As we continue to return to some sense of normalcy post-pandemic, old staffing problems have returned to the forefront with a little more gusto than before. In response, have spent time discussing retention strategies, and how to avoid management mistakes, but, as our 2022 State of Rehab Therapy report indicates, there still appears to be a disconnect between management and employee engagement. And as a result, we are at risk of losing nearly approximately 27% of our clinical workforce.
To be clear, the rehab therapy industry isn’t the only market experiencing employee satisfaction and retention issues—not by a long shot. In fact, it’s become so prevalent of late that a new term has been coined for it: “quiet quitting.” As stated in this recent article by Harvard Business Review (HBR), quiet quitters “reject the idea that work should be a central focus of their life. They resist the expectation of giving their all or putting in extra hours. They say ‘no’ to requests to go beyond what they think should be expected of a person in their position.”
But, is this a crisis of the worker or rather a crisis of the employer? From what HBR can tell, quiet quitting is a new way to describe an old behavior—and one that’s largely a byproduct of an un-incentivized workforce. So, how can today’s business leaders properly incentivize employees so that they’re motivated to go the extra mile? We’ve got a few ideas—take a look!
1. Consider switching to a pay-for-performance compensation plan.
Let’s start with the foremost employee incentive: salary. Finding a way to competitively compensate and draw the best talent to the clinic has become increasingly difficult over the years. Therefore, it may behoove practice owners to get more creative with salary models. As generational shifts continue, reimbursements decline, and a host of additional stressors close in on private practices, two effective alternative compensation options are gaining momentum.
Fixed-pay, Performance-based Hybrid Plans
These plans start with a base salary that is accompanied by a secondary performance-based incentive. The key success indicator with these types of plans are that they’re customizable to each provider’s comfortability. For instance, a conservative hybrid compensation plan may consist of a 90/10 balance where only 10% of pay is based on performance. Whereas, more risk-tolerant providers may prefer a 50/50 split that allots 50% of their pay to performance metrics. Therein lies the beauty of this type of compensation model—owners get to choose how they’ll be measuring their therapists’ performance, and therapists then get to choose which plan they feel is most suitable to their workflows.
A more unconventional compensation plan is the revenue-sharing model, which eliminates the fixed salary component altogether and allows the clinician to share directly in the successes and failures of the clinic. As this model factors in all the practice’s overhead and labor costs, it often creates a transparent culture that enables providers to make proactive decisions regarding their personal compensation goals and how those tie into the practice’s overall budget. Although there are inherent risks with this plan, the ceiling is near limitless.
When asked how successful these types of alternative models are in this blog post, Jason Wambold, MSPT, co-founder and Managing Partner of OnusOne, stated that they can actually bring teams closer because their individual successes are directly tied to the clinics’ growth initiatives. In turn, bonds are built, productivity is heightened, and company cultures thrive. These shared-risk compensation models have worked so well for the companies Wambold works with that he forecasts traditional “fixed salary plus bonus” structures will be obsolete in the next 12-15 years.
2. Offer tuition reimbursement to help fight those dreaded loans.
As revealed in our report, one in two students will graduate with more than $70,000 in debt while 16% will start their careers more than $150,000 in the hole. As Richard Severin, PT, DPT, OCS, CCS, owner of PTReviewer stated, “student debt to income ratio is one of the most important issues regarding the long-term sustainability of the physical therapy profession.” But employers can be a beacon of light in this black morass of debt by incentivizing rehab therapists with tuition reimbursement/student loan repayment programs.
Brian Gallagher, PT, founder and President of MEG Business Management has championed this type of incentive program as an untapped strategy for hiring better talent—and retaining that talent for longer. Gallagher estimates that employers who provide student loan repayment see a 25% increase in hiring success, as well as a 50% improvement in employee retention. This is supported by a recent survey that found that 86% of 23- to 33-year-old workers are more likely to sign a five-year employment contract when offered some form of loan repayment plan.
There are also employer-facing benefits too, specifically in the form of tax-free incentives. The Consolidated Appropriations Act of 2021 extended a program (to 2025) that enables employers to make contributions of up to $5,250 per employee annually toward eligible education expenses. This would include tuition or student loan assistance. Plus, it can be done without raising the employee's gross taxable income. As Laurel Taylor, CEO of FutureFuel.io stated in this article, the legislation "allows employers to address a chief concern of the current workforce with a targeted and equitable employee benefit." Helping to fight an already mammoth-sized problem for much of the workforce will provide flexibility and diversity in incentivizing the best clinicians entering the workforce.
3. Invest in paid time off.
The subject of paid time off can be a touchy one, and many practice owners have balked at the idea of increasing this perk without doing a proper cost-benefit analysis. But skeptics may be interested to know that 58% of workers would agree to a salary reduction in exchange for more paid time off. What’s more, allowing employees to take more time off—and encouraging them to take it—can reduce stress in the clinic and allow workers to stay fully engaged. Keaton Ray, co-founder and COO of MovementX, does a great job of explaining how her organization is able to offer its employees unlimited PTO in this blog post. “Instead of trying to scramble to make up short-term productivity losses every time someone wants time off, we have built these time-off trends into our unit metrics of the business,” state Ray. “This means that ‘unexpected’ time off is actually planned for in our bottom line.”
While we’re not saying unlimited PTO is a must for every practice, MovementX’s approach can help inform your efforts in creating a plan that provides your employees with a greater work-life balance.
Things to also consider when re-evaluating your PTO structure include:
- Paid parental leave: A recent poll that found that 82% of Americans feel employers should offer some form of parental leave.
- Flexible schedules: While this remains a great strategy to satisfy and retain employees, schedules could stand a reset in the post pandemic era—especially when factoring in new revenue streams that are now available to therapists.
4. Career growth opportunities should not be overlooked.
In a recent conversation with Gallagher, he noted that his company’s clients consistently outperform other rehab practices in large part because they:
- Are committed to lifelong learning; and
- Have created a culture that prioritizes career growth.
The benefits of offering career growth opportunities in the workplace have been well-documented for years. And not long ago, The University of Phoenix released its Annual Career Optimism Index (which was reference in this SHRM article), and it found that 49% of employees “want to develop their skills but don’t know where to begin—this is up six percentage points compared to 2021.” Our own annual report findings corroborate this, as well. It was revealed that graduating students’ top desired addition to their curriculums was more clinical training and residency opportunities.
Employers can better incentivize their new and senior staff with active commitments to professional growth in the form of mentorships, residencies, and continuing education programs. (See this blog post for even more ideas along this vein.) But, before taking action, your best bet is to have a conversation with your employees to better understand their career goals. Our co-founder and Chief Clinical Officer, Heidi Jannenga, discusses how to frame up these conversations in this Founder Letter.
5. Even small gestures can make big impressions.
A paper salesman turned regional director once elated in his excitement for an annual conference exclaiming, “Swag! Stuff we all get. I basically decorated my condo for free with all my swag!” The fictional character, Michael Scott, really summarizes the feeling any person gets when they get something for free. Although swag often comes with company-related propaganda and quirky puns, the free stuff goes a long way to create a sense of belonging. Simple things like a T-shirt, drink koozie, stationary, or other fun (and useful) items work well to fill the proverbial conference swag bag of engagement.
The simple act of gift giving forms a reciprocal relationship that supports teamwork and underscores the value of employees’ work. As summarized in this New York Times piece, “giving gifts is a surprisingly complex and important part of human interaction, helping to define relationships and strengthen bonds with family and friends.” The gift does not have to be large or monetary. In fact, small, thoughtful gifts can be incredibly effective. Here are some quick ideas:
- For the early risers, bring them bagels and cream cheese.
- For the night owl, provide chips and dip.
- For the social butterflies, host a virtual or live happy hour.
- And for the quiet reader, give a recent book that suits their liking.
Not So Random Acts of Kindness
Recognition for good work is an easy incentive any rehab practice can implement through use of a company-wide kudos, a physical card, or presenting the MVP “game ball” to the person who excelled that week. Even without a tangible object, managers can take time to say something positive about each teammate’s contribution during staff meetings.
Larger practice groups have even used events like company picnics, holiday meals, and celebrations to successfully engage staff and give the group an event to look forward to next year and stick around for the next one. These can be leveled up further with inclusion of games to win company perks like swag, extra PTO, giftcards, or pieing a manager in the face. (For a more exhaustive list of staff appreciation ideas, take a gander at this article.) Although small, these events cultivate memories, and therefore will be something your staff will talk about long after they conclude.
Now, let’s put the plan into action.
Now that we’ve covered the “why” of employee incentive programs, it’s time to discuss the “how.” Here are some steps you can take to build a strong employee incentive program.
1. Open the floor to suggestions.
Including the team when devising incentive ideas and structure can solve two problems in that it:
- provides a transparent company culture and atmosphere, and
- gives staff a say in their development.
2. Devise a plan for incentive start dates and duration.
Choosing when to implement certain aspects of an incentive plan will depend on the time of year and business cycle of each individual clinic. As Wambold summarized in this blog post, enacting a new payment structure with performance benchmarks should coincide with the busy and slow times of your clinic to ensure staff are invested. For example, the beginning of the year is usually a slow period due to a variety of reasons, but come April, clinic’s begin to get busy again. As such, this would be an ideal time for your incentive ideas to go live.
3. Keep it simple.
Achievable, tangible, and memorable incentives will yield an increased likelihood for full staff participation, but they need not be complex. When the programs are rolled out, staff should have a clear understanding of what is at stake and how they can get to the finish line.
4. Align incentives with business goals.
Since the primary goal of any private practice is the health of the business itself, incentive programs should work to increase staff engagement that will in turn improve quality of care, the hallmark of rehab therapy business growth.
5. Be consistent and frequent with rewards.
Given therapists are often competitive in nature, it may be beneficial to divide larger incentive goals into smaller milestones. This not only gives the team something more tangible to strive toward, but it can also be a great strategy to keep them on track to achieve the clinic’s overarching aims—thus earning that well-deserved celebration.
6. Always be closing.
Maybe with a little less profanity and a little more harmony than how Blake—from the movie Glenngary Glen Ross—comported himself, employers should continuously promote and educate staff about what the business objectives are, how they can achieve them, and what’s at stake if they do (or don’t). This will keep incentives fresh in clinicians’ minds, helping them maintain a “closing” mindset.
In my experience as a physical therapist, having worked in over eight states and countless clinics, the best companies I’ve worked for have always been the ones whose managers actively find ways to help their staff be better. Incentivizing your staff is a mutual—and must-have—ingredient for business success.