Travel Therapy Licensing Process

Written by Travis Kemper, PT, DPT with contributions by Whitney Eakin, PT, DPT, ATC


Licensing and housing are probably the two most frustrating and challenging aspects of being a travel healthcare professional. We will cover housing in future articles, but let’s dig in to the current state of licensing, and I’ll give an overview of how my wife Julia and I, as well as Jared and Whitney, have attempted to navigate licensing as traveling physical therapists thus far.

How Does Licensing Work as a Travel Therapist?

In general, if you want to work in a different state as a travel therapist, you need to get licensed in each individual state where you plan to work. There is a “PT Compact” license that has begun for physical therapists, which makes the licensing process much easier for those who are eligible for the compact. Some type of compact license is also in the works for occupational therapists, but has not been passed yet. But, with the exception of the small percentage of therapists that can take advantage of a compact (or multi-state) license currently, the rest of us have to take care of licensing the old fashioned way.

What does licensing entail? Generally, an application, a fee, sometimes a jurisprudence/law exam (usually can be taken online or sent in on paper, but some states require you to test at a testing center), sometimes fingerprinting, and sending in a lot of verifications including: school transcripts, original board exam scores, and verifications that your license is in good standing from all other states in which you are licensed.

In some cases, travel therapy companies can help with the licensing process. Generally, this means they will reimburse you for a license once you’ve obtained it yourself and have accepted a contract with their company in that state. Sometimes, they can help you with the licensing process up front, including paying some of the costs and doing some of the leg work for you. But this is usually only once you are already a current traveler of theirs and are looking into your next contract with them in a new state.

Our Approach to Licensing Thus Far

We certainly don’t have all the answers, and like housing, there are multiple approaches and techniques to the licensing process that can all be successful for different travelers at different times. As a couple, finding positions has generally been time consuming and difficult, and starting contracts when we want has been challenging. Our friends who travel solo have found it much easier to find positions in the states in which they are interested and in a more timely manner than we have.

At first, we decided to only look at quick license states, meaning that we could look for jobs in states that would allow us time to find the job first and then get the license second. Therefore, we would ensure that we were only paying for the license once the job was already secured, instead of wasting time and money getting licensed in several states without knowing if we would actually take a job there. This tactic was primarily because we were broke after grad school (I’m sure most of you can relate) and couldn’t afford to pay for multiple licenses out of our own pocket up front, with the hopes of taking positions in those locations and then getting reimbursed.

We started with our first license and job in Arizona, because that is our home state, and we were getting that license no matter what. Next, we went to South Carolina, because it was a quick license state.

A note about “quick license” states: They are quick once they get all your paperwork, but most still require paper verifications from your current licensed states, and this can be a very timely process in itself. Licensing makes me speak very negatively about our state governments when they take two weeks to print out and send a piece of paper that I paid them $15-$25 to send! In the case of South Carolina, our start date was delayed two weeks because of the license verification from Arizona.

After that fiasco, we became more proactive and decided to get licenses up front in West Virginia, Kentucky, Maryland, and Tennessee while on contract in South Carolina, so we would not have a delay again in starting our next contracts. This seemed like a great idea at the time, and we figured a couple thousand dollars we spent on these licenses could be recouped fairly quickly.

This once again turned out to be a losing plan, after taking two extra weeks to find positions, we finally accepted positions in New Mexico (notice New Mexico was not on the list of licenses we had!) and started that licensing process there due to not being able to even interview for any positions in the other states. Again, the other states where we were already licensed made getting this license expensive and time consuming. New Mexico also lost half of the documents that were sent in. Luckily, the staff there was actually helpful unlike other states (cough West Virginia cough), and after 8 hours on the phone, we were able to get our licenses pushed through even though they did not have all the physical documents that were required.

What We’ve Learned About Licensing

So, where are we currently with licenses and what have we learned? Well, as of this point we are back working in Arizona, and seeing as that is our home state, we will be keeping that license. We still have New Mexico and Kentucky, but will be letting Kentucky expire in March 2019 instead of renewing. We already let the rest of them expire instead of paying to renew them.

Right now we are in the process of getting our California licenses, because California is reportedly a gold mine for travel therapy couples, and it is a gorgeous state. The current plan is to hang out in California and Arizona until our home state of Arizona starts issuing compact license privileges, and then use the compact to be able to move around the country again.

You can find out more about the PT Licensure Compact here.

What About Jared and Whitney’s Experience?

So far, Whitney and Jared have had a little better go at licensing than us, for the most part. Similarly, they chose to start by working in their home state of Virginia. After that, they were methodical in their licensing choices, and chose to get licensed in advance in each state rather than wait until after they found jobs to get licensed. They always chose states based on trends of which states tended to have the most PT jobs, since they also travel as a couple.

They chose their next state, Massachusetts, based on seeing a lot of job options in that area, and that choice worked out well with them being able to find two jobs together for their desired start date after they were already licensed. Next, they chose North Carolina, for the same reason. They wanted to be in South Carolina, Georgia, or Florida ideally, but they were seeing a lot more jobs show up in pairs in North Carolina, so they went with that. And, that ended up being another good choice, with them able to start with two jobs in the same area right on time, after they were already licensed.

After North Carolina, they chose Illinois due to seeing a lot of jobs there in general, but this choice never quite panned out. They ended up letting this license lapse and never used it. For what ever reason, the timing wasn’t right and they weren’t able to nail down two jobs together in Illinois. Similarly, they got licensed in Arizona due to a high number of PT jobs, but so far the timing has not worked out for them to go to Arizona either. They plan to keep this license though and use it in the future.

So, their travels have been a little limited due to licensing restrictions, and they’ve only ended up working in Virginia, Massachusetts, and North Carolina so far in 3.5 years of being travel therapists. But, a big reason for this also is that they were risk averse, and did not want to waste a lot of money on licenses if they didn’t think they’d use them, so they’ve held off on some opportunities because of that.

They too are holding out for their home state of Virginia to start issuing compact license privileges, which will significantly open up their options. Otherwise, they plan to get one to two more licenses, including California and possibly Washington due to lots of PT opportunities in those states, making it more likely to find two jobs together as a pair.

Take Home Points

The licensing process can be challenging and frustrating as a travel therapist, especially when traveling as a pair. All of this is at least twice as easy if you are traveling as a solo healthcare professional, but you may still have some of the same challenges that we have faced.

In general, you have a few different strategies you can use to approach licensing, which include:

  1. Pick a state you think will have good job options, one at a time, and get licensed in advance. Have the license in hand, then start looking for jobs there.
  2. Look for jobs in quick license states, and then if you find a job, get the license there afterwards.
  3. Get a few different licenses up front to open up your options before starting to look for jobs.

Although this process can be cumbersome, it is still doable. Many therapists don’t have near the trouble Julia and I have had, especially those traveling by themselves. Jared and Whitney had a fairly easy time with licensing and job finding for the first 2+ years, and have only recently run into some hiccups. If you play your cards right, you’ll still have a great experience as a travel therapist, as long as you’re somewhat flexible and willing to go with the flow if setbacks do happen.

Let us know what strategies have worked or failed for you for licensing! We are always open to hearing ideas from fellow travelers. Have questions for us about licensing? Send us a message!

The Single Biggest Advantage of Travel Therapy

Written by: Jared Casazza, PT, DPT


In the past I’ve written several articles on the financial advantages of being a travel therapist and how those advantages have allowed Whitney and me to embark on an alternative lifestyle full of international travel. In fact, I’ve always made it known that the financial aspects of being a travel therapist are the biggest reasons I was so dead set on going down the path of travel therapy even two years prior to graduation. However, there is one even bigger advantage that I’ve been thinking a lot about lately that is even more important to me than making more money… and that is flexibility.

The Many Faces of Flexibility

Flexibility as a travel therapist comes in many forms. There’s the flexibility to take extended periods of time off.

  • I’m currently writing this after last working over 6 months ago.

There’s the flexibility to try out different settings for a three month stint to see if you have any interest in that area.

  • I’ve now worked in outpatient ortho, acute care, home health, skilled nursing, and wound care while traveling.

There’s the flexibility to choose to invest money instead of paying down student debt.

  • This is primarily due to travel therapists having lower taxable income meaning a lower monthly income based payment due each month. And this is the path I’ve chosen for my own finances.

There’s even the flexibility to decide if pay or travel location is more important to you for the next three months and to change your mind about that decision after each assignment.

  • Occasionally these two coincide, but generally higher paying contracts are in less desirable areas.

Flexible Time Off

Starting out traveling as a new grad, I was most concerned about making as much money as possible to offset my student loan debt (and in my case, start investing heavily early in my career). For that reason, pay was the primary consideration for me, but I’ve recently found that the flexibility to take time off is even more important. These things go hand in hand to some degree, because without making so much more money as a traveler, it would be difficult to take extended time off of work, but the flexibility goes beyond that.

If I had taken a permanent job out of school, there’s little doubt it my mind that I also would have saved a large percentage of my income despite the lower total pay at a permanent job. After a couple of years, I would have likely had enough saved to take an extended trip out of the country, but because of the nature of a permanent position this would have been impossible. After all, it’s difficult to find a permanent employer in healthcare that is willing to let an employee take two consecutive weeks off, much less 5 months! So to me, the flexibility in time off allowed by travel therapy is huge.

Flexibility to Try New Settings

The flexibility to try out different settings is something that I didn’t know at first would be a benefit of traveling. I was always most interested in outpatient ortho as a student and undoubtedly would have taken a permanent job in this area had I not decided to travel. Whitney with her Athletic Training background was 100% in agreement with me in this area. To my surprise, after taking a couple of contracts in other areas, I found that I actually really enjoy home health and even wound care!

As a student, wound care was something that I was terrified of, and I would have never willingly taken a job with that requirement if it wasn’t for knowing it was only for three months. Home health is an area that I started to become interested in, but I most likely wouldn’t have taken the leap into trying it out at a permanent job due to fear of the unknown. As a traveler, it is much easier to get over that fear when you have a predetermined end date that you know will be there pretty quickly if it turns out you really don’t like the job (this was skilled nursing for me).

Flexibility to Invest Instead of Paying Down Debt

I’m not sure if investing instead of paying off my debt is something that I would have done if I had taken a permanent job, but there’s no doubt that it’s more feasible as a travel therapist. The biggest reason is that with a lower taxable pay as a travel therapist comes a lower income based student loan payment. Ordinarily, this wouldn’t be a big deal, but when using the REPAYE income based repayment plan, this becomes more important.

The reason is that under REPAYE, half of the accumulated interest each month is subsidized, which ends up being a massive benefit for travel therapists who choose an income driven repayment plan. For me, this is the difference between having an effective interest rate of 6% on my loans versus an effective interest rate of 3.2%. Or, to put this in different terms, it’s the difference between my student debt growing at $500/month versus growing at $266/month.

If you take into account that the stock market returns on average 7-10%, then you can see why investing your money to get that return instead of paying off low interest debt at 3% would make sense. Having the interest accumulate much more slowly makes investing instead of paying down my student debt a no-brainer in my current situation.

Flexibility to Choose Between Pay and Location

Since the primary motivator of travel therapy for Whitney and me was pay, to this point we’ve always chosen to take higher paying travel contracts in rural areas. In addition to the higher pay, we like the slower pace, caring people, and lower cost of living that goes along with traveling to rural areas. Although rural areas are great for us, they lack the excitement of being closer to bigger cities and more desirable areas.

In the future, as money becomes less and less of a motivating factor for us as we approach financial independence, location is likely going to become more important. For example, we’ll likely sacrifice pay and low cost of living at some point to take travel assignments in Hawaii and southern California, which is something that we would never have done three years ago when starting out.

Take Home Points

It’s inevitable that priorities change throughout one’s life. The many different forms of flexibility offered by travel therapy have made pursuing these changes in desires and priorities much more feasible for Whitney and me. Starting out, we never would have guessed that some day we would value being able to take 5 months off to travel around the world, being able to experiment with different settings, or being able to try out the city life without committing to it long term. Travel therapy has given us the ability to do all of the above due to the flexibility, and that has been priceless!

 

jared doctor of physical therapy

Author: Jared Casazza, PT, DPT – Traveling Doctor of Physical Therapy – Aggressively seeking Financial Independence early in his career

Is Contributing to a Company 401k Worth it as a Travel Therapist?

Written by: Jared Casazza, PT, DPT

What Makes Travel Therapy Different?

Travel therapists are in a unique position with respect to 401k accounts. When working with most travel healthcare companies, therapists will be eligible to contribute to the company sponsored 401k plan. The 401k benefit eligibility will vary company to company, but most companies provide it in some form. However, since many travelers switch between travel companies pretty frequently, it is a common concern whether contributing to the company 401k plan makes sense for them, or if it would just be additional hassle. Unsurprisingly, since most of my articles on FifthWheelPT are finance related, this is definitely one of the top five most common questions I get asked by current and prospective travelers. In addition to wanting to know if using the 401k plan is worth the hassle if switching between companies, I often hear that there is concern about what happens with account once the individual leaves the company or stops contributing to the account.

I hope to shed some light on my thoughts about 401k plans for travelers in this post, but I do not intend this to be specific advice for any of you. This is just what I’ve done and what works for me, but everyone’s situation is different, so be sure to do your own research on the topic as well.

What is a 401k?

First let’s cover the basics of what a traditional 401k plan is and why one would choose to contribute to it in the first place. Most travel companies don’t offer a Roth 401k option, so we can skip over that for now, but if you’re interested in my thoughts on Roth vs. Traditional accounts, you can check that out here.

A traditional 401k is a retirement account that is offered by an employer and allows the employee to contribute pre-tax money to the account from each pay check. The amount contributed is up to the employee, but it is usually based on a percentage of the employee’s taxable income. Since the money isn’t taxed when it’s contributed, it’s able to grow in the account tax free for however long it remains in the account. When withdrawals are made (usually in retirement), the money withdrawn each year is then taxed along with any other earnings (social security, investment income, rental income, etc.). The big benefit of this account is that it allows you to contribute money while working and earning a lot, therefore in a higher tax bracket, and instead paying taxes on the money in retirement while (hopefully) in a lower tax bracket. The money also grows more quickly in a 401k than in a regular investment (brokerage) account since the amount that would have been taxed is compounded. The maximum that an individual is able to contribute to a 401k in 2018 is $18,500, and for 2019 it will be $19,000. Taking advantage of the tax benefits of a traditional 401k (and additionally, a traditional IRA) is a huge part of what has allowed me to semi-retire and travel around this world this year after only three years of full time work as a travel therapist.

401k Employer Match

A 401k sometimes has the added benefit of employer matching. The amount that is matched, if any at all, is determined by the employer and will usually be somewhere between 3%-6% of the employee’s taxable income. The employer can also include a contingency that it is only matched if the employee contributes a certain amount as well. This is the employer’s way of helping the employee have a more secure retirement by contributing to their retirement account. In many companies, the employer match took the place of a pension that used to be standard but has now disappeared in most public sector jobs. An employer match is in no way equal to a pension since the benefit is comparatively small, but any extra money toward retirement is a great thing!

The employer match is great if the company offers one, but for the majority of travelers this will be a moot point. Most travel companies offer a 401k with some sort of employer match, BUT they have a vesting schedule. The vesting schedule determines how much of the employer match you get to keep if you leave the company early, which makes this an incentive for the employee to stay with that employer. Many of the companies require that you have to work between 3-5 years with the company to keep all of the employer match. Some plans will have a tiered vesting schedule: something along the lines of at one year you keep 20% of the matched amount, at two years you keep 40%, etc. However others have a “cliff” vesting schedule: something like if you work three years or more you keep all of the matched amount, but if you leave before three years you don’t keep any of the amount that has been matched. Basically, the 401k employer match is great, but unfortunately it won’t apply to travelers that switch between companies often or that don’t plan to work three years or more as a traveler. In that case, an individual retirement account could make more sense and involve less hassle for the traveler.

Traditional Individual Retirement Account

A traditional IRA (Individual Retirement Account) is another option which has the same benefits as a traditional 401k, and doesn’t require an employer to utilize, and one other big difference, the contribution maximum. A traditional IRA allows a maximum contribution of only $5,500 for 2018 and $6,000 for 2019. If you’re a big saver like me and plan to reach financial independence as quickly as possible and maybe even retire early, then that’s a relatively small maximum each year.

If you plan to switch companies often, and therefore won’t benefit from the employer match, and don’t plan on putting $6,000 or more toward your retirement account each year, then foregoing the 401k and choosing an IRA instead could be the best choice. An IRA does have the added benefit of more flexibility between investment choices. With a 401k, the investment choices are usually limited to 10-20 options chosen by the company, whereas with an IRA the investment options are essentially limitless.

Utilizing a 401k and an IRA

For those, like me, that plan to put more than $6,000 toward retirement each year, then contributing to a 401k account in addition to an IRA will likely be necessary even if the individual won’t benefit from the employer match.

Luckily, having a 401k and an IRA is pretty easy, even if you switch travel companies often. (Keep reading below to learn more about that process if switching companies.) I’ve switched between companies on a few different occasions and have always taken advantage of a 401k account if offered, while also contributing the maximum amount to both the 401k and an IRA.

There are income limits where the benefit of an IRA (the tax savings) starts to diminish if the individual is also contributing to a 401k, but the limit is higher than most traveler therapists will make at $63,000 of adjusted gross income (tax free stipends are not factored into this number).

In my opinion, if you plan to save more than $6,000 toward retirement each year, then it makes the most sense to me to contribute the maximum to an IRA, and then any additional money you wish to save would be invested in the 401k. This is assuming that you wouldn’t benefit from the employer match, but if you would, then it would be foolish to pass up that match.

Here is the general order of operations that I have used and that I think makes the most sense:

  1. 401k contributions up to the amount to get the full employer match (if applicable)
  2. IRA contributions up to the maximum ($6,000 for 2019)
  3. 401k contributions up to the maximum ($19,000 for 2019)
  4. After tax investments (brokerage account, real estate, etc.)

If your company doesn’t offer an employer match on the 401k or if you won’t be able to benefit from it due to the vesting schedule of the company, then skip #1.

What Happens to the Money and 401k Account When Switching Companies?

Let’s say that you follow the order of operations above and stay with the same company for your first year as a travel therapist, but then get a better offer from a different company and decide to switch. You knew that you would probably be changing companies eventually, either for a better paying job or a job that your company may not have, so you assumed you wouldn’t benefit from the employer match. You maxed out your traditional IRA and contributed an extra $10,000 to your 401k. Great job!

Now, since the IRA isn’t associated with the employer, it isn’t affected at all by switching companies. That account belongs to you only. But the 401k is affected by switching companies, so you’ve got a decision to make.

Here are your options:

  1. You can have the money paid out to you.
    • This is almost never a good idea since you will not only pay taxes on the money, but also penalties!
  2. You can keep the money in the 401k account of the employer
    • This will occasionally involve additional fees since you no longer work for them.
  3. You can roll the 401k over from your previous employer’s 401k account to your new employer’s 401k account.
    • This could also be a hassle if you don’t plan to stay with the next company very long.
  4. You can roll over the 401k into your already existing traditional IRA account.
    • In most cases, and what I’ve always chosen to do. It makes sense to roll the 401k balance over into your traditional IRA. This gives you the increased flexibility with investment options mentioned above, which usually means lower fees on the investments as well which is a wonderful thing. The account is also yours and not associated with any employer, so you don’t have to worry about moving it around again at a later time. And the accounts work the same way with taxes, and you won’t have to pay penalties.

401k Rollover to Traditional IRA

By rolling the money over into your traditional IRA account, you have essentially contributed the full $16,000 (investment in the IRA to the maximum plus the investment in the prior 401k plan that is now rolled over) to your traditional IRA. This is an easy way to effectively contribute more than the maximum amount to an IRA when switching companies. This simplifies your finances (less accounts to keep track of) and gives you more investment options which are both great things. The rollover process is very simple and can be repeated every time you leave an employer and have a 401k balance with them. I have rolled my 401k balance into a traditional IRA several times and it has never taken more than 30 minutes.

For those travel therapists that are saving a significant amount toward retirement each year, I think that this is the best option with all things considered. I max out my IRA, contribute as much as possible to my 401k, and then roll the 401k into the IRA each time I leave a travel company to give myself the most investment options and to keep my financial life as simple as possible, while still contributing over $20,000/year to the accounts that wouldn’t be possible with a traditional IRA alone.

If you do this as well then you’ll want to make sure that it is a direct rollover. More information on the different types of rollover can be found here.

Conclusion

I know that for those of you that aren’t very familiar with saving and investing, this can all sound intimidating, but it really isn’t very difficult and takes minimal time to figure out and implement.

For those travel therapists that don’t plan to save more than $6,000 toward retirement each year, then just foregoing the 401k and choosing an IRA instead is the most simple option. For those that want to save more than $6,000 per year and also switch companies often, it’s worth the extra effort to contribute to the company’s 401k plan once you’ve maxed out your IRA for the year and roll that 401k over each time you leave a company. Once you’ve done it once it’s a piece of cake and will take you no time.

Above all else, make sure that you’re saving for retirement in some capacity no matter what account(s) you choose to utilize!

Remember to do your own due diligence before implementing anything that I talk about, since this is not intended to be specific advice for you. Thanks for reading and I hope that this post helped to clarify things for you.

If you have any questions about this post or anything else travel therapy related then contact us and we’ll do our best to help you out. If you need assistance finding a good travel therapy company or recruiter then reach out to us and we can help you there as well.

How do you currently handle your retirement accounts as a travel therapist? Let us know in the comments!

 

Understanding a Travel Therapy Contract Bill Rate

Written by: Jared Casazza, PT, DPT

All travel therapists want to get the most money possible out of their contracts. In fact, the increased pay associated with travel therapy is the #1 reason that most people that we talk to choose to travel in the first place, so not getting as much money as possible would be no good. While there can often be room to negotiate when presented with an initial offer from a recruiter, there is, of course, a limit to how much they can actually pay a traveler for each contract. The big limiting factor in the equation of pay for any travel contract is the “bill rate.”

What is a Bill Rate?

A “bill rate” is the amount of money that the facility (hospital, clinic, nursing home, etc.) pays the travel company for each hour that a traveling therapist works. As travelers, this is a number that we rarely ever find out about, since it is negotiated between the travel company and the facility usually before they ever even list the job or present it to travelers. Most recruiters do not wish to share this number with travelers either, but you really can’t blame them for that. The bill rate is much higher than the hourly rate that the traveler receives, but that is because it has to account for all overhead costs and company profits as well, so sharing the bill rate could make the traveler feel like they’re being taken advantage of, even when that’s not the case. BluePipes wrote a great article on other reasons why travel companies don’t divulge bill rates as well, which you can find here.

How Much is an Average Bill Rate?

Bill rates vary drastically depending on setting and area of the country (just like traveler pay), but I’ve heard of ones as low as $60/hour and as high as $80/hour, which shows why there can be such variation in traveler pay across the board, since it’s all based on the bill rate. In some situations, the bill rate can even be higher if the facility is in urgent need of a traveler and is willing to pay more to get someone there quickly. In general, the facility is going to pay the travel company as little as possible, while ensuring that their opening will be filled, so how desperate they are can have a big impact on the bill rate.

So if a company is receiving around $70/hour ($70 x 40 = $2,800/week) from the facility, while the traveler is only getting a take home pay of about $1,600/week, where is that extra money going?!

Costs that have to be Subtracted from the Bill Rate

Overhead costs of running a travel company can be pretty high. The company has to pay staff (recruiters, managers, payroll department, benefits department, etc.), for rent and utilities on their offices, for marketing, for taxes, and they also have to make a profit in order to stay in business. This all usually adds up to about 20-25% of the total bill rate, depending on how big the company is and how much their overhead costs in total. That means that after overhead costs are subtracted out, that $2,800/week turns into about $2,100/week.

From there, we have to consider that the company pays for part of the traveler’s health insurance (assuming the traveler chooses one of the company sponsored plans); maintenance fees on 401k plan; CEUs (if offered by the company); FICA taxes on the traveler’s hourly pay (7.65%); and credentialing costs for the traveler for each assignment such as: license reimbursement, travel reimbursement, drug tests, TB tests, and backgrounds checks.

They also usually have to keep a small percentage to account for contract cancellations, since when a traveler’s contract is cancelled early, not only does the traveler lose out on money, but so does the travel company. I think of this as like an “emergency fund” for the travel company for when unexpected events occur.

It’s also important to keep in mind that the “take home pay” amounts that we usually use to discuss travel contracts is after the traveler’s taxes are subtracted out, which means that the travel company actually pays you more than that amount, but that’s the amount you see on your paycheck after federal, state and FICA taxes are subtracted. So “take home pay” refers to after-tax, or net pay, not gross pay.

For example, a $1,600/week “take home pay” usually means that the travel company actually pays out $1,800/week in gross pay to the traveler. It’s easy to see how the $2,100/week devoted to the traveler’s pay can quickly be reduced to much closer to that $1,800/week figure paid out to the traveler each week, once all of the above costs are factored in.

Getting the Highest Pay Possible

In most cases, honest recruiters are doing their best to offer the highest pay possible to the traveler, within the bounds of the bill rate that they have to work with. Many travelers hear about how high some bill rates can be and quickly assume that recruiters are trying to take advantage of them, without first considering all of the costs incurred by the company, taxes they have to pay, and also also the benefits offered to the traveler that aren’t seen in the weekly take home pay number. Don’t forget to consider these factors before jumping to conclusions! But, it doesn’t hurt to push for more money when you feel it’s warranted, have considered all the “extras” already included in your pay package, and have considered the type of job, location, and cost of living!

The bill rate is also the reason that it is important for travelers to push for higher pay for overtime hours worked. Overhead costs don’t need to be factored into overtime hours worked, due to them already being accounts for in the initial 40 hours. With overtime, the company will get the same bill rate (sometimes 1.5x the bill rate even), while the traveler only receives 1.5x their taxable pay rate in most cases. This is a great situation for the travel company, but a terrible situation for the traveler. So understanding how the bill rate works and how your pay is broken down is a key factor here in advocating for yourself with a higher overtime rate!

Conclusion

It’s very important to have an understanding of the bill rate and all the costs that must come out of that hourly pay amount the travel company receives from the facility, in order to understand how your weekly take home pay is determined as a travel therapist. The more you understand, the better you can advocate for yourself and get the highest pay possible.

I hope you have a little better insight into how the weekly take home pay amount is calculated now with a basic understanding of bill rates!

Thanks for reading and feel free to ask any questions you may have on bill rates or anything else travel therapy related in the comments below or contact us directly. If you need some recruiter/travel company recommendations that we trust to not take advantage of you as a traveler, then send us a message here and we’ll help you out!

Should You Get a Contract Extension Bonus as a Travel Therapist?

Written by: Jared Casazza, PT, DPT

The Benefits of Extending a Contract

If you are a prospective or current traveler whose primary goal with travel therapy is to earn as much money as possible (likely to pay off student debt), then extending contracts when possible is a great idea. Whitney and I always try to extend contracts in places that we enjoy, and I actually extended my very first contract as a new grad twice for a total of nine months there. Extending a contract means less, or hopefully no, downtime between contracts since you don’t have to move to a new location. Most travelers choose to take at least a week off between contracts to move to their new assignment location. but that missed work means less money earned. Mitigating time off is a primary way to earn more throughout the year. Additionally, extending a contract is also easier because you’re already accustomed to the facility, staff, and patients.

Another big benefit of extending a contract is that you can almost always earn more money on the extension than you did on the original contract, either in the form of a bonus or an increase in taxable hourly pay. We usually try to get about $1-$2/hour extra when extending a contract, which ends up being $40-$80 more per week or $500-$1,000 more over the course of a 13 week contract! A dollar or two extra per hour may not sound like much, but it really adds up over time. Another option is to have the travel company reimburse travel expenses incurred while traveling back to your tax home if you plan to do that at any time during the contract. A reimbursement is almost always better than increase in taxable pay, if possible, because reimbursements aren’t taxed and therefore will mean more money in your pocket.

Understanding “Extension Bonuses”

Some travelers believe that getting an extension bonus means that the recruiter was keeping more money than they needed to be on the original contract, and now they’re somehow able to offer you more money the second go round, but that is not the case. So where does the extra money come from? Let’s investigate the answer to this question!

When you start a new contract as a travel therapist, the travel company has some upfront costs that they have to cover in order for you to start. These costs include things like: travel reimbursement for you to get to the new place, license reimbursement if applicable, background check, drug test, and TB test. All of those costs added together can end up being a significant amount of money that the company pays out in the beginning before you ever start working at the new place. These costs have to be accounted for by the company of course, so they reduce the amount that you make each week so that these costs can be recovered throughout the course of the contract. This reduction in the traveler’s pay is to be expected since all of our pay, reimbursements, and the travel company’s overhead costs, as well as their profits, come out of the “bill rate” that the facility pays the company. In other words, all the money has to come from somewhere, and that somewhere is what the facility pays the travel company. Under normal circumstances where the traveler moves to a new facility after every contract with no extensions, the company has to incur these costs again before each new contract. On an extension however, these costs aren’t incurred again, which means that there is extra money that can be added to your pay!

Negotiating Extension Bonuses with Your Recruiter

Most experienced recruiters understand that by the traveler extending in a location, there will be extra money to allocate to the traveler on the extension. But I’ve worked with recruiters in the past that say that an extension bonus isn’t possible since the bill rate is the same for the extension, and the facility “isn’t offering any additional money.” Unfortunately, they were overlooking these costs that the company would be saving on the extension. After explaining how they would be saving money on the things I mentioned above for my extension, I’ve always been able to negotiate some amount of extra pay or bonus for the extension.

It’s important to discuss this with your recruiter and make sure you are on the same page. You are your own biggest advocate and need to be an informed and educated traveler.

Bottom Line

Less missed work and higher pay on an extension make it a no-brainer if you’re at a facility and location that you enjoy AND the facility needs continued help. Always be sure to ask for more money on an extension if the recruiter doesn’t automatically give it to you, and be sure to mention the costs that they would save by you extending instead of taking a new contract to back up your request.

If you have questions on this topic or would like recommendations from us on a contract, extension, or working with travel recruiters/companies, please reach out to us and we will be happy to help!

 

Travel Therapy: Pros and Cons of Home Health

Written by Travis Kemper, PT, DPT

As travel therapists, there are a lot of opportunities to work in home health across the nation. And, the pay is usually pretty high which makes it an attractive option. It might be even more attractive for someone who is getting started as a new grad and looking at a large amount of debt to pay off. Recruiters often offer to submit new grad therapists to home health positions; but, as with everything, there are some positive and negatives to consider with home health therapy that should be taken into account before being submitted.

Here’s my take on working in home health after doing my first two travel physical therapy contracts in the setting. I will expand further on each bullet point below to give you a more comprehensive view of my thoughts, but here is an overview of the basics:

PROS:

  1. Even as a new grad, you have will the opportunity to dramatically improve the quality of care that patients are receiving in this setting.
  2. You can create closer relationships with patients than in most settings, and potentially make a larger impact on their personal lives than in other settings.
  3. You can make your own schedule, or at least have a significant amount of flexibility in your schedule.
  4. The pay is much higher than other areas of practice, although of course pay also depends on location.

CONS:

  1. On the flip side of #1 from the “pro” list, the con in this situation is that your colleagues may not be the best and your patients may not be receiving the best care across the board.
  2. There may be the potential for less growth as a clinician in this setting.
  3. Sometimes there are higher productivity requirements.
  4. There is more time spent in front of a computer than in other areas, and way more time being sedentary. The paperwork is much more intense than any other setting where I have worked.

 

Let’s take a closer look at the positive aspects of working in home health:

1. As a clinician, and even as a new grad, you can dramatically improve the quality of care that patients are receiving: This is in some ways a pro and a con.  The pro is obvious: you can literally be a rock-star clinician in home health on day one. I was told on numerous occasions, by numerous people, that I was the best home health provider that has ever come to see the patient. That’s awesome, and very rewarding for you as a clinician, but also incredibly sad. Check out the cons list below to see the flip side of this.

 

2. Potential for increased quality of relationships: I have patients/caregivers that still contact me from across the country to tell me how much they appreciate the work I did for them. There is a great potential to make a larger impact in your patients’ lives than in other settings. There is nothing in healthcare that can prepare you to see how a patient moves in his/her home environment. Sometimes you must get creative to make their homes work for them. I routinely helped patients redesign their living rooms to make them safer, and I also removed two bathroom doors because the patients’ assistive device would not fit through the door and the patients could not safely access the commode without a device.

 

3. More flexibility in your schedule: Because you can design how your day looks with visiting each patient, it allows things like making stops to the post office or other businesses that have daytime only hours much easier to manage. It also makes it easier to design a schedule that works for you as an individual, within reason.

 

4. Higher pay than other settings: This depends on the location, but home health is almost always one of the highest paying settings. This is a huge pro for choosing to work in this setting. More money, more options in life.

 

Let’s take a closer look at the negative aspects of working in home health:

1. Other clinicians in this setting may be sub-par: As I mentioned above, sometimes you can really stand out in home health as an amazing clinician, because unfortunately sometimes the patients are receiving sub-optimal care from other clinicians. Sometimes, depending on the team you are working with, you may have to perform tasks or communication for the patient that is more appropriate for another discipline, such as nursing, social work, or another therapist, or else the patient will not get the care they deserve. For example, at one point I worked with an OT who would perform an evaluation, make goals, and on the next visit perform a discharge stating all goals were met, when the patient had not received or been trained on half of the recommended equipment. This happened with several patients. Unfortunately, when providers are paid for quantity, as is the case with most home health companies (presumably because that is how insurance pays the company), quality of care will decrease from most providers. This caused me a lot of stress because I care about my patients, and I get incredibly frustrated when I see sub-par care.

Here’s a quote that I feel is appropriate to my experience in this situation: “People that aren’t used to quality always chase quantity.”- unknown

 

2. Potential for less growth as a clinician: When it comes to growth as a clinician, I believe you grow by seeing and interacting with other therapists as well as performing personal research, going to conferences, and earning CEUs. In home health, although you often work with a team, you are by yourself almost all the time. I truly feel that as a physical therapist, I did not grow nearly as much in this setting as in other settings where I have worked.

 

3. High productivity standards are standard: This has obvious downsides. I have only taken hourly positions in home health, but the company will still try to enforce productivity standards on you. This is the toughest thing, especially with the cons listed about your potential coworkers and why you can be a “rock-star” as a new grad, which requires extra work from you if you want you to provide the best care. This combined with last con on the list (see below) are the reasons that, unfortunately, I probably won’t be doing home health anymore.

 

4. Lastly, the paperwork is brutal! People have tried to tell me that it is no worse than other settings, but I have worked in just about every setting between clinicals and paid positions, and it is by far the worst in my opinion. Every day I would spend half my day documenting, and that was with doing as much as possible in the home with the patient.  Combine documentation time with drive time, and you have landed a sedentary profession. I chose a career with physical in the title. I don’t want to sit, and I hate computers!

Conclusion

Overall, I think home health can be a great place for the right person. If you’re very organized and don’t mind increased paperwork, you can make a huge impact in this setting right away and really feel you’ve provided a lot of value to your patients. But, there are definitely some cons to consider, and you want to make sure to ask all the right questions before going into a contract in home health.

I hope this helps you! Please feel free to reach out with any questions about home health here. I will happily look at your contract, set up a phone call to chat about home health, or provide any other assistance I can.

Stay tuned for a future post about specific questions I recommend asking during a home health interview!

Travel Therapist Health Insurance Options Explained

Written by: Jared Casazza, PT, DPT

It’s currently the 2019 marketplace health insurance open enrollment period, so naturally there is a lot of interest in health insurance options and alternatives right now. I’ve seen a ton of posts recently in various travel healthcare groups regarding health insurance options, alternatives, and people asking for general advice. Navigating the various health insurance options can be tough, especially with the many changes in the past decade and likely many changes to come in the future. Rising healthcare, and therefore health insurance, costs are a major concern for most Americans currently.

For travel healthcare professionals, health insurance is a particularly common topic since our contracts are generally only 13 weeks at a time, and figuring out what to do about health insurance after a contract ends can be confusing. I want to explore the various options here and hopefully give you some insight to help you make a decision regarding your own health insurance as a travel therapist.

Company Sponsored Health Insurance

Usually the cheapest and easiest option for a traveler is to take the company sponsored health insurance through the travel company that he/she is working with. The lower cost compared to other options is due to the fact that the company sponsored health insurance is partially paid for by the travel company as part of your total benefit package. The company pays a portion of your health insurance premium (in some cases 75% or more of it) so that it’s more affordable for you. If you pass up this benefit, in some cases the company will be able to give you slightly higher weekly pay based on the money they save from not having to pay for a portion of your health insurance, but this can have potential legal implications for the company if done incorrectly so it is not a common practice. We have never talked to a travel company that doesn’t offer health insurance, but it’s possible there are some small companies out there that don’t. The company would have to be very small though, because any company that employs more than 50 people is required to offer health insurance to all employees.

Most companies offer 2-3 different plans based on your individual needs. There will likely be at least a high deductible plan that offers a relatively low premium and a lower deductible plan with a higher premium. Which plan you choose depends on your own needs, but in general, those who are young, healthy and therefore unlikely to meet the deductible of either plan are better to choose a high deductible plan with the lower premiums, while those with more medical needs or perhaps growing families can often come out better with a lower deductible plan while paying the higher premiums.

In my experience, the premiums on these plans are pretty affordable no matter which plan you choose. I’ve paid anywhere from $5-$25/week for my company provided health insurance coverage over the past few years. Luckily, I rarely have any need to use the health insurance, but when I have needed it the coverage has been sufficient for my needs.

Signing up for a company sponsored plan should be very straight forward with guidance offered by your recruiter or by the benefits department of the travel company. You should be eligible to sign up for the coverage any time that you start a new contract with a company. Most companies offer health insurance benefits starting on the first day of your assignment, but some require you to wait for 30 days or until the first of the month before they take effect, so make sure to ask your recruiter about this to avoid any problems or confusion.

Affordable Care Act (ACA) Marketplace Plans

Some travelers choose to go with one of the ACA marketplace options available to them and forego the company sponsored options. The marketplace plans will almost always cost more than the employer sponsored plans and, as mentioned above, this shouldn’t be a surprise since in this scenario you will be responsible for the entire premium amount instead of having the travel company pay for a portion of it. For some, the increased cost of the plan is offset by more variety with plan options that can allow the traveler to find a health insurance plan better suited for them. Since the marketplace offers subsidies based on the individual’s income from the previous year, there are cases where the subsidy amount will be high enough to actually make these plans even more affordable than the employer sponsored coverage. I’ll cover the income levels and subsidies available in the marketplace plan in depth in another article in the near future. Since the amount of subsidy you qualify for can drastically change the amount of various plans for you, it’s always a good idea to get some quotes for potential marketplace plans even if you will likely take the employer sponsored health insurance. The vast majority of travelers will qualify for at least a partial income based subsidy due to the level of taxable income that we receive, but how big the subsidy is will depend on your Modified Adjusted Gross Income (MAGI).

Getting quotes for various plans and signing up for one through the marketplace is pretty easy. Visit the healthcare.gov website and follow the steps to get started on the homepage. I’ve spent a lot of time on the website and have found it to be user friendly. One thing to remember with these plans is that you can only enroll during the open enrollment period (November 1 – December 15) each year or when you have a “Qualifying Life Event.” This means that if you choose to forego employer sponsored health insurance and miss the open enrollment period, you could potentially have to wait until January 1st of the next year to have coverage! Make sure to watch the dates and don’t miss the November 1st – December 15th window if you choose to go this route.

“Off-Exchange” Health Insurance Plans

The above two options are by far the most common ways that regular employees and travelers alike receive their health insurance. There are a much smaller number of people that either forego company sponsored health insurance or aren’t eligible and choose to not get coverage through the marketplace. They instead may choose “off-exchange” plans, which are plans offered directly through the insurer themselves or through a broker. These options vary based on the state in which you’re located. These plans are not eligible for the subsidies offered based on income through the ACA marketplace, which will be a huge downside for most travelers and make this option unrealistic. Without the subsidies, the plans are often much higher priced than employer sponsored plans or insurance plans offered through the ACA marketplace. To partially make up for the higher price tag, these plans can occasionally offer better coverage options than those found on the marketplace.

These plans will rarely be a good choice for travelers and probably shouldn’t even be considered in most cases. If you’re interested in learning more about the “off-exchange” plans, this healthinsurance.org article is a good resource.

Health Care Sharing Ministries

Even though this option is not technically health insurance at all, I would be remiss to not include it in this list. Health Care Sharing Ministries are organizations created to share medical costs between a group of people that have the same religious views. These organizations are very careful to spell out the fact that they do not actually offer health insurance, since they do not offer any guarantee to pay. This sounds scary, but in practice, they seem to work pretty well, and most of what I’ve read about them has been positive written by those enrolled.

This is how it works: everyone enrolled in their organization has a monthly premium and a stated deductible amount, just like with a normal health insurance plan. The money is then pooled and paid out to anyone enrolled that makes a claim, after the claim is verified by the organization. They cover the same things as most insurers, although there are some things that may not be covered due to religious reasons, which can include things such as birth control pills. To be eligible to enroll in these organizations, you generally must be a Christian and be dedicated to living a Christian life, which means abstaining from activities such as smoking cigarettes, using drugs, drinking in excess, or engaging in extramarital affairs. They also generally do not allow major pre-existing conditions like the ACA marketplace plans are required to do.

Health Care Sharing Ministries offer much lower premiums for their coverage, which is largely made possible by the fact that they are able to exclude those with severe medical conditions. These organizations’ plans are also not eligible for the subsidies offered by the ACA marketplace like the “off-exchange” plans above. More people are choosing to enroll in these organizations as health insurance prices continue to increase, with estimated membership between all Health Sharing Ministries at 340,000 people.

These plans may be a viable option for travelers, especially those that aren’t eligible for any subsidies through the ACA marketplace and don’t want to take the employer sponsored coverage, assuming that the traveler meets all of the criteria and is willing to accept risk involved. For more information on Health Sharing Ministries or to compare companies, this article is a good resource.

Why Not Always Go With the Employer Sponsored Health Insurance?

Since employer sponsored coverage is often the easiest and the cheapest option, you may be wondering why a traveler would ever choose to go a different route. The two most common reasons have to do with coverage between assignments and meeting the deductibles of the health insurance plan.

For those that choose to take time off between contracts, the employer sponsored plans can sometimes prove difficult. Most travel companies will allow you to stay on their plan for somewhere between 14-30 days between contracts, but that’s only if you take your next contract with them as well. If you take more time off between contracts than the company allows, or you switch travel companies for your next assignment, then this will mean a lapse in coverage during that time. Whitney and I have found ourselves in this position a few times in the past, and going without health insurance, even for a short time, isn’t ideal. Luckily, COBRA coverage exists for this reason, but I’ve found that many travelers don’t know about it. Sometimes this causes them to choose to forego the employer sponsored plan due to these anticipated lapses in coverage.

COBRA stands for Consolidated Omnibus Budget Reconciliation Act, and it basically gives an employee the right to continue his/her employer health insurance coverage after losing his/her job (which would be the case for a traveler between contracts). This coverage can last for as long as 18 months or until the employee finds a different health insurance plan. This is perfect for a traveler who is switching companies between contracts or taking an extended period of time off of work. It is important to note that when switching to COBRA coverage, your premium will increase due to your employer no longer paying a portion of it, but the cost should still be a reasonable, especially for a short duration.

My personal favorite part about COBRA coverage is that you have 60 days after your loss of employment to sign up for the coverage, and any medical costs incurred between the date you lost your coverage and the date you sign up for COBRA will be retroactively covered. What that means in practice is that if you have a month off between contracts, and you’re switching travel companies, you could wait the 30 days between contracts to see if you have any medical expenses. If you don’t, then you can skip signing up for the COBRA coverage altogether and save the  money on the premium since you didn’t need the health insurance during that time anyway. If you happen to have a big medical expense come up during that time (not unreasonable if getting to the next assignment involves driving across the country), then you can sign up for COBRA afterward and have it retroactively cover that medical expense. This is the best of both worlds since you’re protected either way, but you only have to pay for the coverage if you actually end up needing it during that time off.

The other big reason a traveler may choose not to take the employer sponsored health insurance is that he/she plans to usually meet his/her deductible amount throughout a normal year. This can be a problem if switching between companies, because each time you leave one plan and start another, your progress toward the deductible starts over and you lose the progress you’d made toward the deductible on the old plan. For someone with a lot of medical expenses (usually a chronic medical condition requiring expensive treatment or medication), having to start over on the deductible with new plans can mean a lot more money out of pocket than the money saved by using the employer sponsored plan. In this situation, I think it makes a lot of sense to go with a plan through the ACA marketplace and keep it while traveling, instead of switching plans often through different employers.

What’s My Choice When It Comes to Insurance?

Over the past three years, Whitney and I have always chosen to go with the cheaper employer sponsored health insurance plans through the travel companies. We generally choose the highest deductible plan offered since we don’t use our insurance often anyway and would rather have a lower premium. Between contracts, we forego insurance knowing that we can sign up for COBRA as needed. So far we have never actually incurred any medical expenses between contracts to make it worth it for us to sign up for the COBRA coverage retroactively. It does give us peace of mind knowing that it’s available if we needed it though.

Although that’s been our strategy in the past while working almost continuously throughout the year, in the future we will likely sign up for a health insurance plan through the ACA marketplace. This is because we plan to take several months off at a time to travel internationally, making the employer sponsored plan + COBRA combo not nearly as appealing.

Conclusion

For the average travel therapist, going with the cheaper health insurance offered by your travel company and using COBRA coverage for any gaps between contracts probably makes the most sense financially and logistically. For some cases it can be more reasonable to sign up for a plan through the ACA marketplace and decline the coverage offered by the travel company. This is especially the case with travelers who plan to take multiple months off between contracts or that often meet their deductibles and will have to start over on the deductible each time they switch between companies. “Off-Marketplace” plans will rarely make sense for a travel therapist since most of us will qualify for subsidies through the ACA marketplace that wouldn’t be possible with an off-marketplace plan. But, these are still another option to consider based on your individual situation. Health Sharing Ministries usually offer a lower premium than insurance plans offered through the marketplace, but they are more risky since they aren’t actually health insurance and therefore don’t offer any guarantee to pay. In practice, most people enrolled in the Ministries seem to be pretty happy with the coverage based on reviews for them. The requirements to be accepted into the Health Sharing Ministry you choose can be restrictive, and anyone that isn’t a Christian isn’t allowed to join.

Hopefully this helps to clear up the health insurance options available to you as a travel therapist. Keep in mind that health insurance (and healthcare in general) is likely to go through many changes in the near future, so make sure to check that things haven’t changed between the time I wrote this and when you’re reading it. I’ll do my best to keep this up to date as well.

If you have any questions about this or anything else travel therapy related, feel free to reach out to us. If you are new to travel therapy and would like help getting started or recruiter/travel company recommendations then we can help with that as well! Thanks for reading!