"Mills," vs a 6 month wait
This is not medical advice.
A “Mill” in physical therapy jargon is a clinic that shoves as many patients in the doors as possible. People aren’t seen one of one, and the employees think that profit is the only motive.
They are generally not thought of in a good light. I have worked in a couple, and there are some positives and negatives to Mills. This discussion will also help shed some light on the healthcare debate.
Business naive employees
I was 25 when I first started working in one of these places. There were on average about 10 therapists, and 5 assistants working there at any given time. Our boss/owner was a business genius. He had an outpatient clinic with orthopedics, pool therapy, wound care, and the following contracts; inpatient, schools, home health, and nursing homes. We were very busy, to say the least.
If we saw outpatients, we might have 2-4 people per hour. If we were seeing the other types of patients, it was usually 1:1. Pool classes might average 6 patients.
Us employees were constantly bitching and griping about how hard we were worked, and how little we were reimbursed. We had some good arguments on our side, but were also naive about business.
You can’t be "just the right amount of busy.” You have to constantly strive to be as busy as possible, otherwise the slow times will grow. And there’s nothing worse than being slow, for employee moral, and fiscal company health.
Having been on the inside as an owner, I can tell you it feels like you’re always being cheated, and you are always fighting against everyone else. No part of the government or insurance companies want you to succeed. Or at least, that is how it feels, and that is how they treat you.
The Good
The good part to working at this extremely busy Mill was the amount of experience I gained in my field in the 9 years I was there. Hundreds of similar cases and patterns. I learned about patients in every realm. That type of education and experience is priceless.
It also taught me to think quick on my feet, and to really know the body and many different exercises and variations. I might have 4 new outpatients, and as I’m cycling through that hour, I need a new exercise for that condition, right now! Others are waiting…
This shared “perceived” hardship also brought me very close to the other employees. To this day, 20 years later, we are all very close, and share a close bond of, again, perceived misery and injustice! Mostly it’s smiles and laughter about the good ole days. There were a few outlets of alcohol consumption after hours to blow off steam.
The Bad
Seeing 2-4 people at the same time was not great quality care. Some people are more independent, and we did have some very well trained and experienced techs that helped.
When I bought my own clinic, I made the conscious decision to only schedule 2 per hour, and some more serious cases were blocked off as 1:1. I didn’t realize when I started, that I would have to schedule at least 2 per hour just to make it. You don’t foresee all the cancelations, and the fact that you need to offer many times for patients. You can’t always say “that time is taken”. I also didn’t realize that on average, I wouldn’t be paid for between 5-10% of those visits.
The paper work was unpleasant at 2-4 per hour. If you rushed through it, you might not have a dozen notes to complete after hours. The rushed notes looked like a 5 year old wrote them.
The Ugly
The worst part about a Mill is compromised safety. Having that many patients at once can compromise safety protocols. It’s just too busy. Many of these people are also fall risks.
Ethical billing was also a debate, although I feel foolish even writing that now. There is nothing ethical about a half trillion dollar private insurance cartel. They aren’t worth that much by paying claims.
Much of why we were able to see 2-4/hour, was that many of them laid down on a table and received heat, estim, and or ultrasound for the first 30 minutes.
Most of the efficacy of that was pure nonsense, and not helping people get better, and was a time filler.
Some people are weak and injured due to inactivity. Thankfully, most places don’t do all those modalities any more.
The Healthcare debate
All of this plays into debates about healthcare. One of the reasons the Mill was so busy, was because people need to be seen. The quicker the better. So that is one reason/excuse we received for needing to see 2-4 patients/ hour.
And that is not completely unwarranted. I recently wrote about the Canadians waiting 6 months to see someone. That is not good either.
Some Medicare and insurance guidelines have now caused us to only see one patient at a time, and that’s also leading to increased wait times.
Many of our large network systems are extremely bloated with administrative overhead. These companies are overburdened by liability, paperwork, and human resources. Many of those people make quite a bit of money, and don’t see patients.
The right answer might lie somewhere between a large corporate Mill, and a socialized medicine clinic.
If you’re a provider thinking that the Mill just needs to hire more PT’s, you really need to start your own clinic. And I don’t say that just to be snarky. That experience will help you with a new perspective.
