It's the Per Diem PT Life, For Me

Have you ever wondered about working solely as a per diem physical therapist? I’ve seen this topic discussed more and more around the internet lately. The reasons PTs seem to be interested in this vary: burn out, wanting to spend time with young children, having more time to start and grow your side hustle, simply looking for more flexibility and control of your time…and time off! Whatever your reason, it can definitely be done.

My Story

I’ve worked as a per diem (or PRN) physical therapist more often than not throughout my career, from filling in the gaps between travel jobs to practically full time per diem. Between travel jobs, I worked for a staffing agency that was able to find me work whether I was staying with friends in the Bay Area or with family in Philly. Most of these jobs were in SNF, some I'd been to before, some were one time only. I never quite knew what I was going to get, and I definitely learned how to get comfortable in a new situation quickly!

As I wrapped up my travel days, I decided to stay at my last assignment in a per diem position since I wasn't quite ready to give up the flexibility of travel. It was a busy acute care hospital in Portland and they would have used me seven days a week if I had wanted to work that much. I did not. I was quite happy to have the option to work as much as I wanted to though. Even as a PRN PT, I was able to pay off my student loans and establish a healthy savings account. After reaching those goals, I felt more comfortable cutting back and averaged about three to four days a week.

When I moved to a more rural area and gave full time home health a try, I found myself counting the days until I could switch back to per diem. I never anticipated there would be enough per diem work here to pay the bills, but my expenses are lower and it’s turned out to be plenty for me. I work between two hospital systems doing some home health and some acute care.

The small critical access hospitals where I now work generally only have enough patients to support one full time therapist in each discipline. That means that when the regular PT or OT is off, the outpatient therapists are usually required to cover. I know some therapists don’t mind, and consider this a good a way to maintain their inpatient skills. I also know many who would never step foot inside the hospital again if they didn’t have to.

I never saw a per diem posting for either of my acute care jobs, but I reached out to the managers and both were eager to have me. One had never even considered the idea that there would be someone who lived out here that didn’t want or need a full time job. The moral of the story is, it never hurts to ask. You might just create a job for yourself that didn’t exist before.

Taking the leap probably doesn’t always work out this seamlessly. Things you may want to consider include: having extra savings before you make the leap; pay rates; health insurance and retirement options; your planning style, or lack thereof; your risk tolerance; and practice settings you are or are not willing to work in.

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The Financials

Pay Rate

Some jobs have a flat hourly per diem rate. This rate should be higher than a full time hourly pay rate. Others offer an hourly rate plus a differential, usually 10-20% of the base pay. Some have a higher differential if you commit to a certain type or number of shifts (usually weekend) per month. Keep this in mind when calculating the costs of health insurance and not having PTO. That differential is meant to help to make up for the fact that those benefits are not being provided by the employer.

Savings

Most personal finance experts suggest everyone have an emergency fund, between 3-12 months of your monthly expenses, in case something happens to you or your job. Since COVID, we’ve all become more aware of how suddenly things can change, and more of them are recommending the higher end of that range.

In the case of switching from full time to per diem, you may also want to err on the higher side. This might help you worry less about your income during a slow time or if you get called off at the last minute more often than you'd like.

Personally, I had a smaller amount saved when I worked in a city with more opportunities than I do now living in a small town. Before making the switch here, I saved a year's worth of expenses since I knew there was less guaranteed work available. I haven't had to dip into my savings much, but I’m glad to have it to supplement my income if needed.

Health Insurance

This is probably one of the biggest benefits that ties people to full time jobs. At my first hospital job, the PTs that had been there for a long time always referred to benefits as the golden handcuffs. I could see why. Our medical benefits were free, the coverage was great, and they had families. Even with full time work, most people pay some premiums these days, but purchasing your own insurance is generally more expensive than the premium you pay with a full time job.

I’m content to buy my own insurance and pay for what I consider the cost of my freedom. Especially since the Affordable Care Act was passed and it’s been even more…affordable. I am only paying for myself, however. If you have a family that needs coverage, it might be a different story. If your spouse or partner's job can provide insurance for a reasonable cost, that's a great option. But even if not, I’d recommend doing some research before you assume you can’t afford it. You might be surprised to find that with some prioritizing in your budget, you can.

Retirement Options

Many companies allow you to contribute to a retirement account regardless of how much or how little you work for them. The hospital systems I’ve worked for even provided a match for per diem employees that worked at least 1000 hours per year. This may not be the norm, but it's worth looking into. If an employer doesn’t allow you to contribute to their plans, you can always contribute to a Traditional or Roth IRA at any brokerage firm of your choice.

The Other Things

Scheduling

Are you a planner? Prefer spontaneity and variety from week to week? Some jobs will fit one on of those personalities better than the other. Your best bet is to ask as many questions as possible about the needs of the company during the interview.

Some companies love to have therapists that they can count on to work set days on a regular basis but still consider them PRN. This is most likely because if they hired part time employees to fill this need, they would have to provide more benefits. If you are planner, this type of 'scheduled' per diem work might be just right for you.

Other companies might only schedule you ahead of time in order to cover for vacations. They may be more often calling you at the last minute to fill in for a sick day or higher census. This situation tends to work well if you don't need to schedule child care ahead of time or if like me, you just don’t like commitment!

Of course because PRN means as needed, you can also get called off at the last minute. This seems to happen most frequently in acute care where the patient census can fluctuate daily, but it is possible in all settings.

Risk Tolerance

If you aren’t sure you can handle the uncertainty of not knowing how much money you will earn in a given week or month, this might not be an easy path for you. You can help to mitigate the risk of not enough income by starting with a larger amount of savings and working for multiple employers, especially those that like to give PRN therapists a set schedule.

Weekend work is also a good option if you like acute care, as hospitals are almost always looking for more weekend help. It might not be ideal for some, but for others it may mean you don't have to pay for childcare because your spouse is home on the weekends or you can go have fun in the outdoors during the week without the crowds!

Practice Settings

Some settings lend themselves to per diem work better than others. If you are only interested in one type of setting and you work in an area that has limited options in that setting, it might be harder than if you live in a large city or are open to multiple settings.

Acute care and SNF can be easier to tap in and out of due to the nature of their fluctuations in patient census and turnover. Outpatient and home health might be harder due to more set schedules and expectations for continuity of care with the same therapist.

On the other hand, you could find yourself in a home health job like mine. Most of the time when I work I only do start of care and evaluation visits, so I don’t have to try to fill someone else’s shoes. The truth is, you can work per diem in any type of setting, you just have to find a job (or jobs) with needs that fit your wants.

So…Can You Work Solely as a Per Diem Physical Therapist?

You sure can! Do your homework and consider some of the topics in this post to decide if it might be a good fit for you. And if you think it is, give it a go! You can always switch back to full time if it doesn't work out. As an old supervisor told me when she was persuading me to transition from being a traveler to working on staff at that same hospital, “It’s not permanent, it’s just full time.” She was right. She didn't convince me to work full time right away, but I did stay at that hospital for 9 years, and the middle few years did end up being full time. But it wasn’t permanent.