Be Careful Who You Work For, Things Aren’t Always As Promised
I was really fortunate. The first two jobs I had after graduation were in outpatient clinics where I had the opportunity to work with patients one on one in a semi-private setting. I worked like that for around 5 years and really enjoyed having that kind of privacy with my patients to talk about all sorts of matters. I’m an empathetic person, to a fault. I think it’s one of the soft skills that are important in this career. It’s amazing what people will share with you if they have some privacy and a listening ear.
But this story isn’t a persuasive essay on the benefits of that model of care. Rather, it’s some background information that leads us to talk about what happened next.
Here’s Where The Trouble Started
Long story short, life circumstances lined up just right so there was an opportunity for us to move to a city we always wanted to live in. Because of the distance and travel involved, I didn’t have the luxury of conducting job interviews on-site. At one of these off-site interviews, I was wowed by a clinic owner. They assured me that while I would be getting a salary (I had previously worked only on an hourly basis), I would never work more than 45 hours a week and I would be able to continue working with patients on the same one on one basis. There would be regular raises, a high standard of ethics, and an open channel for communication with her. It was perfect. I gladly jumped at the opportunity.
Reality was a slap in the face. I quickly found myself working up to 12 hour days, and never less than 50 hours a week. I was also scheduled to see 3 to 4 patients at a time. This allowed me to get at most 10-15 minutes with each individual patient in an open gym setting. It also meant that I was so rushed that I rarely had time to talk with them about problems they might be having, not to mention the lack of options for privacy. The way the clinic was set up, PT techs provided a lot of treatment (modalities and taking patients through their exercises) and I was expected to bill insurance for this. I was also required to write progress notes for the supervising PT (I’m a PTA) and sign them electronically as the PT.
So. Many. Red. Flags.
I was naive. I thought it was all some type of misunderstanding and that a talk with the boss would straighten things out. This was clearly unethical activity, even illegal from a billing/insurance standpoint, so the clinic owner would be glad that I pointed out this huge problem, right?!
I was nervous before the meeting with the boss, but my concerns were heard. Yes, it appeared that it was all a misunderstanding. What a relief! I was assured that we would have a staff meeting immediately and go over proper billing practices. The only problem was, that meeting never happened. Days stretched into weeks until it was obvious that another uncomfortable behind closed doors meeting was necessary.
While all this was going on, I started asking my new co-workers about the history at this clinic. The conversations I had with them were revealing. Almost none of them had ever worked anywhere else. Most were only a year or two out of school. And apparently the staff turnover was sky-high. I would ask them questions about billing, ethical issues, and how some of these things we were being asked to do seemed an awful lot like insurance fraud. They were also concerned, but since they had nothing to compare it to, they just went with the flow. The owner had previously told anyone who asked that this is how things are done everywhere else.
I didn’t know what to do. I had a lot of pressure to go with the flow as well. Pressure to bill for time that wasn’t actually spent treating patients, pressure to look the other way regarding practices that were unethical at best and illegal at worst, pressure to be a team player and not rock the boat. Further discussions with my boss were getting more and more heated (because I continued to only bill for the time I spent with each patient) and I was stressed to the breaking point.
Even though I didn’t have another job lined up, I decided it wasn’t worth my license (not to mention my conscience!) to continue at a place like that, so I resigned. I felt like a failure and that I had let my family down. We needed that income.
This Happens In Way Too Many Places
In the years since this happened, I’ve learned that many people have been through the same thing. There are clinic owners and directors out there that burn through new grads and take advantage of therapists who don’t know any better. They demand that therapists engage in unethical and even illegal billing practices. They push clinicians to do things that could put their license at stake. This doesn’t only happen in the outpatient setting. I’ve heard plenty of stories about other settings as well.
This stuff needs to stop. It’s a major source of burnout and damages our profession as a whole. We need to warn students and new grads about the predatory behavior of some of the clinics out there. I hope my story can serve as a warning call. I don’t know if we’ll ever be able to get rid of clinics like this, but maybe we can help others avoid them.
If you’ve had a similar experience, please know that you’re not alone. Please also know that there are plenty of good clinics, owners, and directors out there who are doing the right thing. If or when you’re job hunting, make sure to do some extra work and find those good clinics.