Every New Graduate Should Consider A Mixed Setting Assignment

As a new graduate or therapist with limited experience, it can be difficult to break into new settings. Even if you had a clinical rotation in the setting, it may not be enough to secure a travel assignment in that setting. I remember experiencing this over five years ago when I began my journey as a new grad travel PT.

Like many aspiring travelers, I wanted to work in the outpatient and acute care settings in bigger cities with lots of things to see and do. As you may have noticed, these jobs exist, but they can be competitive. I was lucky to have my first assignment in Cleveland in an outpatient clinic. The location was great, but the clinical setting could be considered incredibly challenging for a lot of new graduates. I was a solo therapist in a busy outpatient clinic, seeing 16+ patients a day including walk-in evaluations and human performance evaluations for pre-employment testing that did not count towards productivity. I did not have an aide to even help with laundry or cleaning of equipment. It was a lot to handle. Despite all this, I enjoyed the assignment and the patient population I saw while I was there.

As a student, I had really enjoyed my clinical rotations in acute care and pediatrics. Part of the of the reason I chose to travel was to grow my resume and keep my options open. Professors had told me if you didn’t get clinical experience in the acute care setting within your first few years of graduation, it would be difficult if not impossible to switch to this setting later in your career. I certainly didn’t want to close any doors.

As my first assignment was wrapping up, I was presented with a unique opportunity. The opportunity entailed working in a hospital-based outpatient clinic for most of the week. However, I would also be covering a maternity leave for the pediatric outpatient Physical Therapist. They would be prioritizing the patients that still needed to be seen while she was out on leave. As a result, I would only be seeing treatments. There was no standardized testing to be done and the plan of care was already established for each patient. All I would have to do was follow the treatment plan. What a great way to get my foot in the door with outpatient pediatrics! The outpatient therapists would also help cover the acute care setting of the hospital when census was high as they only had one full time Physical Therapist.

The hospital was a critical access hospital. I had never heard of such a thing, coming from growing up in the suburbs and attending PT school in New York City. A critical access hospital is a designation given to eligible hospitals by the Centers for Medicare & Medicaid Services (CMS). The designation was intended to help reduce the financial vulnerability of rural hospitals while at the same time, expanding access to healthcare in rural communities.

As you might expect, critical access hospitals are not very big. To meet the requirements to be considered a critical access hospital, they must have fewer than 25 acute care beds. In the case of my second assignment, the hospital had an 18-bed acute care capacity in addition to a small swing bed unit. If all the beds were full and most of the patients were on the physical therapy caseload, it was too much work for one therapist. If outpatient therapists had a break in their schedule, they would help the inpatient therapist with their caseload.

The outpatient clinic was a lot different than my first assignment as well. This was my first experience in a hospital-based outpatient setting. All patients were seen one-on-one. The evaluating therapists had an hour to complete evaluations and 45 minutes for follow-up treatment sessions. The team consisted of four PTs and three PTAs. I had never worked with PTAs, so this was a great experience learning how to delegate and supervise them as I never had that opportunity as a student. The clinic had a lymphedema specialist, dry needling specialist, aquatic specialist, vestibular specialist, and a McKenzie certified therapist. I loved getting to work in aquatic therapy and seeing what the other specialties were about. Who would have thought I could have been exposed to so much in a rural, critical access hospital setting? Simply amazing!

While the rural setting isn’t my favorite, it was certainly worth spending three months there to gain the valuable experience I did. I now had true work experience in the acute care setting, swing bed setting, hospital-based outpatient setting, and pediatric outpatient setting on my resume! It was this assignment and the experience I gained as result of it, that I was able to secure travel assignments in multiple level one and two trauma centers including an esteemed hospital in the heart of New York City!

There are a few additional pros of working at a critical access hospital as a new grad traveler:

1) Low cost of living

• Most new grads have little to money. Taking an assignment in a rural area can help you save up money and replenish/build your savings account. In more desirable areas, you often have higher cost of housing and may have to front more money at the beginning of the assignment to secure housing. This can be difficult for new grads with little to no money.

2) Less likelihood of contract cancellation

• In all travel contracts, there is a cancellation clause. The clause may be 14 days or 30 days. If a facility hires a permanent staff member or census drops drastically, they can issue a cancellation notice to the traveler. Since it can be harder to fill permanent staff positions in these areas, the risk of cancellation is lower than that of a city where the market is already saturated, and they have several applicants for the position you are covering.

3) Usually, good rates because reimbursement tends to be higher in rural areas.

• You may or may not have learned that reimbursement rates for therapy services vary in different areas of the country. Just because an area has a higher cost of living, doesn’t mean that insurances reimburse more. In fact, New York has some of the lowest reimbursement rates in the country despite its high cost of living. Oftentimes, to increase access to healthcare services in rural communities, hospitals in these regions are incentivized with higher reimbursement rates.

In my opinion, there are a few cons of taking assignments in rural areas while on assignment at a critical access hospital.

1) Housing can be harder to find:

• While housing costs may be cheaper in these areas. They can be hard to find. For this particular assignment, I found an unfurnished rental about 20 minutes away from the hospital. In other rural assignments, I’ve stayed in hotels and even park model RVs. Check out my other blog posts for several resources on securing housing.

2) There is less to do in the area:

• As a city girl, it seemed like there was nothing to do in rural areas. Overall, there are less things to do in the immediate vicinity. However, usually you can access parks and the great outdoors. You might be surprised what’s within an hour’s driving distance. If you are truly a city person, you can also plan weekend trips to cities in the state/region that you haven’t visited before to help break up the assignment.

If you are trying to grow your resume to break into other settings, consider an assignment in a critical access hospital. To connect with a recruiter who can help you fulfill this goal, fill out the contact form! Also feel free to join the New Grad Travel Therapy Job Board on Facebook. Here you’ll find job postings and additional resources such as interview prep including questions to ask in the various clinical settings!