Tuesday, March 31, 2015

Experiences: By Dr. Ben Fung

Getting to know Dr. Ben Fung through his blog as well as twitter has given me great respect for him. His ideas are fresh and innovative. I highly suggest you visit his blog for great new insights on physical therapy. 
  • Bio
Ben Fung, PT, DPT serves as a consultant in the space of physical therapy and healthcare. He is based out of San Diego, California and graduated in 2009 with a Doctor of Physical Therapy degree from Azusa Pacific University. He is finishing a Master’s in Business Administration with a concentration in Marketing from the University of Michigan-Dearborn this April, and, aspires to self-publish his first book in early summer.

  • How was the transition coming out of school and starting your first job?
The transition coming out of school was quite smooth. I felt I was very well prepared at a clinical level, and, my program’s faculty continually stressed professionalism in the strictest fashions. If anything, I had the fear put into me that should I do anything remotely unprofessional at any time, I’d fail my rotations and get kicked out of the program. As work began, there were certainly random things here and there that I just didn’t know, or, knew academically but haven’t seen in real life. Nevertheless, I felt that I responded to each situation with poise when paired with a healthy dose of asking when I needed clarity or guidance – after all, nobody knows everything. In any case, the majority of quandaries weren’t too difficult to solve. It was the politics that I had difficulty with… more on that later.

The learning curve was also quite seamless. Being that I’ve worked in every major healthcare setting from acute hospitals to rural home health, I felt that what I needed to be fully functional in each setting was a short time of exposure to the work environment. After that, I was running on all cylinders. Where I felt that I was weakest was my understanding of healthcare politics and my ill-preparedness for effect business solutions within physical therapy and healthcare at large. This was one of the reasons for my pursuits of an MBA.

  •  What is your work load like and what is typical day is like for you?
 Well, how about I go through a range of my past experiences since my current days are quite anomalous to what the newly graduated professional experience is like.

In Acute Care, I worked both 5x 8s and 4x 10s. I loved 4 x 10s, but, I was spent after the day’s work. Typically, I would arrive on the hospital campus around 715am and clock in at 730am. My shift went from 730 to 6pm. Productivity at this hospital was 75% so I needed to put in 30 units or 7.5 hours of direct patient care. I recall I got an extra unit for evaluations so evals were a nice thing to boost that productivity measure. Usually, I would try to slam out 4 or 5 evals in the morning until about 1230pm. I’d take a quick 30 min lunch then scramble to get the rest of my evals or treatments as quick as I could. I also loved picking up new evals and swapping treatments with PTAs. It helped everyone as it boosted productivity for all. Some clinicians didn’t like having more patients because it meant more documentation… this is where I feel Acute Care standards for productivity could improve across our industry.

It remains an lazy measure of hospital “productivity” for rehab clinicians to take their time with patients, get 45 to 60 minute treatments (which may not be necessary) and get a bunch of slow easy units in that fashion. I’m just not like that. I rather get my butt moving and see as many patients as I could to help alleviate the supply chain. Anyway… enough of that soapbox.

As a Rehab Director, I was in charge of inpatient SNF rehab, outpatient, and community home health. This was a hard life. I worked 10-12 hour days, typically 5 but sometimes 6 days a week. I had to do all sorts of ad lib scheduling and staffing duties that spilled over at home and anywhere else when I was mobile. My son was born in this time frame as well, so, my wife had to take a brunt of the parenting. It quickly led to my resignation due to poor work-life-balance. But in any case, I would arrive at 630-7am almost every day. I would fine tune the schedule as best as I could. I’m not necessarily a perfectionist; however, I do believe optimization. I feel passionately about optimal operations. It actually served me quite well on the job, leading my region in profit margins and raising a sinking ship in less time than upper management ever expected. Well, from 830-900am I’d be in meetings. Then from 930-1030am I’d be in more meetings. Several times a week I’d have 11-1230pm meetings with occasional 1pm meetings. Sooooo many meetings. There would also be meetings which lasted from 1030am until 3:30pm. What time I had left was left to optimizing the next couple days in terms of operations and revenue streams followed by seeing my own patients. Since most of my team didn’t like doing outpatient or community home health, I helped alleviate that by taking it on myself which led to lots of walking back and forth between offices and throughout the community itself. It took less than 3 months to completely destroy a pair of dress shoes.

In Home Health, I found myself driving more than I was actually seeing patients on most days. I’d leave the home around 630am or 7am to get to where I needed to be by 730-8am. I averaged 25-40 minutes treatments with OASIS starts of care to be around 1.75 – 2.5 hours. If I was lucky and the patient didn’t have many medications, I could get done in 1.5 hours. Regular evals would just be the normal hour. The most annoying thing was that many times, I’d have to drive PAST my patients to get to the next one. It is a funny thing about home health, all the patients that you have clustered together never seem to want to be seen in the same breadth of time. You always find yourself driving to and from, back and forth… just to keep up your visit quotas. So close, but, so far…

See, in home health, most companies require you to meet a certain quota or productivity equivalent of patients within a time frame. This could be something like 28 weighted units in a week; in such cases, you may be working 3 hours one day, 10 hours the next, picking up a quick eval over the weekend summing to 6 days a week but random hours. This is the case because in home health, you get paid for what you do, not how long it takes. A 20 minute treatment makes as much as a 45 minute treatment. The faster you work, the more money the company makes and the more of a cut you get. Does this lead to some shoddy treatments in the midst of a large company? You bet! But, that’s life in the home health industry. Home health is just a different animal compared to the rest.

  •  What do you wish you would have known/been prepared for after graduating?

I wish I knew more about business in PT school, and, even more about the very complex lattice that is healthcare politics. PTs are in a bad place when it comes to healthcare politics. Anything except outpatient and you’ll find that we really lack a strong stance. The problem is that most healthcare corporations see PTs as an add-on in the medical continuum rather than a pillar in the healthcare environment. As such, physicians and nurses tend to be the political powerhouses. All decisions, budgets, and executive positions are held by either of the two. PTs need to find ways into roles such as COO of a hospital, regional director of operations, and even CFO for health systems – another reason I went to get my MBA. I was told that without this stamp of business approval, larger organizations wouldn’t really consider us. I found this advice to be true.

If we don’t shine out in business, we won’t truly shine in the scheme of things because we won’t have any control of our own fates. It just doesn’t work the way our current internal culture says it does where: tip-top clinical skills + years of experience = influence. Truth be told, clinical savvy means very little in the spectrum of healthcare politics. Positions hold the power. Until we get into those positions, we will remain with very little power.

  • What is it like/managing student loans on a physical therapist salary?

Coming out of school, I was offered $30/hr. No flexibility, no bargaining, non-negotiable. I was offered a sign-on bonus which was nice. It was what it was. By the time I was working in home health, I was getting paid a six-figure rate.

Managing loans is a personal story for everyone. The best I can say is that a tool such as PowerPay.org can really help with structuring your financial lifestyle to keep up with your goals while having a reasonable life of enjoyment. Find the best balance for you.

Personally, I’ve always been very disciplined about living within my means. I do my very best not to spend more than I have (or will reliably have). I can still recall some college and grad school days when I’d eat the same meal, 3x a day to make it buy both financially and nutritionally. I carried the same work ethic coming out of school. Discipline and hard work are beacons of fiscal solvency at any level. If you get financially lost, look to those lighthouses… you will find your way back.

Discipline and hard work.

  • Additional thoughts.

There are five things I really want to encourage students and new graduates to pursue:
1)      Get as many students into advocacy as possible. Laws can either confine us or empower us. If we don’t advocate our own laws, then we will be confined, contained, and extinguished by competitors. If we define them, we can in turn empower our practice and truly work at the top of our credentialing. Start early and don’t stop caring.
2)      Get into social media. A profession has a brand and it is represented by every member that it boasts of. The more presence we have, especially the more positive presence we have without infighting, the more the public will recognize us. That is the first step to cultivating a strong, positive, favorable brand in the public eye. Also, there have been enormous opportunities made available to me because of social media; I can see the same will be the case for students and new graduates when it comes to employment in the coming future. Get involved and invest early in your personal brand.
3)      Realize the life cycle of a new grad: Start working. Quit your first job early to shed your “new-grad-ness” (I have a whole post about this in my blog). Rise to management. And, empower the generation under you. Management is the first barrier to making sure PTs get competitive pay. Too often, companies which employ PTs (PT owned or not) are managed by stagnant and disengaged individuals. They don’t want change. They want status quo. In our current healthcare environment, that just isn’t good enough. Get in. Rise up. Change our world from within. Again, those key positioning within the healthcare political matrix is where things start. We need to get there fast as a culture and as a profession. THEN changes will happen as a tidal wave of improvement across our industry.
4)      Don’t settle in working for bad companies, for bad pay, and for circumstances that demean if not insult what you’ve worked for. Once you’ve graduated, you’re doctors. Make sure your lives reflect it in every dimension. Live healthy. Stay fit. Represent yourselves and your colleagues well. Also, by not settling, you will set up a momentum that will deny bad business patterns the oxygen they need to perpetuate. Shoddy SNF programs that pay amazing for terrible practices will lose the human resources they need. Seasoned PTs won’t go near it because it typically means a big change in their lives, those that have work currently aren’t interested in any change, and thus only new grads and travelers will get sucked in and burnt out. Deny them this and you deny them bad brand perpetuation of YOUR legacy. Deny companies that want to rob you because you are new and fresh out of school and you will deny them that “cheap labor” idea of new grads. Work for places that respect you, not for those that wish to take advantage of you. I know it is tough coming out of school being picky about jobs, but honestly, if we don’t start becoming picky, they will always pick on us.
5)      The title doesn’t mean good pay. Hard work means good pay. DPTs are generally the lowest paid doctoral professional in any industry in present times. This sucks, isn’t equitable, and needs to change. That said, ANYONE regardless of profession, working 60 hours a week will make more money than someone working 40 hours a week. There ARE ways to make 6 figures as a PT and pay off all sorts of student debt right out of school. The challenge is finding work-life-balance when you’re grinding away so many work hours. As your career matures, you’ll be mystically valued more in the job market – then you can work fewer hours to make the same. It’ll take time. But, if you get into management (again, with this politics and business thing), you can help change this and have it that people earn according to their level of performance. Imagine that?! Being paid for the worth of work you do. Advocate, learn the business, navigate the politics, rise to leadership and key positions, and such will be your reality. It’s yours to capture!

A huge thank you to Dr. Ben Fung for his awesome insights. For more about him check out his blog or find him on twitter. I want to reiterate Dr. Fung's advice to get involved in advocating as well as getting on social media. Both of which are powerful tools that will help you connect with like minded professionals and help you find mentors.

Twitter: @DrBenFung

Click HERE to read about other PT's experiences.

1 comment:

  1. Thank you Dr. Fung for your motivating words and insight into the practice of PT. As a current PT student, it can be difficult to see beyond the books. But I know graduation will be here before I know it. Armed with some of your advice (i.e. social media presence, advocacy, leadership and continuous hard work) I am looking forward to hitting the ground running and continuing to add value as practicing PT to patient care, help inspire PTs for the future and continue to build pride in the profession.