Founder Letter: Culture, Compensation, and Career: The Elements of a Competitive PT Hiring Package

There’s never been a better time to be a physical therapist: there’s a large population of aging—yet active—baby boomers, direct access is now the law of the land in all 50 states, and the healthcare system at large is moving toward a value-based care paradigm that prioritizes the delivery of safe, cost-effective treatment. At the same time, this year’s class of new PT graduates is on pace to be larger than ever, with as many as 10,600 newly minted physical therapists joining the workforce in 2018 (according to CAPTE). And that number is only going to grow with each passing year—which is a good thing, as hospitals and private practices are hiring more staff therapists than ever before. After all, with the continued expansion of health insurance coverage, the increased incidence of chronic disease, and the aforementioned proliferation of active seniors, rehab therapists will remain in high demand for the foreseeable future.

Still, we know that only 8% of patients who could benefit from physical therapy actually receive it—based on our own research. So, how do we break through the 8% glass ceiling of those patients who actually get in to see a therapist? Furthermore, how do we not only maintain our strong foothold on that 8%, but also expand our piece of the pie? Well, as I always say, it all starts with a foundation of great people who help form your organization’s culture. And if you want that foundation to be strong, you must convince the best incoming talent that they should work for you. Easier said than done, you say? Well, not if you use these helpful strategies, which have worked in many clinics across the US. It may even surprise you to learn that they don’t involve offering the highest salaries to win candidates’ favor. In fact, today’s employees—especially millennials—are looking for more than just competitive salaries and standard benefits. But, before we get down to the “how,” we must first understand the “why.”

A Changing Workforce

The high demand for PTs means new DPT grads can afford to be selective about where they choose to work, so hiring packages must be competitive. But, with so many new grads entering the workforce—most of whom fall into the millennial age range (i.e., people born between 1981 and 1996, according to Pew Research)—that hiring package now includes workplace culture. That’s because millennials tend to have different attitudes toward work culture when compared their more experienced colleagues. And if your practice isn’t actively working to align with that shift, you could have a tough time drawing in the best new hires.

Culture

Company culture is in the midst of a major nationwide shift due in part to the growing millennial workforce. So, it’s important that you evaluate your practice’s culture with respect to this trend. How do millennials look for work, and what do they value in an employer? If you take to Google, you’ll see article after article attempting to analyze and explain just that. But, I think it can be condensed into to a few concise points that—when you really think about it—apply to pretty much anyone in our profession, regardless of age:

• Millennials want to feel valued;
• They want to have flexibility; and
• They want their work to be meaningful.

For many millennials, a job is about more than just a paycheck. Most people will spend one-third of their lives at work; thus, many young people want that time to be meaningful. (I’ve found this is especially true of millennials who choose to work in a healing profession like physical therapy.) Perhaps this is partly why we’re seeing such a massive influx of millennial PT students.

Organizational culture is also a major sticking point for millennials. They recognize that they’ll spend most of their waking hours in the workplace, and as a result, they want to find an organization with a culture they can live and breathe—one that aligns with their ideals. As they explore their options and go through the interview process, they want to know about things like:

• your core values and the pillars of your clinic’s culture,
• team outings and happy hours,
• opportunities to give back to the community,
• what the patient experience is like in your practice,
• how you objectively determine patient outcome expectations, and
• employee work-life balance.

Ultimately, your clinic’s culture matters, regardless of practice size. But it’s up to you to clearly articulate how that unique culture translates to employee expectations, your clinic’s day to day operations, and your employees’ future growth opportunities.

Career Pathing

Now, while some PTs are perfectly content with the idea of being a staff therapist for the duration of their career, others have dreams of ascending into management or potentially even opening their own practice. For those who fall into the latter group, offering learning opportunities in areas of professional interest could be a huge differentiator. That’s why it’s critical to have this conversation early in the hiring process. Not only will you be able to determine whether the candidate’s goals align with your practice’s, but you’ll also help the candidate determine whether his or her talents will be maximized under your leadership.

This conversation shouldn’t end once the therapist comes on board. Long-term objectives can—and do—change on both the employee’s end and the business’s end, so make sure your employees are given a platform to voice those changes and that you establish a climate of transparency. When you do that, you’ll create not only a strong team, but also a loyal one. So, if a new grad—or any other potential hire—expresses interest in a certain career path, finding opportunities that’ll help him or her achieve those goals will be crucial to keeping that talent within your company. As an added bonus, the more you diversify service offerings and specialties among your team, the more patients your practice has the potential to serve. And that’s a win for you, your team, your patients, and your community.

Continuing Education

To continue the conversation on career advancement, your benefits should definitely include continuing education. Unfortunately, continuing ed—specifically, CEU reimbursement—has taken a backseat to other employment perks, primarily due to the lack of objectivity in selecting CEU courses that would prove relevant to a practice’s needs. However, times have changed, and thanks to the power of data, practice owners and managers can measure things like patient outcomes and satisfaction scores, which help them better assess the clinical team’s needs and tailor continuing education courses to target areas ripe for improvement.

And you don’t have to break the bank on continuing education. Instead of blowing your budget on travel expenses, you can:

• use an online platform (like ),
• collaborate with other local practices to bring in a guest speaker, or
• select one employee to attend an continuing education event and host a post-course “lunch and learn” session for all providers in your practice. (This was something we did during my time as a clinical director.)

Performance Incentives

I’ve written in the past about the importance of cultivating cognitive diversity in a clinical setting. A diverse tableau of communication styles, values, and treatment approaches not only creates a richer, more collaborative work environment, but also promotes an improved patient experience. However, as you focus on fostering a cognitively diverse team, it’s important to avoid “cookie-cutter” performance assessments.

Traditionally, therapist performance reviews were fairly subjective, and that simply doesn’t cut it anymore. There’s more than one way to evaluate performance objectively. And while productivity and visit utilization are certainly easy—and important—metrics, they only quantify a particular employee’s contribution to the organization based on direct revenue generation. But, there are a lot of factors that influence revenue, including your company culture and how your employees engage with it. Furthermore, the number of visits a therapist completes isn’t the only thing that makes an employee great; it’s also about the outcomes he or she achieves. After all, when a therapist delivers value to his or her patients, retention—and thus, visits—will naturally follow. So, instead of basing your performance reviews solely on revenue metrics, consider patient outcomes and patient satisfaction as key employee performance indicators. (Because at the end of the day, isn’t that the reason we all do what we do?)

Keep in mind, however, that if you go this route, it’s important that you also measure patient loyalty through tools such as the Net Promoter Score® (NPS®), as satisfaction surveys are vulnerable to bias. All in all, subjective data isn’t always as easily measured as objective data, but it can help ensure you’re assessing performance fairly and completely.

Referral Incentives

If one of your organization’s goals is to attract new patients—which it should be, if you’re planning on staying in business—then you should reward providers who take it upon themselves to build relationships and generate referrals. Of course, if you’re on the leadership side, there may be a voice in the back of your head expressing concern over encouraging staff therapists to take referrals into their own hands. After all, if a particular therapist leaves your practice, that therapist’s patients may leave with him or her as well. One way to combat this is to evenly distribute patients among therapists so patients feel loyal not to a particular therapist, but to your practice as a whole.

Obviously, building relationships with physicians is an important piece of the referral generation puzzle. When you establish strong ties with a particular physician group, not only will you receive incoming leads, but you’ll also have an ongoing relationship with a “PT friendly” physician group that can better accommodate physical therapy patients. That said, building relationships can be tricky. When your therapists reach out to physician groups, it’s important that they foster a relationship with the PT practice as a whole rather than one specific to him or her as an individual therapist. You may even want to provide therapists with marketing materials that tout outcomes, patient satisfaction scores, and patient testimonials for the entire practice as a whole to further support the development of a relationship with the entire physical therapy practice—not just a single therapist.

Brand Image

Finally, the image your practice projects can play a major role in the type and quantity of potential hires you attract. Today’s incoming grads were primarily raised during the rise of the Internet and will be drawn to practices that value staying current—in terms of technology, business best practices, and clinical practice. That means they’re looking at your practice’s website, social media pages, and patient reviews—as well as employment review sites like Glassdoor—to get a feel for your practice culture. So, in addition to projecting your image in a way that will attract new patients, you want to make sure your brand also attracts the right providers. Some things to consider highlighting publicly are:

• staff spotlights,
• mentoring opportunities,
• continuing education offerings,
• pictures from team outings, and
• community givebacks.

The market for physical therapy services is growing, and so, too, is the volume of new physical therapy graduates. But while it’s tempting to think your organization will have its pick of new recruits, the truth is that new grads tend to flock to the practices that’ll provide them with the kind of employment experience that aligns with their personal values.

I strongly believe that there is no “one-size-fits-all” solution in terms of job satisfaction, which is one reason why I feel that all therapy organizations—large and small—have an important role to play in our profession. While I can’t overstate the importance of remaining open-minded about shifts in attitudes and mindsets, at the end of the day, there’s no “wrong” or “right” culture. So, always stay true to the culture of you, and don’t reinvent your practice’s image just to meet someone else’s ideal. After all, your practice could be just what that next new DPT grad ordered.