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PT and the Greater Good

Productivity Woes

Published June 18, 2014 3:28 PM by Dean Metz

Many of my fellow ADVANCE bloggers have been voicing concerns over productivity standards where they work. There is concern over not being able to reach targets and still do required work that's not billable; concern over working on one's own time; concern over patient outcomes; and concern of personal burnout and exhaustion.

They are not alone. I've recently come across an excellent piece by a speech-language pathologist on the same issue. What value is there in measuring productivity? General Motors sold 9.7 million cars last year... very productive. But they've already recalled 16.5 million cars this year. So although they got the product out the door, what good did it do them or their stockholders? Isn't that exactly what's going on in SNFs in the US now?

Somehow we need to know that employees are working optimally. Gross numbers are a bad way to measure that. If the product is without quality, then who cares about how many things get made or the number of people who get seen? Also people lie about numbers -- just look at the current VA scandal about misreported waiting times!

When we balk at doing work on our own time, managers can manipulate the situation by reminding us about our professional responsibility or how we should keep the patient in mind. Where will they be should an audit turn up questionable billing or when an unhappy family files a lawsuit? Will they be there to defend you or will they point the finger and simply hire another PT? Although the APTA is not a trade union, they must not remain silent on poor treatment of PT professionals in the SNF settings.

What does this mean beyond those therapists toiling away in sweatshop-like conditions, wondering if they could get fired for missing targets or speaking out? (Which, by the way, is perfectly legal in states with "at-will" employment).

It means that the public is not getting the services it needs in the right amount at the right time. Errors in process or documentation are more likely to impact this vulnerable population. Unscrupulous companies looking to maximize their short-term earnings are pillaging the resources set aside for the needs of this population. SNFs are raping the Medicare system now the way home health did in the early 1990s. If there are no funds left by the time we need them, we'll have only ourselves to blame for not speaking out now.

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2 comments

Nice article Dean.  Please encourage all of your colleagues to speak up as well.  I don't work in a SNF but am very aware of the companies who are using patients' benefit dollars unscrupulously. They have no morals or ethics.  This information has to go public so consumers know what is occurring in health care.  Thanks again!  

Nannette Crawford, Speech Pathology - SLP June 18, 2014 9:40 PM
Erie PA

Thanks so much for referring to the ASHA article that featured some of my work. You can learn more about what I'm doing to advocate for elder care and be an activist for better workplaces by checking out my website: http://graymattertherapy.com/snf-ethics/. This is not a solo venture. It will take occupational therapists, physical therapists, speech-language pathologists, AND rehab companies to affect change. I am always looking for help with this work. You can help without fear of retaliation as there are several things you can do without putting your name out there. And I'm looking for an OT, PT, COTA, and PTA that are willing to speak out in the same way I have to collaborate with as I move forward with continued advocacy.

Rachel Wynn June 18, 2014 4:56 PM
Boulder CO

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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