As you may or may not know, I’m an occupational therapist by trade. This blog is just a hobby for me. I recently started working with a new company and when I got the itinerary for mandatory trainings they specified that these would be unpaid. This is not an uncommon occurrence in the therapy world. In the medical world in general, it’s expected that most of your day is spent in direct patient care. Any of your time that is NOT spent in direct patient care is either unpaid, or sometimes, if you’re lucky, reimbursed at a lower rate. That means, any documentation that I do, any phone calls to doctor’s offices or families–I get to do that all for free unless by some miracle I’m able to complete all of that while I’m simultaneously treating my patient. I don’t know if you’ve ever had to overhaul a seating system for a person with dementia, but it requires both hands. Likewise, I can’t be assisting a patient to the toilet and typing on my computer at the same time. It’s almost like people who end up in sub-acute rehab settings require hands-on care. Weird.
Here’s my issue, though. If what I’m doing could be labeled as a “necessary”, “mandatory”, or “required” part of my job–I should be getting paid for that time. It’s asinine that things like documentation, which are legal documents, by the way, go unpaid. This was a constant source of irritation for me when I worked in nursing home settings for the first 10 years of my career. As an aside, if you think that nursing homes are just buildings where nanna goes when she can’t cook for herself anymore, you’re mistaken. Most skilled nursing facilities have several units that consist of patients who require short-term rehab and will then return home or progress to another level of rehab referred to as inpatient rehabilitation. These short term rehab patients are what drive the reimbursement, thus the revenue, for the facility. Without these patients, nursing homes would not be able to survive financially. Ok, tangent over.
When I left the skilled nursing sector, I went into the school system in the hopes of having a schedule that would more easily align with my kids’ schedules. While that was true, it was a horrible financial decision. You’re only paid as an OT or PT in the school setting when you work directly with the kiddos. That’s all well and good, but when half of your caseload is out sick, welp, you’re not getting paid for most of your day. There’s a chance that you can squeeze your treatments in for the kids who are there and leave early, but that’s not always possible. Most kiddos have at least one subject, like reading or math, where they can’t be “pulled” from the room for the therapist to treat them. So, you have to either wait for your regularly scheduled treatment time, or possibly treat in the classroom, if the teacher is agreeable to it and the session could still align with the student goals. While some therapists are all about the “push in” model of school therapy, I hated doing it. It inevitably ended up distracting the other kids and I couldn’t help but feel that I was making the teacher’s already challenging job all the more difficult.
We also don’t get paid for daily notes or documentation in the school setting, either. You will get paid for attending an IEP meeting, but in most cases, you will not be paid for writing up your portion of the IEP–even though it’s required that you contribute to the report. Add to that fact that most therapists make a lower hourly rate in the school systems and you have therapists leaving left and right. I’ve spoken with more than one new graduate who had to the leave the school systems because they weren’t making enough to cover their living expenses, let alone their loan payments from graduate school. There’s always the option of taking on additional work, like filling in for therapists in different settings when the call off, working weekends in hospital or sub-acute settings, or taking on early intervention cases that you can do in the evening. That’s really sad, though. No one should have to work multiple jobs to survive, but when you’ve dedicated six years or more to your post-secondary education, that’s the last thing you expect to be doing. While it may be possible to work in two or three different settings when you’re single and free, when you add kids to the mix, it becomes much harder. Parents, you get it. If you want to take on a job that has evening hours, you have to ensure that your partner will be able to run your kids to activities or appointments. Or, just make sure that you’re partner is ok with being a single parent for most nights of the week. They get stuck with the dinner, the homework, the school projects, the bath time, the bed time, and everything in between. Typically, you’re partner was working all day, too, so they might appreciate being able to tag-team with you in taking on the daily responsibilities of your family.
Taking all of this into consideration, a lot of therapists end of leaving their careers. It’s really a shame because the need for good physical, occupational, and speech therapists has only increased over the last 20 years and it is projected to continue to grow exponentially. After a while, you just get burned out. You’re tired of sacrificing your mental and physical health for your job. You’re working in a high stress environment with physically demanding patients, and you’re not getting paid for at least half of your job requirements. It’s no wonder people leave. I’m aware that therapists are not the only ones who have this problem. I know many teachers feel the same way and I’m sure that there are other careers/jobs out there that have the same or similar expectations. It’s exhausting and it no doubt leads to a lot of the mental health issues, marital problems, and stress-related physical conditions that we see here in the United States.
So, why do I think this is an unpopular opinion? Most of the work force would likely agree that if something is a required or mandatory part of your job, you should get paid for doing it. Unfortunately, the individuals making millions, if not billions of dollars, to run hospitals, insurance companies, and other major organizations will be unlikely to sacrifice their bottom lines to ensure that their laborers are getting paid what they’re worth. I have heard countless complaints from co-workers over the years about this, I have sat in numerous meetings with my boss and my boss’ boss where these concerns were aired out, and the answer is always the same. There’s nothing they can do about until the “system changes”. I’ve been hearing that for 15 years now. Maybe by the time I’m ready to retire there will be palpable change running through “the system”. I guess I’ll just have to wait and see.