Why I Left Clinical Physical Therapy: Part 1

Before I begin, I first want to say that I have enjoyed my time as a Physical Therapist. I got into Physical Therapy to directly be able to change the lives of others through interventions I have selected. I honestly believed prior to 2021 that I would remain a treating clinician for my entire career. It came as a surprise to many once I let them know I was going to take a job where I was not treating clients. Here are some of the reasons I chose to begin my nonclinical career.

Productivity not sustainable

During 2020, many home health agencies either decreased their employees’ wages or increased their productivity requirements. It was a combination of PDGM and COVID-19 that decreased revenue for many home health agencies. I was seeing many posts on Facebook that therapists had to take a 20% pay cut to keep their job. It wasn’t until September 2020 that the announcement came from the Director of Nursing through a Zoom call that effective October 2020, the productivity expectations were dramatically changing. To meet full productivity standards, there would need to be more visits for the same amount of pay. I recognized quickly that I wouldn’t be able to keep that up because of the next issue.

Decreasing census

PDGM and COVID-19 had a synergistic effect on many home health agencies. I do know of some that said they were thriving, but it seemed as if the majority had a much lower census than 1 year prior. The reasons for it ranged from Assisted Living Facilities not allowing therapists into the building, clients that did not want to risk being seen, difficulty getting physician referrals, and many others. I expressed concerns to management for a few months after October 2020 but nothing seemed to change. I was staying under my 30 units most weeks to achieve productivity. Most weekends in 2021 I was the on call PT because I needed to meet the units for productivity. In addition, other therapists who were being paid per visit couldn’t get additional visits because I had to be the one to take the visits.

Wanting better work/life balance

For me, the bane of a home health therapist’s existence has been documentation. I do know there are therapists who can get all their documentation done while with a client, but unfortunately that has not been the case for me. I have been able to do that for regular visits but never evaluations or admissions. Much of the time I spent a few hours finishing up documentation when I got home. If I had an admission that had multiple medications, I knew it would be more than an hour to finish the Start of Care. In addition, scheduling visits, creating Home Exercise Programs and looking up resources for clients would blend into my time at home. I already mentioned that I was working multiple weekends. It felt like I was unable to be fully present with my family because I couldn’t “leave work at work.”

Greater challenges with Medicare reimbursement

In 2020, there was a fight to prevent Medicare from decreasing reimbursement in the outpatient setting. Although it didn’t directly affect me in home health, it would affect me if I decided I would start my own business treating clients with Medicare. I was starting to realize that it would be difficult to rely on Medicare as a payor source in the future when there is an ongoing battle to decrease reimbursement that appears to happen every few years, if not every year.

The amount of reimbursement would not be the only obstacle. In the summer of 2020, I joined a Facebook group that involved therapists who were getting approved to bill Medicare. It was eye opening to see how many hoops have to be jumped through just to provide treatment to someone with Medicare. After all that work, one could unfortunately end up with a denied claim. That just wasn’t a risk that appealed to me. I decided to look at other options.

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