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PT and the Greater Good

Consent for Professional Abuse

Published June 24, 2014 4:22 PM by Dean Metz

If you're thinking this is a post about patient consent, it's not. Last week I wrote about the nearly unachievable productivity levels in skilled nursing facilities. I got a lot of responses from it. A former classmate wrote to tell me he was just separated from his employer due to saying "no" to unreasonable productivity levels.

Professionals are working off the books, unpaid overtime, or making themselves exhausted trying to cram everything into 7.5 hours a day. As professionals we're expected to practice based on the evidence base. Why should our employers behave differently? Productivity should be based on evidence, not randomly picked numbers.

There are many options for our employers to effectively determine what reasonable expectations for productivity are. My ADVANCE colleague, Lisa Mueller, has written about lean management. It's an objective way of maximizing productivity. It focuses on process, flow and the elimination of waste. There's nothing wrong with asking employers how they came up with productivity expectations. If they balk at the question, the odds are good there was no real process to figuring out the numbers. Do you really want to work for a company like that?

We have spent good money and/or gone into debt to learn the skills of care management, care planning, patient and caregiver education, interdisciplinary meetings, and documentation. Why shouldn't we expect to be reimbursed for those skills? They most often are part of the job description when working in an SNF.

Unless one is a business owner in private practice or receives some sort of profit-sharing bonus, one should expect to be paid for all the work one does. When one starts working without reimbursement, then consent has been given for professional abuse. On occasion, we all have worked a few hours over here and there. Generally in those instances, my employers have allowed me to take that time back at a later date. That is not what I'm reading in the posts of many of my fellow ADVANCE bloggers.

The APTA is striving for us to have nearly complete autonomy as professionals. If we keep allowing ourselves to be abused by employers in this fashion, that goal will most likely stay out of reach. If we can't stand up for ourselves, how can we be expected to stand up for our patients? That's why I believe the APTA needs to be part of this discussion.

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Am unemployed AGAIN  for saying no to over treating inappropriate patients.  If communicating and treating one's clinical judgment became the norm again, corporate could not fire all of us. They need us as much as we need them. As long as therapists give away their clinical judgment, the problem will remain.

carole datwho, ot, snf - unemployed June 25, 2014 9:15 AM

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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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