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Episode 7: Ortho Physical Therapy - Hospital-Based or Private Practice


Nate Reynolds 0:00

Welcome to this week's episode. I'm your host, Nate Reynolds. This week, we are going to be talking about outpatient orthopedic physical therapy clinics. Basically, I'm going to be comparing my experience being in a hospital based clinic versus being in a private practice clinic. And I really want to dive into the pros and cons of the two, I think it's an important topic for new grads. And really anyone looking to switch from one to the other. I think sometimes we always think the grass is greener on the other side. But I just want to show that that's not always the case. It really depends on what you're looking for. So I have a few topics I want to talk about.

So the first topic I'm talking about is the referral source, then we'll talk about volume, then we'll talk about, you know, the salary, and then benefits. And if I had to choose what I would choose, or why I chose what I chose. So to start off, talking about a referral source in the hospital, there's always a consistent referral source, that the hospitals is self affirming system. So there really is never a shortage on patients. The con of this is that you don't always get to treat the type of patient that you would like, when I worked in Binghamton, I saw a lot of chronic pain patients based on where I was located. And that was something that wasn't something that I was very fond of. Sometimes, you can kind of weigh you down, because you don't see the progress, you would see with like a young athlete. I also work with high school athletes, which is great. And a lot of the high schools now, the hospitals will put in athletic trainers and strength coaches. So that's an easy referral source to work with high school athletes. And a population that when we think of physical therapy, especially outpatient, we think of working with athletes, and so that I think that is a perk of the hospital base. As far as being private practice, because the hospital is self referring, you need to develop your own referral sources, it is very difficult to pry patients away from the doctors that are associated with hospital systems. I've had many conversations with my girlfriend's dad, he's a hospital administrator. And it is very, very frowned upon to refer outside of the hospital system if you are a non op or a surgeon, because they want to keep that money within organization. And a lot of times patients don't know they have options. You know, the doctor says you have to go here. And they just think that's the only place they have to go. Today, I heard another local PT clinic advertising that the patient can choose where they want to go. And it's just something that we just don't think about, our patients don't think about. And so talking about referral sources, as a physical therapist says in a private practice, we need to be really creative with who we market to, we need to figure out who can we market to that are that are not necessarily surgeons or non op Doc's. So that can be chiros, licensed massage therapists, strength and fitness coaches. I think, sometimes, if you can develop a good relationship with a chiro, they look at an orthopedic condition, and they look at it with a different lens. So sometimes they know that if it's something that's not spine related, you can be a referral source for a shoulder, a hip and knee, and elbow, things that really are in their wheelhouse. And my experience with talking to some chiro's is that their patients are very loyal. You know, they have like those wellness patients that come back once a month. So if you can get tied in with a good chiro, and a chiro that has a similar belief with how you treat, I think that can be a great referral source. As far as strength and fitness coaches, I think having a good relationship with them, will allow you to work with, you know, those active adults, those young athletes. And that's how you can get that referral source even though there's all these athletic trainers and strength coaches within the high schools now. So um, another thing that I'd like to point out is that if you're trying to get a referral source and you're working with another local business, nobody will care about your business if you don't invest or care about theirs. So I would highly suggest go shattering at chiro. Go talk with a strength and fitness coach, go take a class. If you're going to get a licensed massage therapist, go get a massage from them, know what they provide, invest a little bit of your own money in them, and then they are more likely to refer to you. And another perk of creating your own referral sources is that it allows you to treat the patients that you want to treat.

The next topic, talking about volume, in my experience working in Binghamton working at the hospital hospital based outpatient orthopedics clinic. We had a high volume, we were very busy all the time. And I would say that a lot of times this leads to high burnout rate. And early on in my career, I think it was a benefit that I was actually in a high volume clinic. And the reason that being is that I was exposed to a lot of different types of patients. And you cannot treat what you've never seen. So I felt like I was exposed to treat a lot of different types of people, and a lot of different types of cases. And because I saw so many people, I think that helped speed up my learning curve. However, I don't believe that's sustainable for your entire career, because you will be burned out. I think that's why you see a lot of physical therapists that go into management do something else, as they get further along in their career. But also twofold. If you can't handle a caseload, even though you're exposed to a lot of things, you're going to be giving very mediocre care to a lot of patients, I was fortunate that I had a very good PTA that helped me manage my caseload. And I don't know how I would have done it without her. So I think there's pros and cons, you know, if you have a good PTA, and you have a team, like it was set up where I worked, then that can help you out. But if you're by yourself, and you're seeing 1516 patients, you know, I think that's something I would definitely weigh with when deciding if I want to take that job. So the perks of being in a private practice. So I would say that you probably have a little bit Lord volume. So in my current setting, it's just me as the physical therapist, and so I, our goal is to treat 14 patients a day, which I think is pretty reasonable. But I don't have a PTA, so I always have to be getting equipment for patients always have to be doing, I always have to keep my eyes on all my patients at once. And that takes a lot of multitasking. I would say that, that's one con. But at the same time, when you ever PTA it doubles your caseload. So I'd be seeing at sometimes, you know, 25 patients a day, and I had to keep all those patients in check. So really, you know, instead of let's say I have 40 patients on my caseload, I had 80. I had I'm keeping track of what every patient was doing and how to progress them. The next thing about volume is that when you have to develop your own referral sources, it takes time to build up your caseload much longer than I was anticipating coming from a hospital based setting, I was pretty much anticipating that the referral rate would be somewhat similar, but it was actually significantly less. And instead of you know, I remember one of my last weeks, at my last job, you know, I had five evals in a day. And our goal in my new clinic is, you know, pretty much five evals a week. So just a different mentality of how to build your caseload. However, once you do build up your caseload, people are coming to see you because of your reputation and how well you do your job. It's not because the doctor next door said just try PT. And they're just referring them to you. If someone comes to you, in a private practice, they're coming to you because they know that or they've heard from someone else that you're good at your job. And that, to me is rewarding, because it gives you that confirmation that you're doing a good job.

The next thing that I want to talk about is salary. So in a hospital based practice, hospitals get reimbursed much better than private practice. So I think the salary is probably higher at a at a hospital since private practices don't get reimbursed as well. So I think that means that it's kind of safe to say that private practices will often pay a little bit less. Currently, I'm working on an a performance pay model, which could be in my favor if I do well. It's putting a lot of stress on me. I won't speak much on this because I still am building up my caseload, but it's something that is out there. There is one thing that I want to talk about when it comes to salary. And I've actually heard that heard this quite a bit.And especially me being a clinical specialist, so I studied for about five months. I'm a board certified orthopedic clinical specialist. So I had my OCS and, you know, I heard in a few interviews that the company won't pay you more because you have your OCS because the insurance companies don't reimburse you more. How I would counter argue this is that neither does experience. So no matter how long, a clinician has been a physical therapist, and they do not get reimbursed more than a new grad, you also don't get reimbursed more based on having fancy equipment either. So you can have these, this equipment that you know, is 10,000 $100,000, a unit of ther ex is the same regardless of the type of equipment that you use. Whereas a Board Certified clinical specialist, no matter the setting, should be able to treat any condition that walks through that door and be able to provide great care. In my opinion, a person that is a clinical specialist, has better outcomes, drives more referrals, and will bring more profit to the door.

The next thing is talking about benefits. Insurance Benefits favor big corporations. For example, when I was working on the hospital, my health insurance cost me $140 per month, is about $69 per paycheck. My health insurance now at my current company cost me 500. So it's substantially more I have not as great coverage, and I have a higher deductible. So I think if you're looking at having a family, if your spouse doesn't have, or seemingly doesn't have a good insurance, then working in a hospital base clinic would definitely be something to consider. As far as continuing education, at my last job, I got $2,000 and continue to add every year, my current job, I only have 750. And my last job also paid for my OCS which is about 15 $100. And so if you're early on in your career looking for trying to take a lot of courses, trying to learn as much as you can, then you may want to look at off always, I think it's safe to say that a private practice doesn't have the resources, unlimited funds for your Con Ed. But I will say one perk, that that was very attractive at my current job was the retirement. So in a hospital based because it's nonprofit, you needed a 403 B. And there's no matching involved with that. Whereas my current company has a 401k. And they match 4% if I put in 6%. So that's a huge perk in the long run. So if I had to choose, what would I do, or what did I do? So early in my career, I was glad that I worked in a hospital based setting because I had more content opportunities. And I had a more diverse patient population. So I thought that combination helped me develop my skill set a lot more. Now that I'm almost four years into my career, I think working in a private practice is much more fair role for me. I think I've developed my confidence where I can sell myself and get people to come to me. I've also had enough time where I've developed a few niches. Couple of my niches are CrossFit Olympic lifting, working with baseball players. And I think that experience with working with them, Well, I mean, attract the clientele that I want to treat. Also that there's a little bit more flexibility in our private practice. If I don't have patients, I can come in late or I can leave early. And I think the work life balance is better. You know, it's not as rigid of a structure as the hospital based on even if I had no patients, I had to stay there until my shift was over. So if you're someone that is just looking to get paid, you don't really want to try to get people to come to you. You don't think that you're someone that networks well, and putting yourself out there is a challenge, then I think hospitals would benefit you more. And if you need great benefits, then I would say definitely go hospital base. However, I'm sure larger private practices such as like ATI athletico have better insurance based on the number of clinics and collections they have. It's a national chain. So it's all about striking numbers with insurance.

And so I think the last thing that I want to say is that when deciding as a new grad if you want to go hospital route, or going private practice, there's pros and cons to each side. You need to determine what you want to do and what's best For you. I think, for me right now, and at my stage of my life, I think private practice is something that I'm very interested in. Because I want to develop my own caseload work with the patients that I want to work with and develop my reputation. I think any business that I bring in the door is based on me as a clinician. My success as a question is determined based on the outcomes that I get from my patients, and the word of mouth referrals. And to me, that is exciting. And that's worth the risk because I don't have a family right now. struggled in that and I didn't have get the referral sources like, like I want, then then I start rethinking that, but right now, where I'm at in my life. I think private practice is perfect for me.

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