I always assumed I’d work a full-time job until the day I retired. I had never even heard of per diem employment, much less considered it as an option for myself.

Then, three years into physical therapy practice, I found myself at a crossroads.

I had been working two part-time jobs at small outpatient orthopedic clinics, feeling a bit overwhelmed by both, and longing to get back to a hospital environment. A former classmate of mine told me his hospital was hiring an acute care per diem physical therapist—and that per diems frequently went full-time. So, I decided to give it a go.

Things worked out: I landed the job, and per diem PT wound up being the best thing that ever happened to me as a treating clinician. The flexibility and high pay enabled me to focus on all sorts of other pursuits on my days off. I wound up never working as a full-time physical therapist again!

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What is per diem physical therapy?

Per diem—or PRN—physical therapy varies from facility to facility, but generally speaking, per diem PTs serve as on-call physical therapists. Facilities use them for extra coverage on days when full-time staff members are sick, vacationing, or otherwise unavailable. In some cases, per diem physical therapists end up working almost as much as full-time PTs, while in other cases, they only work a few days a month.

As a per diem PT, you’ll sometimes know your work dates in advance, but you’ll often find out you’re needed the night before—or even the day of—a shift. Shifts are usually eight hours long, and they may or may not have flexible hours, depending on the facility.

These positions almost always come without employment benefits, meaning you won’t get paid time off, sick days (unless they’re state-mandated), continuing education coverage, health insurance, or other perks. Those benefits aren’t cheap, so if you’re not receiving them, your employer typically will “sweeten the pot” by hiring you at a higher hourly rate. This pay differential is even more pronounced when you’re fresh out of school.  

Of course, there are some drawbacks as well: you’ll be the first one to have your hours reduced when the census drops or things get slow. There will also be times when you have to see patients while other therapists attend team-building events and staff meetings. So, it’s easy to feel left out as a per diem therapist.

Essentially, you can think of per diem as having “no strings attached” on both sides of the coin—which means you’ll have unparalleled flexibility. At the same time, it means you’ll need to take quite a bit of initiative to ensure you’re getting what you need in the way of hours and professional growth.

Here are a few tips to make per diem work for you:

1. Pick up weekend shifts once you’re comfortable.

Weekend hours are pretty standard for most per diem physical therapists, unless you wind up working per diem at an outpatient facility. Many hospitals have difficulty staffing the weekends for obvious reasons, but that’s actually when I preferred to work.

Hospitals tend to be much quieter on the weekends. That means you’ll have better luck working with patients who are more overwhelmed during the week—from being rushed around the hospital for tests or seeing multiple practitioners (physicians, occupational therapists, speech therapists, and the like).

When patients have fewer interruptions, they’re also generally better-rested and more eager to work with you. It can be challenging to get difficult patients to work with you on a busy, frenetic weekday—but it’s an easier sell to get them out of bed when they’ve had most of the day to rest. You’ll have a much easier time making productivity on the weekends, too, as fewer interruptions mean you can cruise seamlessly from patient to patient.

2. Take initiative.

When you’re a per diem therapist, you might be overlooked for training in specialty areas (e.g., lymphedema, wound care, and aquatic therapy). But, you shouldn’t let that stand in the way of specializing as much as you’d like! You can still do it—and you’ll be incredibly valuable if you take the initiative to get those certs.

You’ll just need to carve out your own funds for professional growth. And remember, the more skills you have, the more marketable you are. While your workplace likely won’t pay for you to attend a course on wound care, it’ll certainly let you work with any patients who need wound care!

And don’t forget to attend physical therapy conferences, meetings, and other events. Per diem jobs can dry up quickly. You can be swimming in hours when you’re first hired, and then, the next thing you know, a full-time PT comes on board, leaving you high and dry—and desperate for hours. The more you network at conferences and take initiative, the more options you’ll have for getting those hours.

3. Consider registry roles.

I like to call registry PT “local travel PT.” If you’re the type who chose per diem because you’re motivated by variety, you might still manage to get bored or burned out from working the same type of per diem role over and over.

If this sounds like you, then check out registry physical therapy! You’ll get daily rates that are similar to those for per diem therapy, but you’ll also get to check out sites around town, meet new coworkers (which is a really easy way to network without feeling like you’re networking), and learn new skills. If you work enough hours through a registry company, you might even become eligible for employment benefits. For that reason, some people opt to work registry jobs if they absolutely must obtain healthcare coverage.

And the best part, of course, is that you’ll never get bored!

4. Understand your role.

As wonderful as per diem physical therapy can be, it can also be a nightmare if you’re not familiar with the terms of your contract. In many cases, per diem PTs are required to work several weekends per month. You could also find yourself working on Christmas and Thanksgiving—not to mention Memorial Day and Fourth of July.

The upside is that you’ll often be paid a premium for working the aforementioned holidays. Some per diems even get paid more for working extra weekend shifts. As I already mentioned, weekend work is mellow, and it’s often easier to meet productivity requirements when you’re not competing with other clinicians for your patients’ time. So, getting paid more is just icing on the cake!

Before you sign on the dotted line for a per diem role, however, I implore you to scour your employment contract. Make sure you understand the minimum number of hours, days, weekends, and holidays you’ll have to work. Take note of the cancellation policy. Hospitals often won’t think twice before flexing you off, but if you cancel a shift at the last minute—even if it’s technically allowed—your manager could be very upset with you.

Lastly, look for any non-compete clauses in your contract. Generally, you won’t run into any trouble working for multiple chains or hospital systems, but smaller clinics and facilities might balk if you intend to work for the competition.

5. Volunteer for holidays.

Don’t get me wrong—Fourth of July parties are fun, but making overtime pay is way more fun (especially if you can use it to pay down your PT school debt!).

Plus, holidays can be quite fun at hospitals. Staff will often dress up and have a little fun, and you might land a pretty tasty free meal in the cafeteria. One facility where I worked as a per diem PT used to really hook us up. I ate several delicious Thanksgiving and Christmas meals. In one case, I had my husband meet me at work, and it felt like we were getting paid to have a date!

As a fresh hire, you should be extra proactive about picking up holidays (and weekends). By picking up the days that nobody else wants to work, you’ll immediately be in the team’s good graces, which is always helpful when you’re first getting started.

Additionally, if you’re gunning for a full-time position, you’ll likely get priority because you’ve been so accommodating and eager—and they know you won’t be the grumbly therapist who refuses to pull his or her share on weekends and holidays.

6. Build rapport with the rehab manager and staff.

Just because you’re a per diem therapist, it doesn’t mean you don’t have a career and a reputation. Be sure to build a relationship with your rehab manager. Ask about his or her life. Show sympathy when he or she struggles on the job. It’s not always easy managing a team of therapists (even though we’re a pretty awesome bunch). Show up for the holiday gift exchange, even if you’re not being paid for it. You’ll be loved, and being loved is a huge part of being successful as a per diem PT.

One way to build rapport is to become known as the most reliable per diem PT around. Technically, you can choose your own schedule and should be able to cancel shifts at the last minute, but you should try to avoid the temptation. If your colleagues begin to view you as the unreliable per diem, you’ll soon be the per diem who doesn’t get the shifts.

On the other hand, if you become the preferred per diem PT, you’ll be the one who still has hours when things get slow and all the other per diems are sent home. Plus, you’ll be the first one considered for full-time and part-time gigs when they open (if you want them, that is).

The same goes for the rest of the staff, meaning rehab therapists, nurses, and physicians. Just because you’re only at work once in a blue moon doesn’t mean you should avoid learning your coworkers’ names, smiling at them, and generally being friendly. Remember, you might not be full-time, but you’re still part of the team.

Plus, you’re paying it forward for other per diems. By being friendly and engaging, you’re setting a precedent for future per diem PTs—and the rest of the staff will likely welcome them with open arms.

7. Use a budget calculator or spreadsheet.

Per diem physical therapy can be feast or famine. You might be hired in June, when all the full-time therapists are taking vacations and there’s a huge need for coverage. When your bank account gets a huge influx of that per diem money, you may be tempted to splurge on cars, fancy apartments, or other luxury items that you can afford—until you get flexed off for six days straight and realize you don’t have PTO.

Suddenly, that massage you just booked feels like a financial death sentence.

So, be sure to speak with a financial advisor, accountant, or trusted finance geek in your life. Per diem work is highly rewarding, but it can also be very risky financially. Make personal finance a priority, and you’ll be able to live the per diem physical therapy dream!

Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways.

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