Travel Therapy: Working as an “Internal Traveler”

Photo of Lesley and her friend hiking with title "Travel Therapy: Working as an Internal Traveler" Guest post by Lesley Sheeley TravelTherapyMentor.com

When considering US based travel therapy careers, there are a few different options for how therapists can become employed. Most travel therapists and other traveling healthcare providers work through staffing agencies who help them to find travel jobs anywhere in the country, with any type of facility (this is what we do personally and is by far the most common route). Some travelers choose to arrange their own contracts directly with facilities, which is called being an independent contractor (you can learn more about independent contracting here). A third option would be to work directly with a particular therapy company or hospital system as an “internal traveler” who only goes between the facilities that company has. For example, you could work at any location that a certain hospital system has, an outpatient physical therapy company, or a chain of skilled nursing facilities. Below we are featuring Lesley Sheeley’s story, a physical therapist who is currently working as an internal traveler, to help you learn more about this type of employment!


Background

Hi! I’m Lesley. I am a military brat and was born in Colorado Springs, but I primarily grew up in Warner Robins, GA. I went to the University of North Georgia in Dahlonega, GA where I graduated with a Bachelor of Science in Athletic Training in 2017 and continued on to graduate with my Doctorate in Physical Therapy from UNG in 2020. 

I love to travel (duh), I also enjoy all things outdoors and CrossFit. It is not super uncommon to find me at a winery every now and then either 😉

After graduating as a Doctor of Physical Therapy in 2020, I took a position with Upstream Rehabilitation as an internal national traveler.

Upstream Rehabilitation is an outpatient orthopedic company with over 850 clinics across the United States. Some of the common clinic names you might recognize under the Upstream Rehabilitation “umbrella” are Benchmark, Drayer, and Serc Physical therapy.

My Why

I decided to take an internal traveler position as a new grad physical therapist due to it providing more stability and support than “traditional” travel positions through staffing companies.

With Upstream, I am able to remain in outpatient orthopedics, go through a 1-year mentorship program, have set documentation system, set salary, set benefits, and the opportunity to go permanent with the same company following my time as a traveler with them.

Perks to My Job

With Upstream, I make an average salary for a new grad in the Outpatient Orthopedic setting. I qualify for benefits such as loan repayment, 401k with matching, health/dental/vision insurance, and continuing education money.

Due to getting a full salary, the stipend is more of a set stipend rather than based off the area’s cost of living. So my income month to month remains the same no matter where I am working. The stipend is untaxed and follows the regulations of any other traveler stipend to help cover housing, meals and incidentals when I’m at my travel location.

Cons of Internal Travel

As an internal traveler, some cons compared with working as a traditional traveler would be:

  • I do not have as many options of locations
  • Cost of living does not always determine the amount of pay
  • I do not get to experience other settings

Logistics


Relocation: The company reimburses me for mileage to travel from one location to the next. I have been responsible for moving myself from A to B just like a traditional traveler. I pack everything in my car that I need to bring! The time moving between jobs has varied from a weekend to a week depending on the distance. If I had to take a longer time between assignments, I used my PTO through the company to cover that time and my annual salary remained unchanged.

Licensing: I do have to get licensed in each state just like a traditional travel therapist. The company pays for my licensing costs, and I take care of the licensing application process myself.

Housing: So far, I have found housing on my own for each location through people at the clinic I am going to, Furnished Finder, or Airbnb. I believe the company would help me if absolutely necessary, but I have gotten lucky with each one so far and have not needed their assistance!

Assignment Length: The time spent at each location varies based on the clinic needs. They aren’t the typical 13 weeks like for traditional travelers. My jobs have varied from 10 to 18 weeks so far.

My Experiences

So far I have lived and worked in:

  • 2 different clinics in Georgia
  • 1 clinic in Olympia, WA
  • Currently going between 2 clinics in Eugene, OR 
  • And I will be heading to Kansas City, MO next!

The locations are more limited and are determined by need. When originally hired, I gave a list of the states I was willing to go. Based off that list and the need in those states, they then offer me a position. If they offer a position I do not want, I am allowed to decline. There are not as many options, but still plenty to choose from in my opinion!

Switching clinic to clinic has been a wonderful learning opportunity as a new grad. I love to see the different ways clinics are operated, do scheduling, and treat patients. As someone who looks at going into leadership in the future, the experience is great!

I am so thankful to have had the opportunity to be an internal traveler! It has been a wonderful experience.


Thank you to Lesley for sharing her insights about being an internal traveler! If you have specific questions about internal travel therapy, please contact Lesley below. If you have questions about being a travel therapist in general, please contact us!

I am happy to answer any and all questions you may have! Feel free to email me at lesleysheeley@hotmail.com or message me on Facebook at Lesley Ashton Sheeley.

Should You Pursue Travel Therapy as an Independent Contractor?

Should you pursue travel therapy as an independent contractor?

Written by Jared Casazza, PT, DPT


“Couldn’t I just cut out the middle man and negotiate my own contracts?”

Have you ever thought about this before? Have you considered trying to set up your own travel therapy contracts instead of working through a travel agency? If so, you’re not alone.

Whether to take travel therapy contracts through a travel company or to work as an independent contractor through a business entity as a 1099 employee is a question we’ve received quite often. This is a very valid question, considering we all know that travel companies keep a percentage (sometimes a significant amount) of the bill rate that the facility pays the travel company.

If you’re completely unfamiliar with bill rates, then this article should give you baseline knowledge to better understand the calculations that I’ll go through to compare taking jobs through a travel company or as an independent contractor.

Financially, on the surface the answer seems obvious, but upon investigation it gets much more complex as to which choice is more lucrative. Since I’m a finance nerd and all for optimizing income, I initially planned to eventually go this route myself, cutting out the middle man so to speak in order to keep more of the hard earned travel pay. I dug deep into the tax laws and ran calculations to see just how much more I would actually be able to make as an independent contractor instead of taking jobs though a travel company.

What I found surprised me and made me decide it wasn’t worth the hassle, and since then Whitney and I have continued to take travel contracts through travel companies. Let’s explore how I came to this decision and help give you some food for thought as to whether this is a possible option for you, complete with plenty of math! 🙂

Pros and Cons of working as an Independent Contractor on Travel Assignments

The main benefit of working as an independent contractor, and the reason that just about everyone that goes this route decides to do it, is to keep the entire bill rate like I mentioned above and make more money! Instead of the travel company keeping 20-25% of the bill rate, you get to keep it all! What’s not to like about that?

The downsides will vary from person to person, but generally include: establishing a business entity (most people seem to prefer an LLC for this to reduce potential personal liability), more hassle finding assignments (you have to do this all on your own of course), writing your own contracts or being able to understand the ins and outs of contracts written by the facility, being responsible for getting your own health insurance, being responsible for getting your own liability insurance, having to pay self-employment tax on income, and having no one to advocate for you. Let’s explore each of these downsides individually.

  • Establishing a business entity: For this, it is best to consult a professional for advice on which business entity would be best for your situation. As much as I hate spending extra money, if I was going to go the independent contracting route this is an area where I wouldn’t cut corners. Being sure that you’re doing everything by the book is not only the best way to avoid future issues, but will also help you sleep better at night.
  • More hassle finding assignments: When working with a recruiter, you will be presented with potential jobs options from their clients (facilities) with current therapist needs. As an independent contractor, you have to do all of this on your own which usually involves “cold calling” clinics in the area that you’re looking for a job, or looking at permanent position job openings in the area and reaching out to them to see if they would consider a traveler. This is going to be more time consuming than having the jobs presented to you by a recruiter. In addition, some facilities that need travelers often choose to work with only one specific travel company to help streamline the process, which means those jobs might not be available to you even if you contact them directly and are a good fit.
  • Writing your own contracts: When you find a facility that is willing to hire you as a traveler, you’ll either need to write your own contract to have them sign or possibly sign a contract that the facility has. This is an area where you want to be careful since legal contracts can have very specific wording, and it’s easy to miss something if you don’t pay attention. As an upside, this would probably only be an issue for the first couple of contracts as an independent contractor since you’ll almost certainly become more proficient with writing and reading contracts over time.
  • Being responsible for your own health, dental, and vision insurance: This is a big one. As an independent contractor your yearly pay will almost certainly be high enough to disqualify you for ACA tax credits, which means you’ll be responsible for the full premium amount if you get health insurance through the marketplace. The travel company pays for a portion of the usual premium for us, which is why the company sponsored plans are so much cheaper than plans through the marketplace.
  • Being responsible for your own liability insurance: This is a relatively minor cost but not something to overlook. Travel companies provide liability insurance for their travelers, but if you are working as an independent contractor then you’ll have to get this on your own. In general this shouldn’t cost more than a few hundred dollars per year.
  • Paying self-employment tax on income: This is another big one! Self-employment tax is the money paid toward Medicare and Social Security on your behalf. This amounts to 15.3% of your income right off the top, and you can’t avoid it even with retirement account contributions! When working as an employee through a travel company, they would pay for half of this tax on your behalf with you only paying 7.65% (denoted as FICA taxes on your pay stub), but when working as an independent contractor you’re responsible for the whole shebang. For more detail on this tax, check out this link.
  • Having no advocate: Your recruiter (as long as they are good) is a lifeline for you while on assignment. If you have issues with a facility, then they can be the one to have the tough talks with the facility regarding fixing things if you aren’t comfortable doing that. If a contract goes exactly according to plan, then this may not be important at all, but if you end up at a facility where things aren’t ideal then this could prove to be very valuable and significantly reduce your headache.

Yeah, Yeah… But More Money!

I hear you! Despite all the “cons” mentioned above, I was ready to accept all of that and still work as an independent contractor if it meant an extra few hundred dollars per week, and this may be what you’re thinking as well.

However, I was very disappointed to find out that for my and Whitney’s situation, the financial benefit was actually very little or even nonexistent in some cases!

How can that be if the travel company isn’t keeping 20-25% of the bill rate? That’s where the math comes in.

Before we jump into the calculations though, let me explain how that 20-25% extra can quickly evaporate.

  • Stipends (Per Diems): First I want to make it clear here that I’m not a tax professional. The information below is just my understanding of the tax laws as I’ve read them and from what I’ve learned from consulting with tax professionals. Always consult with a professional before making a decision based on what is written here! TravelTax is a wonderful resource for more information. With that being said. The big thing that makes being a travel therapist so lucrative are the stipends for those travelers who meet the requirements for maintaining a proper tax home (the vast majority). The biggest portion of those stipends is almost always for housing. On average our housing stipend has been in the $600-$700/week range while traveling depending on the location. When working through a travel company, this amount can be received even if your actual travel housing doesn’t cost doesn’t equal the full amount. While working as an independent contractor, even though you can write off your housing expense, it can only be for the actual cost of the housing incurred. What that means is that if you find low cost housing at your travel assignment, you’ll only be able to deduct the actual cost of the housing instead of being able to receive the much larger housing stipend that you would when working through a travel company. This is the single biggest reason why working as an independent contractor doesn’t make sense for Whitney and me. The most expensive housing that we’ve had to date on an assignment was $900/month, with the average being closer to $650/month. Divided between the two of us, we’d only be able to write off an average of $325/month each for those housing costs if we worked as independent contractors versus the $600-$700/week ($2,500-$3,000/month) that we each get when working through a travel company. Luckily, the full meal and incidental stipends would still apply to independent contractors just like they do for travelers working through a travel company, so no difference there. But, depending on your average cost of housing on assignment, missing that full housing stipend can be huge as we’ll see in the calculations later.
  • Self-Employment tax: As mentioned above, this amounts to an additional 7.65% of income paid off the top in taxes when working as an independent contractor compared to when working through a travel company. This becomes even more significant than it appears at first glance due to the higher taxable pay as an independent contractor.
  • Health insurance: Paying the full marketplace premium for insurance is going to be much more expensive than the insurance offered through a travel company in almost all cases. For example, on my last contract my health, dental, and vision insurance premiums through the travel company we used cost me $24/week. For comparable coverage purchased through the marketplace, I would have to pay about $120/week. That’s over $400/month more for insurance when working as an independent contractor!

Onto the Numbers

Now that we see some of the reasons why the pay actually received as an independent contractor may not be as high we initially anticipated, let’s do some calculations to see if the actual difference would be worth the other “cons” mentioned above.

I’m going to use my situation on my most recent contract as an example, but keep in mind that this will differ for everyone depending on your own variables. I don’t know what the actual bill rate for that contract was since this is usually not disclosed by the travel company, but I’ll go through two examples using a $60/hour and a $65/hour bill rate which seem to be pretty typical on the east coast in our experience. I’ll also use 25% as the travel company margin, which would typically be on the high end but it depends on the specific company and contract.

The Scenario: 30 year old male, working 40 hours per week, for 48 weeks per year, with both the contract state and the home state being Virginia, working in Fredericksburg. Housing cost of $800/month, split with Whitney ($400/month each).

Working through a travel company taking 25% margin from $60/hour bill rate

$60/hour bill rate – 25% margin = $45/hour total compensation to traveler

  • $20/hour taxable ($800/week gross)
  • $25/hour nontaxable ($1,000/week broken down into $385/week for meals and incidentals stipend and $615/week for housing stipend)

Total yearly taxable pay based on 48 weeks per year worked: $38,500

Total yearly taxes (determined using this calculator): $7,665

Total yearly (taxable hourly pay only) after taxes: $30,835

$30,835/48 weeks = $642 taxable per week after taxes

+ $1,000 per week stipends (untaxed)

=$1,642/week take home after taxes

– $24/week health, dental, vision insurance premium

=$1,618/week take home pay after insurance premiums

Working as an independent contractor making $60/hour bill rate

$60/hour bill rate (all taxable) * 40 hours  per week * 48 weeks per year = $115,200 total pay received (before taxes)

Meals and incidentals: $385/week tax deduction

Housing: $400/month rent tax deduction (actual expense incurred)

$115,200 – ($385 * 48 weeks) – ($400 * 11 months) – ($5,760 insurance premiums for 11 months) = $86,560 after deductions

Total yearly taxes (determined using this calculator): $30,080 (of which $13,244 is self-employment tax)

Total yearly after taxes: $115,200 – $30,080 = $85,120

$85,120 / 48 weeks = $1,773/week take home after taxes

– $120/week health, dental, vision insurance premium

=$1,653/week take home after insurance premiums

As you can see here, as an independent contractor in the situation, weekly take home pay would only be about $35 more per week when everything is said and done!

 

Now let’s look at the same exact scenario, but with a maxed out 401k each year in both cases since that will help reduce the taxable income (on everything except self-employment taxes) which is very beneficial with such a high income as an independent contractor.

Working through a travel company taking 25% margin from $60/hour bill rate with maxed out 401k contribution ($19,000)

$60/hour bill rate – 25% margin = $45/hour total compensation to traveler

  • $20/hour taxable ($800/week gross)
  • $25/hour nontaxable ($1,000/week broken down into $385/week for meals and incidentals stipend and $615/week for housing stipend)

Total yearly taxable based on 48 weeks per year worked: $38,500

401k Contribution: $19,000 (reduces taxable income)

Total yearly taxes (determined using this calculator): $4,344

Total yearly after taxes: $34,156

$712 taxable per week after taxes

+ $1,000 per week stipends

=$1,712/week take home after taxes

– $24/week health, dental, vision insurance premium

=$1,688/week take home pay after insurance premiums

Working as an independent contractor making $60/hour bill rate with maxed out 401k contribution ($19,000)

$60/hour bill rate * 40 hours  per week * 48 weeks per year = $115,200 total pay received (before taxes)

Meals and incidentals: $385/week deduction

Housing: $400/month rent deduction (actual expense incurred)

$115,200 – ($385 * 48 weeks) – ($400 * 11 months) – ($5,760 insurance premiums for 11 months) = $86,560 after deductions

401k Contribution: $19,000 (reduces taxable income)

Total yearly taxes (determined using this calculator): $24,808 (of which $13,244 is self-employment tax)

Total yearly after taxes: $115,200 – $24,808 = $90,392

$90,392 / 48 weeks = $1,883/week take home after taxes

– $120/week health, dental, vision insurance premium

=$1,763/week take home after insurance premiums

As we can see here, maxing out a 401k account helps to reduce taxes on the income, which benefits the independent contractor more than the traveler working through a travel company.

So in this scenario after the 401k contributions, the independent contractor would come out $75/week ahead of the traveler working through a travel company.

If I did ever change my mind a pursue traveling as an independent contractor, I would definitely take advantage of the tax deferred savings associated with a 401k to reduce the tax burden on the higher taxable pay. An extra $75/week would amount to only about $300 more per month or $3,600 more per year. That’s still not worth the “cons” mentioned earlier in my opinion.

 

The pay difference between working as an independent contractor compared to working through a travel company only narrows further as the bill rate increases. This is because as the bill rate increases, the housing stipend can also be increased. This is of course as long as the GSA allows room for additional money applied to the housing stipend without going over the limits for the area that you’re traveling in. In the case of the independent contractor, their housing price doesn’t change just because the bill rate is higher, so the deduction for housing stays the same.

To illustrate this, let’s run the same calculations using the same scenario with a $65/hour bill rate.

Working through a travel company taking 25% margin from $65/hour bill rate

$65/hour bill rate – 25% margin = $48.75/hour total compensation to traveler

  • $20/hour taxable ($800/week gross)
  • $28.75/hour nontaxable ($1,150/week broken down into $385/week for meals and incidentals stipend and $765/week for housing stipend)

Total yearly taxable based on 48 weeks per year worked: $38,500

Total yearly taxes (determined using this calculator): $7,665

Total yearly after taxes: $30,835

$642 taxable per week after taxes

+ $1,150 per week stipends

= $1,792/week take home after taxes

– $24/week health, dental, vision insurance premium

=$1,768/week take home pay after insurance premiums

Working as an independent contractor making $65/hour bill rate

$65/hour bill rate * 40 hours  per week * 48 weeks per year = $124,800 total pay received

Meals and incidentals: $385/week deduction

Housing: $400/month rent deduction (actual expense incurred)

$124,800 – ($385 * 48 weeks) – ($400 * 11 months) – ($5,760 insurance premiums for 11 months)= $96,160 after deductions

Total yearly taxes (determined using this calculator): $34,246 (of which $14,712 is self-employment tax)

Total yearly after taxes: $124,800 – $34,246 = $90,554

$90,554 / 48 weeks = $1,887/week take home after taxes

– $120/week health, dental, vision insurance premium

=$1,766/week take home after insurance premiums

With a $65/hour bill rate and no 401k contributions to reduce the taxable income, the independent contractor would actually come out with $2/week LESS after taxes in this situation!

 

Now let’s see how that would change by maxing out a 401k account.

Working through a travel company taking 25% margin from $65/hour bill rate with maxed out 401k contribution ($19,000)

$65/hour bill rate – 25% margin = $48.75/hour total compensation to traveler

  • $20/hour taxable ($800/week gross)
  • $28.75/hour nontaxable ($1,150/week broken down into $385/week for meals and incidentals stipend and $765/week for housing stipend)

Total yearly taxable based on 48 weeks per year worked: $38,500

401k Contribution: $19,000 (reduces taxable income)

Total yearly taxes (determined using this calculator): $4,344

Total yearly after taxes: $34,156

$712 taxable per week after taxes

+ $1,150 per week stipends

= $1,862/week take home after taxes

– $24/week health, dental, vision insurance premium

=$1,838/week take home pay after insurance premiums

Working as an independent contractor making $65/hour bill rate with maxed out 401k contribution ($19,000)

$65/hour bill rate * 40 hours  per week * 48 weeks per year = $124,800 total pay received

Meals and incidentals: $385/week deduction

Housing: $400/month rent deduction (actual expense incurred)

$124,800 – ($385 * 48 weeks) – ($400 * 11 months) – ($5,760 insurance premiums for 11 months)= $96,160 after deductions

401k Contribution: $19,000 (reduces taxable income)

Total yearly taxes (determined using this calculator): $28,940 (of which $14,712 is self-employment tax)

Total yearly after taxes: $124,800 – $28,940 = $95,860

$95,860 / 48 weeks = $1,997/week take home after taxes

– $120/week health, dental, vision insurance premium

=$1,877/week take home after insurance premiums

After the reduction in taxable income through the 401k contributions in this final example, the independent contractor would come out ahead by a whopping $39!

Additional Considerations

  • In the example above, I did not account for the cost of liability insurance in the independent contractor example, because this cost is negligible in most situations and just adds further complexity to the calculations.
  • In addition, I did not factor in reimbursements for travel expenses that most travel companies will give in addition to the weekly pay. The reason for this was that an independent contractor would be able to deduct that expense as well, and those are likely to cancel each other out, especially in the scenario I laid out above where travel to and from the assignment location from my tax home was only a few hours each way. If this had been a move across the country, and the travel company didn’t reimburse those full expenses, the independent contractor would at least be able to deduct those beginning and ending travel expenses, whereas the traveler working through a company wouldn’t be able to due to the tax law changes last year in The Tax Cuts and Jobs Act (TCJA). That would skew things more in favor of the independent contractor, but by how much would depend on the actual beginning and ending travel expenses incurred.
  • I did not include the 20% pass through deduction that was also part of the TCJA last year due to uncertainty whether that would apply to all travelers in this situation. If this does indeed apply to your business entity as an independent contractor, then that extra 20% deduction would significantly improve the financial aspects of traveling as an independent contractor. Be sure to consult with a CPA on this deduction if you do decide to work as an independent contractor through your own business entity.
  • Single travelers that will be working in higher cost of living areas where housing costs are likely to be much more expensive will have a much higher deduction than in the above example for housing expenses incurred while working as an independent contractor. A much higher housing cost will tilt things more in favor of traveling as an independent contractor and is something that should be considered if this applies to you.
  • The higher taxable pay associated with working as an independent contractor will lead to much higher monthly student loan payments for anyone that has chosen to go with an income driven repayment plan. If you plan to pay your loans off as quickly as possible while traveling by making much larger payments, then this won’t affect you at all. If you plan to pay the minimum, save/invest the difference, and potentially go for 20-25 year student loan forgiveness, then this could be a big potential downside in going the independent contractor route, especially while on REPAYE and having half of the accumulated interest subsidized each month which is the case for me.

Conclusion

Cutting out the middle man and taking travel jobs as an independent contractor to make more money is certainly enticing, but upon investigation it proves to be more hassle and less lucrative than it appears at first glance.

The actual financial benefit of going this route can very drastically depending on the individual and his/her situation, but for Whitney and I, it does not seem to be worth it. This is only a path that I would personally consider if it meant an increase in at least $200/week after taxes, otherwise I don’t think that it’s worth the extra work involved. For us, it’s clear in the above scenarios that it would not be.

If you do decide to go the independent contractor route, maxing out pre-tax accounts (401k, traditional IRA, and HSA) all become ever more attractive options as a means to reduce taxable income and therefore significantly reduce taxes.

If you’ve worked as an independent contractor as a traveler in the past, we’d love to hear about your experience and if it differs from the cases I’ve laid out here. Let us know in the comments or send us a message.

If after all of this, you’ve decided that working as an independent contractor isn’t for you and would like recommendations for recruiters/companies that pay well and that we trust, then reach out to us here! Thanks for reading and I hope that this was helpful to you in deciding the best travel therapy path for you.