A few months ago, I announced that I was leaving my career as a physical therapist. This came as a surprise to some people I knew, and others, had been expecting it as I’d been talking about my disgruntlement with the career for a few years.
I spent years, over $100,000 in student loans, and sacrificed an immense amount of time and effort while exposing myself to dangerous insulin rationing during school all for this career that I thought would be my forever job. I’d climbed the ladder to regional management, and still, found myself finally unable to settle for continuing in this career. Why?
I’ve been meaning to write about it for a while, and while I have many more thoughts I could probably share, here is the story of what led me to leave my PT career.
A year ago, I sat at my computer desk, nervous and sweating as I got on a teams meeting with my boss and her supervisor. It was two days before Thanksgiving. She had told me on Friday that we were going to have a meeting, and I spent the entire weekend stressing about it, feeling deep down that it wouldn’t be good.
They let me know that due to the impending and Medicare cuts that I would be forced to take a demotion back to a Rehab Director. The building that I would be demoted back to had just been sold to a real estate developer, leading residents to move out in droves, with an uncertain future ahead. I would be losing my salaried job where I managed several buildings, to go back to this one building, where with the uncertainty and move outs, I would not be able to maintain a caseload, and would be paid hourly based on how many patients I saw. I saw the writing on the wall, swallowed my beating heart, and told them that I would be looking for other jobs. My boss called me so we could talk after the meeting. “I’m sorry”, she offered. “I didn’t want it to be like this, two days before Thanksgiving on a teams call. I wanted to tell you in person. I’m sure we can work something out. I’ll ask for the highest level pay I can get for you.”
My mid year review had been excellent, and while I had inherited some struggling buildings, we were turning things around. I had a great, loyal team that I loved, and I appreciated the ability to focus more on team building and employee empowerment and less on constant direct patient care. I had never aspired to management at this job, preferring to wait before I pursued the role with more experience, but my boss had pushed me to apply for the role twice, before I finally did and was offered the job. Ironically, I didn’t even get paid much more for this role. I was honestly so speechless, and I had little to say. “I’m going to do what’s best for me,” I told her. “And when I figure out what that is, I’ll let you know.” We awkwardly hung up. I went to Thanksgiving in a funk that entire week because the job I had spent three years being dedicated to was now gone. I was still naive and idealistic about jobs, thinking that the amount of effort I poured into them was tantamount to how highly they valued me as an employee. It was especially hard for me because I had given what I felt like was everything to this job, creating a successful rehab program with the highest grossing profit in my area (impressive for all independent living), all the while establishing a new clinic at the height of Covid as a new Rehab Director with no experience. I had been a good choice for the new area rehab manager role that absorbed my multi site manager role, and I knew it, even if my region had had a higher level of independent livings, which traditionally didn’t drive as much profit as assisted livings. I had shown up, through pandemics and divorce, and driven to Newnan 50 minutes away daily for 5 months without travel pay during the pandemic (“but at least it would give me hours”). However, the choice had been made to give the job to my coworker who had been with the company for three months. I was originally told that everybody with six buildings or less would be losing their job. But I found out on a teams call a week later. No opportunity to interview for it, and no one had taken the time to tell me. That’s when my disillusionment really sunk in, though to be honest, it had started along time ago. Being a therapist drained me. I had become disenchanted early on, as a new therapist in a nursing home, between being asked to come in to complete paperwork at 11 o’clock at night, to be called back in at 6 PM for late night Friday evaluations, to being completely and utterly disrespected when I tried to put in any PTO, because we had no one to cover me. Frankly, that was not my problem, and I was more than willing to be a team player that stayed late at night to accommodate when I was there. Holidays were worked, overtime logged. My PTO would get lost mysteriously, there was black mold in the office that management brushed off, and when the Medicare payer system changed, we were told that we would now be expected to work weekends, but at least we still had a job. The black mold? I ended up purchasing a mold testing kit after seeing my fellow employees coughing in the office for MONTHS. We had insisted that as the office had flooded at least 3 times before due to poor drainage in the area outside, that we really needed new carpet. Management refused. So we swabbed the vents, under the wallpaper, and the carpets, and when it tested positive for black mold, we presented it to our boss. Suddenly, we weren’t brushed off, and corporate flew all the way in from California next day to apologize and let us know that they were renovating the gym. Once it was renovated, I put in my notice and left that setting in the nursing home for a new opportunity in independent living and found it to be a breath of fresh air. However, after three years in this new role, it was dawning on me that the same problems that I experienced in subacute rehab were also becoming problems in the outpatient world. This was hard for me to reckon with because I thought that I had found my work home, however, the burn out still crept up on me, regardless of the satisfaction that I got from my job. I felt exhausted after long days, frustrated by the lack of flexibility, and frustrated by the lack of financial growth. The office chair patients sat in was peeling horrendously, and I asked for 4 months it be replaced, assured that it would but it never was. I bought black leather tape on Amazon to patch it.
These companies would always blame reimbursement for the lack of raises and supplies, which I understand, especially after several roles in management. However, it doesn’t erase the fact that many of us have high student loans and are just struggling to make it by. With my demotion pending, I started looking for a new job, and within a week I stumbled upon one that I thought ended up being perfect for me. It was an area rehab manager job in Georgia, and I would manage all their Georgia clinics. It was a non-clinical role, which was a breath of fresh air, as previously I had been expected to manage five buildings while still treating 50% of the time. For reference, I expected most of my rehab directors to have productivity close to 65%. This company that I moved onto definitely had its issues. The tech issues were utterly obnoxious, and there were obvious instances of clinics not up to compliance standards or having made dubious financial choices. However, I was more than thrilled to hand in my resignation at my previous company, and try my hand at helping these clinics to grow.
Before I left my old job, I was told that I was required to give four weeks notice, not two, otherwise I’d be disqualified from working there again. Christmas was two weeks away, and I shrugged. “You didn’t even wait to hear about my offer,” my boss said.
“I assumed you’d reach out to me about it,” I told her, figuring the onus should have been on the employer trying to convince me to stay. But she didn’t, and I told her that it would have been disingenuous to hear her out when I knew I wouldn’t accept anyways. I asked for feedback about why an internal interview process wasn’t given, and was told that “geographically this just made the most sense.” I gave them the courtesy of staying an extra days to help with coverage, but refused to be guilted by my boss, who told me “I just feel bad for all of those patients who won’t get their therapy.” I asked about severance - they didn’t offer any because they “technically weren’t laying me off”, even though the demotion they were offering wasn’t viable. I had to fight for my PTO payout and only received it after sending a scathing letter to HR stating I wouldn’t be leaving if it wasn’t for their decision to demote and and leave me in a position where I would have unstable pay and struggle to afford health insurance. I did also call to light their lack of an internal interview process…and my suspicions about discrimination.
While settled into my new role, in February, I learned that my new company had been taken off the public market by a private investor. One day at the end of March, an unexpected teams call was added to my calendar. I had a sense of dread about it, because nothing good comes of unexpected teams meetings. I was also still reeling from the unexpected loss of my previous job. I could feel my hands tingling in the all too familiar tell of my anxiety and nerves as I heard that several clinics would be closed over the next three months and all new growth halted. I recall thinking to myself, which clinics am I going to lose? What pay cut am I going to take? However, I did not expect the unannounced teams call 20 minutes after the meeting ended where I learned that I was being laid off once more. I was in such a state of shock, especially considering that four months prior I had been essentially laid off at my previous job. While I hated what happened, and I was definitely frustrated about it, I did have three months at full pay, a severance package, and an incentive bonus to stay, so I appreciated at the bare minimum that I got that, at least, as it was generous for a relatively new employee. However, it was then that the disenchantment finally returned full force. I realized that operations was wearing at me, and that it was hard for what I had to do to sit in my conscience. It’s taken me a long time to realize that I really likely belong, long term, in the public service sector, and I butt heads with corporations. My personality is well suited for public servitude, and my passion for helping the underserved too strong for me to care about profits the way I should. The irony is that my second job - the one I was demoted at - was a not for profit company, although you’d never have guessed it. I have always valued people over profit, even when it has not made me the best friend of fellow operations directors. I stick up for my team, one of my golden rules is that when somebody asks for PTO, I allow them to take it, and I treat my employees with respect and dignity as should be the expectation. I level with them, I explain why certain decisions have to be made, but I am not there to make their life to be any more demoralizing or more difficult than it already is. If they needed a PT to cover because we were short staffed, I would step in. Low caseload? I’ll go screen door to door with you. Our job as a leader SHOULD be to sacrifice for our employees so that they have the best quality of life in their job possible. Yes, minding the business is why we have jobs in operations. But the business is nothing without its workers. Finding the nuance in that is what makes mid to high level management difficult sometimes, however, I felt a lot of reward in my responsibility as a manager.
I felt in my heart that this was it. There was a finality to leaving my career this time. I couldn’t go back to a non-operations level job, where I was a therapist driving productivity, and having absolutely nobody and no one care about what quality level of care I was providing. It is demoralizing to work in fields where it doesn’t matter what continuing education you have, what empathy you provide to your patients, that you go the extra mile. It’s an afterthought to the one thing that does matter to so many therapy companies: productivity and contribution margin.
At the end of the day I was a number on a spreadsheet and I knew exactly what the numbers were because of my roles.
In April, I received another little surprise in a cease and desist letter emailed to me by my previous employer stating I was violating my non compete by poaching patients and employees. I had had two employees from my old company I’d hired, one who was already PRN with my current company, apply for a full time position with us and leave her previous role, and another I had met once at a building I didn’t manage coincidentally apply to one of our open roles. I had written evidence of encouraging patients to stay with my old company because I was not practicing clinically, even though they contacted me. I wrote them back a scathing letter in response, never picked up the physical letter mailed to me from the post office, and never heard from them again. The clinic that they had offered me a demotion in ultimately closed that fall.
I began the arduous role of trying to tailor my résumé once more for non clinical jobs. I had tried back in November when I went on an application binge after I learned about my first layoff. I did not hear back from a single one of them. I knew how hard this was going to be, and I put it off for a while, because I had time, to be honest. I struggled with knowing what I really wanted to do. And I played around with the thought of going back to school, if anything, because I just couldn’t stomach the idea of going back to rehab. I was burned out and felt that everything that I’d gone to school for was for nothing. No one cared that I had a doctorate, and it felt like no one saw past my clinical experience. But I used AI to help tailor my résumé, and I applied to job after job after job, hoping that I would hear back from something. Finally, after weeks of this, I had the idea to apply to a role that I had seen at work in my previous role. I liked the idea of account management, as my favorite part of my job was the connections I made with people, but I just couldn’t seem to break into it because I didn’t have any sales experience. However, I did have experience in therapy, and therefore I applied for an account executive position for a home health therapy company. The argument for why I would be a strong candidate was an easy one given my regional level experience. I sold therapy, in a sense, every day to stakeholders within my role. Within two days after the interview, I had a job offer. I took a day to ponder it, and then I accepted it.
Four months later, I have not looked back. My quality of life has changed drastically, and while I still have days where I feel like I am on a steep learning curve, days I work late and stress, and I beat myself up feeling like I have to do better, I have learned so much in the past several months, and I know that I will continue to learn and become stronger in my role. The job flexibility has been absolutely incredible, and I can’t imagine going back to my previous clinical or even clinical operations life.
My experience unfortunately gave me a lot to think about when it comes to the world of therapy. It’s probably obvious to many that I’ve become very bitter towards therapy. And I probably should’ve known more as a young adult about the career field I was getting into. I found myself feeling restless because I had very few job prospects for growth, and I was already getting paid at a level where I couldn’t expect to see further pay raises. Many of us are lucky if we get a .5% increase for cost of living and merit once a year all rolled into one. Many of us get nothing. And even that is at the discretion of companies who lately have been slashing rates and pay due to declining reimbursement.
After working in operations I feel very strongly that there are a lot of things wrong with healthcare. It’s no secret that workers are burning out. The for profit system is quite frankly burning all of us out, and workers are tired of being treated like a commodity with no humanity applied to the work that we do. Too few managers or corporations care about the value or the empathy we provide, but rather the profits we drive. Too many leaders are too far removed from clinical work and it reflects in the poor morale they create within their teams. And yes, I understand that businesses to an extent have to operate like this, but they deny time off for holidays, don’t pay for advanced ceu’s, give you $10 as a thank you for Christmas, slash your 401k match for the year, and freeze your pay while expecting more and more from us each year. Every second of down time in our day is criticized and counts against us. Employees are written up if they have to take the day off for sick kids. We’re treated as though client cancellations are our fault. Some companies expect 95 percent productivity or higher with no built in time to review a case before a new evaluation or assessment or to do the very specific and arduous level of documentation required for therapists to justify why insurance should even pay us in the first place.
When therapists ask for new equipment, such as a Sara Walker in a SNF because we have nothing to assist us in walking high acuity patients, we’re told there is no money for it. When we needed new wheelchairs whose brakes worked, there was no money for that, either, even when these facilities were marketed as rehab facilities, and even when they spent a week training us on their proprietary “wheelchair management” and fitting program with the design of bringing more long term patients on caseload.
Broken equipment goes unfixed for months, you’re questioned for ordering more than one box of gloves, often forcing us to have to go to the store to buy our own if we run out, and we’re asked to market programs that companies won’t spend money on to ensure we have the proper materials to implement.
We are expected to work holidays and take no time off around the holidays with no extra incentive or pay except for the goodness of our hearts (and we wonder why no one else is willing to cover the holidays when we offer no incentive to do so). When we do ask for PTO, we are asked by our managers if we have someone to cover us, even though it’s their job to ensure that workers have coverage so that they can take their hard earned PTO. For many of us, no N95 masks were provided until well after the pandemic wasn’t as life threatening, even though we had to get up close to patients daily. We don’t provide adequate rest periods or time off for healthcare workers who work in extremely draining and people forward jobs, and for the record, a lot of us don’t even get so much as a pizza party for employee appreciation. I was once given a $100 budget to allocate between 15 employees and 5 buildings for Christmas gifts.
Is it really any wonder why therapists don’t want to be therapists anymore? Yes, there are still plenty who do, and I think some people were just born to be therapists. We need those people. And I’m not implying that my experience with my employers is indicative of all employers.
But then there are some people like me that wanted more, and just got burned out by this constant cycle of being gaslit by my employer for needing a raise or asking them how I can document point of care while grouping several patients or doing a hands on, manual therapy heavy evaluation and giving patients the face to face time they need to build rapport with them as opposed to having my head behind a screen. It doesn’t sit right with me to even continue to work my way up the management ladder when I know that I’m just perpetuating unrealistic standards for my employees that I’m somewhat powerless to change. Yes, I can and have advocated for my employees, but I am one person and will not change an entire company.
Our reimbursement continues to be slashed, and with it, our pay, while tuition for schools increases. I make now what I made my first year as a new PT in a role that expects no more than a bachelors degree, with the potential for bonuses that many of my established coworkers enjoy, indicating that they are quite feasible.
Our lobbying companies lobby for us poorly and charge hundreds a year for a membership.
Stability is few and far between as companies often pass hands, leading us to rocky stability in our health insurance coverage, 401ks, and quality of life.
We’re pushed to see people in “groups” in rehab facilities, leading to sub par care, and high patient volume and insurance dictating reimbursement has led to treatment times being cut short for certain insurance types, meaning you often can’t provide the care that you want to to patients. The high patient volume we are expected to see is exhausting and further perpetuates burnout.
Once you’ve reached your max pay, there is little to no room for pay growth, leaving you in a position where cost of living consistently erodes away at your ability to afford to live.
Insurance companies don’t see the value in therapy, and it’s frankly hard because of our model of requiring several visits from patients who many times have high copays. This has left many people to go to cash based, which if it’s for you, I think can be great, but is also difficult for those who cannot afford it, especially the geriatric population, whom I have a special place in my heart for. Technology has a real ability to transform therapy for the better, but few practices will take the time to invest in it or equipment proven to help maximize outcomes, leading to insurances still expecting more results in fewer visits, and many places unable to deliver, resulting in a model that many patients may feel is ineffective.
So? I decided to walk away. It just wasn’t for me anymore. I crave growth, the ability for my time to be valued, and more possibilities than what the therapy world could offer me.
I still keep up with some of my old patients and I’ve absolutely loved seeing the magic that therapy can do, but I find myself so much happier having removed myself from that world now. Am I letting my license lapse? Certainly not. But I also won’t be back any time soon.
