The Sequel to Crying in PT: Making Friends, Insurance and Other Changes in Healthcare

As I mentioned last week I have been a Physical therapist for a long time. My first resume' was done on a type writer. I remember handwriting notes in a paper chart. I was very late to the computer age because I got paid to work with people, not sit at a desk. At my first job we saw patients for months at an inpatient setting. I remember a colleague who treated a gentleman with a severe head injury for 9+ months. Its unheard of now.

With these long term inpatient stays came close bonds that formed with PT and client. You met the family members that came to visit. You knew who was waiting at home for this person to return, possibly as a totally different individual. You spent several hours each day with these patients so you also played the part of "shoulder to lean on/ear to bend". I remember several patients from that first job that became more... they were friends that I kept in contact with after their rehab stay was over. One gentleman even wrote a song for me.

So these days inpatient stays are vastly shorter. I've been working in outpatient for the past 15 years. Despite the best efforts of the insurance industry I still am able to see pediatric clients for lengthy periods if they have a diagnosis that warrants long term assistance as a child grows. I've been able to make solid bonds with families even though I see these clients 1-2 times per week. Of course social media helps. This wasn't even a blip on the radar when I started practicing but now I can keep in contact with families and see my client's progress even after they are discharged from my care. And they can see me - my family, my friends, what I'm doing on the weekends.

It sounds like a boundary that may be better uncrossed but I have to disagree. Whether I see your child for a month or a year I become invested. I think about your child during my daily life and I get inspiration for our sessions at the oddest times. I love to get videos and texts bragging on your child's progress. And don't be surprised to get a comment from me when I see your child playing at home or with grandparents.

This is for sure the best change in healthcare over the last 30 years. I get to be relaxed and familiar with your child. In return you get more personal care from me. Insurance by definition is a guarantee of compensation for loss or damages. But the system is very broken and not everyone gets that guarantee. Faceless individuals decide the level of care we receive and where we are going to receive it. As a clinician I'm expected to try to bargain with insurance companies to get my clients the services they need, but most times my opinion isn't enough.

So enter the model I've been using for the last year. Its a concierge style model where clients pay for services up front. I don't have staff that answer phones or deal with payer sources. It's just you and me and your child. I answer all your calls. I schedule my appointments. I don't deal with insurance companies. And my stress level and creativity have improved tremendously. I can focus on your needs. I can be a friend, not just a friendly face. I can have the relationship with you that makes me want to come to work. This model doesn't work for everyone but for now I'm carving out a niche for myself and I've never loved being in healthcare more.