earned specialty.

I must remember this story though when my US friends rant about the ridiculously long wait periods in the NHS. Our service's current wait is only 2 weeks.

Dean Metz July 16, 2014 6:19 PM

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