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PTs and Sign-On Bonuses...Let's Reverse Engineer That!

Over the past several weeks, I’ve seen outrageous offerings to healthcare providers in terms of sign on bonuses. I've heard on radio ads upwards of $20,000 for a sign on bonus for RNs, and believe me, I am not writing this to say that we as healthcare providers, especially nurses, do not deserve that.

But as physical therapists, the way business works, to see sign on bonuses in the thousands of dollars for PT's and PTA’s causes me to step back a little bit.

Think about this as a foundation for this discussion: The largest physical therapy outpatient provider in the nation has a publicly reported profit margin of about 4 to 5%. This means that the company as an entity only keeps about 4 to 5% of the total amount of money that they make. By proxy in most circumstances, the majority of providers of physical therapy, both large and small across the country that operate under the same insurance reimbursement model, and have the same types of expenses should also be producing a very similar profit margin. No pun intended, that profit margin leaves very little margin to add expenses such as sign-on bonuses. In the world of physical therapy, the largest expense to a company is the cost of a good staff.

So, how can a company offer for example a $5000 sign on bonus when they are generating a five or even a 10% profit margin? The likely answer is that business is a give and take and when they give you 5k, they may take your time in return and you are likely going to have to work harder, and see more patients in your day in order for the revenue to cover your sign on bonus, and you’re ever increasing salary.

In my opinion, that $5000 upfront bonus can slowly suck the life out of you personally and professionally because all big operations have to look at profit first rather than patient's first. The term "PT Mill" was generated long ago and represents the way that clinics had to increase their visit numbers and see multiple patients at once simply in order to counteract the continous and repeated cuts of reimbursement.

One of the great overriding tenets of my life is that the only valuable currency that we have is time. Sure, young therapists, just starting out on their own with no family who are geared up and full of vigor can go out and really benefit from that large sign on bonus, but my hope is that most clinicians would rather be given time. Time to spend one on one with their patients so that they can give them everything they need and give them the best chance at an outcome that they deserve. Time to actually go home and spend with family. Time to have a life outside of your profession.

I believe that providing physical therapy is absolutely essential for many health issues, and should be considered much more valuable than it is in the continuum of care and the healthcare spectrum in totality, but that is another topic. I would urge you to think twice about the money and think more about your impact and your ability to successfully impact your patients, as well as what you are giving up because you are receiving a lump sum on the front end of a signature.

Can you have your cake and eat it too? To go along with this information, there are companies that actually do one on one physical therapy sessions which are way more valuable than cookie cutter, double up the schedule systems. They too are providing offers with a lot of coin in the form of a sign on bonus. Research these online and you’ll find plenty of information....information about the take part of the give and take.

Certainly, most of you are not old enough to remember the television show the facts of life. The theme song had lyrics that said: "You take the good, you take the bad, you take them both, and there you have the facts of life." The overwhelmingly attractive good in these offers is the dollar sign followed by a four or five digit number. The problem with a company giving is that it’s all about math, and they have to find a way to take in order to be balanced in their bottom line.

When you get a sign on bonus, you’re often locked into a multi year commitment, clauses in your contract that indicate when you may have to pay back your sign on bonus, productivity quotas, which, if they are not met, will affect your salary, a lower starting, or lower average salary for the work that is being done, and certain other things like unpaid travel, unpaid meetings, no compensation for equipment, etc. The list of things that a company can take from you is longer than what they can give back in a great deal of instances.

My advice to you if you read this far is to ask a boatload of questions based on this information when you are chasing the money. The money may be certainly worth some of the headaches that come along with taking the offer but be educated.

If your goal is to make a decent living being as effective and helpful as you can in our profession, I would consider a company that pays you a higher perdiem rate, sees patients one on one, pays for travel, pays for meetings as needed, provides a 401(k) benefit , gives you free reign autonomy over your schedule, and one that is run by a physical therapist who makes company choices not only based on the bottom line dollar, but based on the happiness and success of the clinicians in the company knowing that their patients will be getting their best. We may not be the only one, but Achieva Rehabilitation is certainly one of those companies.

So, as I’ve encouraged you to do, please reach out to us and ask us questions. We would love to see if we might be a fit for what your professional goals are at this point.


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