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Toni Talks about PT Today

Quality Help is Hard to Find

Published December 18, 2007 8:36 AM by Toni Patt

Remember the days when the only people who worked for contract staffing companies were the ones who couldn't get a job anywhere else? Those days are long gone. Some very good therapists work for these companies.

Using a contract therapist can be expensive. When I was a manager, my first concern was getting quality people who could do the work. My next concern was getting my money's worth. Using these companies is a part of life. This is a necessary service. If we didn't have temporary staffing, care would suffer every time someone took off. Like most things in life, there is the good and the bad.  These differences reflect what is happening in facilities today.

In the world of physical therapy, there are facilities that have good reputations and those that have not so good reputations. Here in Houston, the local therapists know which facility fits into which category. We gently sway our friends and family toward the ones known for good care. Unfortunately one disenfranchised therapist can ruin the reputation of an entire facility. The same is true of contract companies. Only in that case, the one bad apple moves around and spreads the damage. These companies have to provide good therapists for numerous locations. There are different ways to approach this. The companies in Houston exemplify this as we have either side of the spectrum represented.

One approach is quantity over quality. This company hires as many therapists as it can, including new graduates and experienced therapists. The therapists are paid according to experience. My problem with this is they charge the same rate no matter which person is sent to a facility. Generally they book the lower paid therapists first. The end result is increased revenue. It seems to me that being profitable is key to them. I'm not saying they don't have good therapists. They do. But a new graduate isn't able to jump and do what has to be done in the time frame available-while carrying a full case load. No one should expect them to do that. Yet, it happens.

Another approach is quality then quantity. Each employee takes a competency test prior to being hired. All have at least a year of experience. As much as possible they match the placement with the therapist's experience. They eagerly welcome experienced therapists. Who you are assigned depends upon who is available, not who makes the least amount of money. They come in, do the job and provide good care.  I've never heard one of them complain about the company. I can't say the same for the others.

These approaches mirror what is happening in therapy now. Many facilities are hiring newer graduates to save money on salaries. To them an hour of patient care is an hour of patient care. It doesn't matter who is doing the treatment. Those of us who work with the patients know differently. So do the patients. Fewer facilities are putting quality first. They say salaries are too expensive. There are some big name facilities in Houston. They almost always hire new graduates. I know because I've worked at some of them. This isn't good for the profession. The contract company that stresses quality is thriving. They are frequently fully booked. This proves that quality can be maintained while, at the same time, the company is successful. I hope the people who make the decisions are noticing this.


Another problem is that every hospital/clinic will assume that their way of doing things is the way everyone does things...from paperwork, to quotas, all the way down to how many minutes you take for lunch.  When the contract person comes in , he or she spends valuable time trying to figure out the system...often the staff therapist that are there are in a rush with their own load and unable to assist.  A short concise summary of expectations would be helpful(not the 3 pound policy/proc. manuals that are on a shelf that we are expected to look at.)

Many hospital will dump the max assist/low level load on a contract personel. It is no wonder many places get a bad rap.  Ultimately contract therapist /staff/administration all become frustrated and it is the patient care that suffers.  

Clay C, PT - PT, contract January 31, 2008 10:49 AM

I have been a contract therapist for several years now.  And I agree with your statement that facilities are more interested in saving money than in providing quality care.  I remember that when I worked as a staff therapist for a hospital I was so confined by the rules, regulations and quotas of patients to be seen that there was little time to improve on quality.  However, I noticed that once I started working as a contract therapist, these facilities could not necessarily impose their rules upon me.  So only then did  I feel I had the freedom to focus on quality of care and troubleshooting to find the cause  of my patient's problems rather than just treating symptoms.   Unfortunately, that freedom becomes short-lived because eventually, most facilities will eventually hire someone who will play by their rules.  Unfortunate -- but that is the reality.

Donna, Physical Therapist January 22, 2008 9:22 PM

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