Physical Therapy Schools|Benefits Of Massage Therapy Schools

We've all heard of massage and many of us have even experienced it, in one form or another. By a masseuse who happened to be an amature, loved one or professional. If the person knew what they were doing, you came away feeling like a million bucks. But what is massage, really!

Massage or massage therapy as it has come to be known in our time, began with the ancient Egyptians, then the Greeks and finally the Romans. Yes these ancient cultures used massage therapy for both healing and pleasure. The science of massage therapy had also spread to other early cultures such as India, China and Japan. The last three went further by integrating it to form an integral part of their systems of medicine and healing.

Massage is the organized form of touch. It is performed by the hands, elbows and forearms gliding over the skin and applying pressure to the underlying muscles by a system of movements. These movements involve stroking, rubbing, pressing and kneading. Massage is not a panacea, but can greatly aid in the normal functions of the body and restore balance as well.

How Massage Works

Massage works by the body responding to the various touch techniques given to it. These touch techniques causes the body to engage in there normal functions. Massage itself, acts like a natural stimuli for the body to respond with positive effects in many different ways. Some of these therapeutic effects are, stimulating the circulation of the blood and lymph, loosening of muscular tension, toning and firming the muscles.

When fibers stop sliding over each other easily, it's most likely the cause of people not getting enough exercise, too much exercise, physical or mental tension. These factors cause the drop of any increase in muscle tone. The waste products from muscular activity, like carbon dioxide, lactic acid and urea, build up in the muscles. Massage therapy fosters drainage of those wastes, therefore restoring there normal functions.

Massage therapy also fosters the drainage of lymph, causing better circulation of the blood. Because of this, the skin looks much better than if drainage was difficult. Why bother with the how the skin looks? Because the appearance of the skin, is usually a good indicator of a persons inner condition. In reference to muscles, massage therapy has a good effect on the fibrous tissue surrounding the joints.

The effects of massage upon the autonomic nervous system gives birth to the feeling of relaxation. How? By stimulating the sensory nerve endings located within the skin, signals are sent to the brain by the central nervous system. This in turn produces the experience of feeling good. Once again because of this action, a new reaction takes place by causing a significant reduction in the body's stress level. When a person is relaxed, abdominal breathing becomes more natural. I can assure you, your abdominal organs appreciate this. It's quite clear that the nervous system plays a crucial role in massage therapy. It's also responsible for the vascular system, since it controls it. A decrease in efficient drainage and supply of blood, is caused by a reduction of vascular.

Massage works by reducing stress, managing the body's waste products, fostering normal bodily functions, providing a sense of well being and boosting mental health.

The Logic of Massage

The gradual development of massage therapy into a full blown art and science can be determined as only logical. When we fall, bruise or sustain any sort of physical injury, we usually tend to touch it. Even if that act produces no form of healing solution, or does it? Touch in itself is very comforting to us. It reassures us, make us feel loved and accepted. Whenever someone is in pain, we tend to want to hug, hold or touch that person in someway. Somehow sensing that the very act of physical contact will contribute to the overall holistic health of the person. Guess what? You are correct in that assumption.

Studies have shown that, touching among other comforting and intimate contact, does assist in the overall recovery and health of a person. Whether that person is in need of physical, mental, emotional or spiritual healing or comfort. In looking at the big picture, I see massage therapy continuing to play an important role in human history for a long time to come. What are you waiting for, join the minions.

Conservative treatment should always be the first port of call when someone has a herniated disc causing either back and leg pain or sciatica. This should also be the case if a patient is suffering from neck and arm pain. There are many forms of physical therapy (or physiotherapy) but one that is established, well-researched and proven is called the McKenzie Method or McKenzie Care.

The McKenzie Method was developed by New Zealand Physiotherapist Robin McKenzie in the 1950's. Robin was treating a patient called Mr Smith. Mr Smith laid face down on a treatment table that had been left elevated from the previous patient. This meant Mr Smith had his back in an arched position which in the 1950's was thought to be a dangerous position for people suffering back pain or herniated discs.

So what happened next? Mr Smith improved rapidly in this arched position with all his leg pain rapidly reducing with only pain experienced in the center of his back. He was actually the best he'd been in over 3 weeks. Robin then experimented with different movements and positions and slowly developed the method which bears his name.

The phenomenon of pain moving to the center of the back while lying in a certain position (as was experienced by Mr Smith) is now called centralization and is associated with a good outcome and means the patients will recover quickly. Research has shown centralization is associated with pain from disc herniation or disruption.

McKenzie therapists have undertaken extra post-graduate training provided by the McKenzie Institute International. The Institute's website has a world-wide list of trained McKenzie therapist. However, many patients recover from their back pain just by reading Robin's book "Treat Your Own Back."

After having knee surgery whether it was an arthroscopic procedure or an entire knee replaced, getting the VMO to function again will be a priority for a properly functioning knee. The VMO does get some indirect work from other exercises when working on the quadriceps as well. There are three exercises that I always recommend to my clients after knee surgery while seeing them in their home to isolate this muscle.

1. Isometric Quad Sets: I have the client squeeze their thigh muscles by pressing the back of their knees down into the surface and hold that position for a slow count of five. You can gently turn your toes outward and that will place more emphasis on the VMO. You can also place a small rolled up towel under your knee or knees and that will help you isolate the VMO as well.

2. Terminal Knee Extensions: You place your affected leg up onto a bolster or a rolled up pillow will do. That will place your knee or knees at roughly a 45 degree angle, lift the bottom portion of your leg up leaving your knee on the bolster and hold that position for a slow count of five. Again turn your toes slightly outward to hit those muscle fibers that make up the VMO.

3. Wall Slides: This is a more aggressive exercise then the previous two mentioned. Once the knee has healed further and is getting stronger, you can go find a smooth surface like a door for instance. Lean up against the door with your back touching only. Slide down the door until you get about a 45-50 degree bend in your hips. Hold that position for a slow count of five also. Then slowly go back up. You will feel this really hit the knee and with those toes pointed outward also it will put the workload on that VMO. Remember to always keep your back against the door to maintain proper body mechanics.

These three exercises have produced great results with my clients in their home before they are sent off for further rehabilitation in the community. Give these three a try. A properly functioning VMO is vital to having a complete and successful outcome after knee surgery.

Some professionals, such as physicians and nurses, are required to complete a certain amount of continuing education each year. This is to make sure they keep up to date on the newest techniques available to help their patients. While having a massage therapist license might not mean you must take continuing education, it is still very important and you should consider it a high priority. After all, you are helping heal individuals just as doctors and nurses are. It is important that you provide the utmost up-to-date service to your clients. Most professional associations require it these days and you insurance may depend on it.

Continuing professional development or education as a massage therapist will not only benefit your clients, but you and your employers (if you work for a company) as well. Employers love for their employees to keep up-to-date on the latest techniques that apply to their field. This means that no only do they have a skilled and qualified employee, but they are providing the best service possible to their clients. Even if you work as an individual massage therapist, the same rules apply. By continuing your professional development, you can let your clients know that you have the skills needed to provide them with excellent massage therapy. This will keep clients happy and happy clients are returning clients. Acquiring new skills will also allow you to charge more for your services. Clients who find a quality massage therapist with credentials to back up their services will be willing to pay more for a massage. You can also increase your business by offering different types of massages. If you were trained in Swedish massage, consider looking to other types of massages to help expand your massage repertoire. Look at continuing your massage development by taking classes in different types of Asian massages such as Thai massage, Thai foot massage, Thai herb compress massage or Chinese Tui Na massage. You may want to study more conventional western forms, such as sports massage, pregnancy massage or aromatherapy massage.

If you are already well versed in Asian massage techniques, maybe you should focus your continuing professional development on a specific part of the body. There are courses which concentrate on the assessment and treatment of upper limbs, cervical and thoracic spine, freeing the shoulder, freeing the lower back and hips, focusing on the lumber spine hip/pelvis and lower leg. There is deep tissue or Remedial massage, which works on specific joints or muscle groups. Going even deeper we have neuromuscular therapy, which focuses on pain relief in specific 'trigger points' and deepest of all, there is myofacial release, which works to release tension in the connective tissue layers.

To continue your professional development as a massage therapist is very important to both you and your clients. Check with your local clinics and community colleges to see what classes are offered that might help compliment the techniques you already know.

Massage before an event can be an integral component of the pre-event preparation for many athletes. Pre-event massage can create a state of readiness in the muscles and tissues so that the athlete's performance can be optimized. Whilst some therapists consider that a pre-event massage can take place up to 48 hours before an event, most Sports Massage therapists judge that, strictly speaking a pre-event massage is one given just before the time an athlete is scheduled to compete (ideally 15-45 minutes before the event). This article will concentrate on massage immediately prior to the event.

A question that is often posed is should the pre-event massage happen before or after the athlete warms up. To answer this one needs to understand the physiological effects of a warm-up: to increase heart rate, body temperature and respiratory rate; and to prepare the body's nervous system. Hence a pre-event massage done after the warm-up would defeat it's purpose and you would not want the athlete's heart rate, body temperature and respiratory rate to drop during the massage.

In general a pre-event massage should assist in increasing the circulation of blood to the muscles to allow the muscles to be flushed and oxygenated. Tight muscles may be relaxed so that joints can be moved through their range of motion. Emphasis should be placed on the muscles used during the activity so improve performance and also reduce the chance of injuries. The athlete can use the time to focus on their event, to relax or complete their mental preparation. At the end of the massage, the athlete should feel great!

More specifically before giving a pre-event massage, the therapist should ask several key questions which relate namely what techniques should be used and what is the intent.

These question include:

- what type of event is the athlete competing in? Are lightening quick reactions required as a pre-event massage given too close to the event may dull reaction times?

- does the athlete's sports permit the use of oils or lotions during the pre-event massage?

- is the athlete required to be "loose" prior to the event (eg boxing) or relaxed (bowling)?

The massage should generally be done at a moderate pace, non-specific, relatively light, warming and short in duration (no more than around 15-20 minutes). It certainly does not have to be a complete routine. As with most massage treatments, it is preferable to be conservative - too little is better than too much. The massage must not be painful or include high impact techniques such as deep cross-fibre frictions or deep muscle therapy. The techniques most commonly used are general Swedish techniques (petrissage, vibration or percussion), compression, jostling, broadening strokes and general frictions.

It is important to note that no two individuals respond to massage in quite the same way and this can present a problem to the therapist seeing an athlete for the first time for a pre-event massage or in the last couple of days before an event. For example, two days before an event the massage can be deep so that the athlete can obtain the maximum recuperative benefit from the pre-event taper. However the depth required to address specific problem areas will vary considerably between athletes. An athlete should see how they respond to a massage in the last 48 hours/pre-event at a competition (or simulated training session) that is non-critical. So please don't leave it until the day before the City to Surf or your big event to have your first massage!

The perks of continuing education are multifold; not only do they encourage licensed professionals to be more mindful of changes and happenings within their industry, they also ensure that these professionals remain up-to-date on key knowledge and facts. Moreover, most professional organizations require such ongoing learning to occur throughout the year. The field of massage therapy is no different. Continuing education is more than just encouraging licensed massage therapists to sharpen their massage therapy knowledge; it also ensures that they adhere to high standards of professional performance.

In the state of Georgia, every two years (every even numbered year), licensed massage therapists must acquire twenty-four hours of massage therapy continuing education units in order to remain compliant with the Georgia State Board of Massage Therapy regulations. This is to ensure that licensed massage therapists are always current and continue to offer their clients the best massage therapy possible.

By October 31, 2010, all licensed massage therapists in the state of Georgia will be required to renew their license with the state massage board. One of the requirements is to submit proof of participation in twenty-four hours of continuing education courses. To learn more about what is needed to stay up-to-date and remain fully compliant as a licensed massage therapist in Georgia, always make sure that you visit sos.state.ga.us/plb/massage.

Remaining Compliant with the State

Course hours & requirements: Twelve of the twenty-four hours of massage therapy continuing education must be hands-on or technique based, while the remaining twelve hours can be on-line or lecture only. Many licensed massage therapists use this time to choose courses that focus on massage techniques and/or modalities in which they wish to specialize or simply learn more about. Topics include sports massage, cranial sacral therapy, geriatric massage, spa techniques or pregnancy massage. The list of possible massage therapy continuing education courses is endless.An approved list of courses and/or providers can be found on the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) website at www.ncbtmb.org.

Credentials: Before beginning any massage therapy continuing education courses, ensure that the program in which you are enrolling is fully recognized by the Georgia Board of Massage Therapy and that the instructors are credentialed. The program should have a provider code number assigned by the NCBTMB in order to issue credits.

Program documentation: Should you be audited, you will need to have proper documentation of completed massage therapy continuing education courses.

• This documentation should include proof of attendance and participation at a hands-on workshop, seminar, conference, or other educational program. Upon completion of the program, you should be given a certificate that includes a massage therapist license number and the approved provider's number (signed or verified by a program official), and a program or course description detailing the sponsor, course title, date, course, content description, and schedule.
  


• For massage therapy continuing education courses that do not involve hands-on techniques, such as lectures, multimedia courses, correspondence courses, or formal self-study, you will also need a certificate of completion with the information outlined above. In the case of self-study, you will need to have verification by a course sponsor as well as detailed information about the nature of the course.

New licensees: If you are a massage therapist who was licensed within the first year of the biennial renewal period, you will be responsible for acquiring only twelve massage therapy continuing education hours, six of which must be hands-on supervised instruction. Massage therapists who have been licensed within the past twelve months are not held accountable for acquiring any continuing education credits until the next renewal period.

Record keeping: Your renewal application is subject to a state audit. All licensed massage therapists will need to keep a record of attendance and any supporting documentation for at least three years from the date of attendance. During the license renewal application process, you will need to certify to the Georgia State Board of Massage Therapy that you have completed the hours required for license renewal.

The Perks of Continuing Education for Licensed Massage Therapists

Schools across Georgia offer stimulating, interactive new ways of learning different massage modalities. Massage therapy continuing education is a great way to learn something new and perhaps even introduce a modality you had not yet considered. Your employers and massage therapy clients also benefit from your additional education.

With so many choices, picking and settling on your twenty-four required CEs should be fun! Just don't forget to file away your documentation in case of an audit!

"Being a nurse is one of the ways you can pay back to the community" if you are still in high school and you are very much interested to become a nurse the first thing that you need to know is the list of subjects that will help you become a nurse in the future as well as knowing if the vocation is truly for you.

Here in the country there are actually three levels of nurses that are serving the sick people. The Licensed Vocational Nurse wherein a person can become an LVN in just a matter of eighteen months and that is great news for anyone who wants to start working in just less than 2 years. The LVN works hand in hand with an RN. A registered nurse is someone who has earned a diploma in Bachelor of Science and Nursing. There is also an associate's degree that one can simply accomplished in just two years. On the other hand, the NP is the kind of nurse who has earned a Master's Degree.

If you are sure about investing in a good future by becoming a nurse you must keep in mind that there are science subjects that you will need to concentrate more to help you obtain that Nursing Diploma. Subjects such as anatomy as well as physiology are two of the most important subjects that you will be dealing with when studying nursing. Not only that but you will also be expected to get your head buried into serious science subjects such as microbiology and chemistry. For those who are science enthusiast you will absolutely love studying such subjects however for people who are not very much interested to learn about such topics as nutrition and the like may well likely exert twice as much effort as you can in order for you to become the best nurse.

Science subjects are not boring subjects. In fact they are one of the most interesting and mind challenging subjects that are fun to study. If you are really serious to becoming a nurse you should invest in studying science subjects. During your free time you can do further research about such subjects to help you advance in your studies.

Math is another subject that needs to be taken seriously when considering nursing. You will be using math as well as science when studying to be a nurse and when practicing your vocation.

The nursing job is one of the most ethical careers in today's world. And if you are planning to become a nurse you should be very proud of yourself because you get the chance to take care of your fellowmen as well as be able to fill the big need of the country's lack for qualified nurses.

Resting is a talent that everybody should learn because it's a crucial part of a healthy and balanced way of living. It doesn't matter which of the many approaches you decide to help you unwind, but you should practise routinely to get the maximum benefit for your physical and psychological well-being. Daily use of a relaxation method may also make it easier for you to cope during periods of extra intense stress and fatigue.

Look for somewhere that is quiet, heated where you won't be disturbed; take off any lenses prior to starting. Lay face up on the floor, close your eyes, breathe in the air at your normal resting rate and rhythm. Firm up the muscles in your hands prior to relaxing them. As you exhale proceed up the body, tightening and relaxing the muscles, and when you reach the face, tense the mouth and eyes, then loosen up like the skin on your face is slipping off on to the ground and raise your head a couple of minutes, then loosen up your neck and jaw muscle groups to let your head to fall gradually back and let your mouth area and throat open up. Do this and after that lie absolutely still for some more minutes. You should feel totally relaxed. Lengthen your fingers and legs gently before you go back into action.

In the past, meditation has been an inclusive piece of a number of different beliefs, particularly those in line with Asian ideas. Persons experienced with yoga regularly use these methods as a route toward religious insight and a happy relationship. For most individuals in the West, however, the intention of meditation is simply to free up bodily pressure and generate deep peace through emptying your mind of fears.Various bodies practice deep breathing.

Choose a place where you won't be disturbed and aim to stay with your back straight, but vary this position in order to get more comfortable. Inhale and exhale at the normal flow, and unload your mind of feelings and ideas: repeat a statement without moving your mouth very much; the word or words should have no emotional significance so you can focus on the practice alone and not evaluate the meaning. Visualize a beautiful landscape and enjoy every minute detail of this picture in your mind's eye. As an alternative, with your eyes open, look at one object but don't attempt to examine its form or design. Meditate for only a few minutes till you think it is easy to clear your thoughts of potential distractions. With practice, you will steadily be able to increase the session of meditation up to 15 minutes. Regardless which technique you follow, you will notice that your brain wanders, or annoying thought processes start to intrude. The secret to success is to take yourself carefully back to focusing on your word, image or object each time this takes place.

Whilst yoga exercise is influenced by an ancient Indian philosophy this pursuit has become more popular then ever in the West in recent generations. Not only is yoga exercise a practice that will help relax your head and cut down strain, some movements improve sense of balance and dexterity, and increasing muscular strength and stamina levels. You ought to learn yoga and fitness inside a class.
There are plenty of massage therapy specialists who are experienced with massage therapy systems that have nothing to do with the more sleazy marketplace. One can find quite a few really good publications around which show you how to rub down your partner and yourself. Therapeutic massage includes stroking, rubbing and pummeling the muscles in several areas of our body. A massage can cut down exhaustion, in addition to leaving your face feeling fresher and more youthful.

You should never drink or eat prior to a massage. Massage therapy is not suitable for individuals with any of these disorders: nausea or an infection, including dermis infection; epidermis soreness in the area to be rubbed; discomfort compounded any time pressure is used; thrombosis, or spider veins (might be aggravated through stimulation of the affected region).

There's no substitute for practical tuition in the art of massage. Here are a few straightforward suggestions to get you started with therapeutic massage: pick a cozy, dimly lit, room or living area where you are not going to be disturbed. Remove anything that could irritate or be distracting, say for example a bracelet; jewelry must be taken off or covered with tape; if it turns out you do not have a specialised couch, the individual being massaged should lie on a cushioned area, possibly a mattress. In case the bed does not have a good mattress, use covers, or a mattress on the floor; the masseuse ought to kneel on anything comfortable to enable both hands to move easily over the skin, utilize a mild plant oil or cream.

An array of aromatherapy massage oils is accessible, each of which is recommended for individual disorders. When you employ a massage therapy oil, never pour it directly on someone getting rubbed. If you require additional oil, put some on to the back of the massaging hand and continue on stroking while you use your free hand to transfer this additional oil delicately on to the skin. Over bigger muscle groups, implement more rigid force but don't push too rigorously. When massage is bringing about a ticklish feeling, increase the pressure or proceed to an alternative region to relieve muscle tension, apply deeper pressure with your thumbs either kept still or moving about in small circles.To successfully loosen up stress filled muscles all around the shoulder blades, and thighs, consider using a kneading strategy. Applying pressure to muscles through clenched fists with your arms relaxed creates a springy push that will also help out.

Ashiatsu massage with overhead bars has not been practiced on a widespread basis until recently. The roots and history of ashiatsu, or barefoot massage, go back further than one might think.

Barefoot Massage is Nothing New!

Before we had memory foam padded massage tables and portable massage bars, there were other massage practitioners using their feet to perform massage therapy all over the world.

Is it an Eastern or Western Technique?

In the Kerala region of India, home of Ayurveda, a practice called "Chavutti Thirumal" is believed to be the one of the earliest ancestors of ashiatsu. "Chavutti" means foot and leg, and "Thirumal" means massage. Chavutti Thirumal practitioners use generous amounts of oil on the body and a single rope hung from the ceiling for balance.

This region of India is the home of the ancient art of Kalaripayattu, a martial art ancestor to Kung Fu, and Kathakali, a classical style of dance. Students of Kathakali and Kalaripayattu have used foot massage techniques (e.g. Chavutti Thirumal) to make their bodies supple and flexible.

Although it is rare, there are a few massage professionals in the United States that practice this ancient form of barefoot massage.

Chavutti Thirumal spread to surrounding countries and continents of Asia. There, it was combined with the study of meridians and the ancient practice of shiatsu. ("Shiatsu" translates to "finger pressure" ("shi" meaning finger).

When broken down, the word "ashi" means foot and "atsu" means pressure.

Around this same time, there were also many forms of barefoot Thai massage that developed from Chavutti Thirumal. Barefoot techniques are still a common staple in most Thai massage sessions.

In the mid/late 1990's Ruthie Piper developed a trademarked form of ashiatsu. This trademarked form is called Ashiatsu Oriental Bar Therapy™, or AOBT. She began training practitioners in the United States. Although she was not the first barefoot massage therapist in the US, she is credited with the recent, widespread growth of ashiatsu techniques. She trained Michelle Mace-Lambert of Barefoot Masters, who also conducts Ahh...Shiatsu™ training.

Today, there are many other massage therapists practicing un-trademarked forms of ashiatsu, barefoot, or gravity assisted massage. These practitioners use this modality to protect their hands and bodies, as well as provide a fantastic massage for clients.

Ashiatsu massage, unlike most other barefoot methods, is performed on the western-friendly massage table instead of a floor mat. The massage table set up allows clients to put their face down comfortably in a face rest (not off to the side). Since ashiatsu is performed on the table, overhead bars are needed for balance. Other barefoot practitioners may utilize physical therapy walking bars, a staff, ropes from the ceiling, ropes across the ceiling, stools, or benches.

"It's ten minutes past eleven at night...Where is Peter?" Alicia asked herself as she woke up from dozing in front of the TV with their daughter, Jessica. She was pleased to hear the sounds of an unlocking door and Peter walking in. He looked exhausted but was happy to carry Jessica to bed. After all, it was a Saturday and he should have had the day off.

Alicia was proud or her husband. He worked tirelessly without counting hours, evenings and weekends, so that he could accomplish his goal of owning his own practice and giving Alicia the freedom to dedicate herself to raising their two children and continue pursuing her MBA.

Peter opened his practice two years ago and built his business from the ground up. Referrals were growing rapidly and he was now seeing 100 patient visits per week. He recently hired a PTA in addition to his administrative staff to help him with his growing case load. His passion was treating patients but his current priority was building his practice. Peter was telling Alicia that in a year or two, he could pull in more than $600,000 a year, perhaps making $6,000,000 over ten years.

"Pete, Jessica was really upset that you missed her soccer game again. All of the other Dads were there." Alicia said disapprovingly. Peter worked every evening and weekend over the past 3 months. "I don't understand why you spend every night and weekend in the office," she said. "Isn't your staff supposed to be doing most of this work while you are treating? Do they stay late to help you?" she asked.

"I really don't need this extra stress right now," he replied. "I can't pay them overtime to help, and I really can't sit there and watch what they're doing all day."

"You know, Peter," pressed on Alicia, "It's clear to me that you're not managing your staff properly."

Peter felt like he was punched in the stomach. He wasn't going to challenge Alicia. For the past two years, she managed to take care of Jessica while pursuing her MBA. Peter started getting a headache.

"You are heads down all day treating patients and not paying attention to what is going on with your staff." she added. "Last month, you had to replace both your front office person and two months ago, you replaced your biller."

"You're paying your administrative staff $12 and hour and you just hired a PTA for $45,000 a year but you're doing most of the work anyway." Alicia continued, getting more agitated. "You have to be losing money because of the turnover and salaries and on top of that, you're never home anymore. If you are going to see 100 patients a week and then spend every night and weekend doing business administration, why have staff at all?" Alicia asked.

"Good question, I don't know" Peter reluctantly replied.

"Katherine called the other day." Alicia said.

Peter went to college with Katherine. They graduated together and were good friends. Katherine opened her practice 4 years ago and was in the process of opening her fourth location. She was averaging 800 visits a week.

"We didn't speak for long because she was about to take her golfing lesson but in the few minutes we spoke, I thought of an idea," said Alicia.

"I couldn't even consider taking a day off to golf," thought Peter to himself. "OK Alicia, what did you come up with?" Peter relented.

"You know, she pays her staff based on performance. Let's start with some facts. Employee salaries vary in three ways: type of service, years of experience, and location.

There are four kinds of basic compensation: hourly, monthly, base salary plus performance bonus, and profit sharing or pure commission," said Alicia, handing the table to Peter. "Employee compensation is a cost of doing business. If you had no employees, you would eliminate that cost but if you spend time greeting patients and chasing insurance claims, you have no time to treat patient and manage referral relationships. So to grow, you need help. "

"So, you hire staff to treat patients, to greet them and schedule their visits, and to chase insurance payments. The problem is motivation. Can you tell me what are the costs of unmotivated front office staff?"

"Well, Alicia," said Peter, "A careless front office person might get patients upset, forget to collect co-pays, not follow up on a missed appointment. They could also get other office staff upset because they would not work together as a team. The cost of unmotivated front office person could be increased patient attrition, impact cash-flow, and the bottom line ultimately. The cost of an unmotivated hire is much more expensive than a few more dollars per hour..."

"So, Alicia," Peter sparked up in spite of the late hour, "Should we look for more qualified front office staff and pay $15, or maybe, $18 per hour?"

"Not so fast." said Alicia. "If you pay more per hour, you will reduce turnover because fewer practices around will compete with your compensation, but you will still have the same motivation problems, regardless if you pay $12 or $20 per hour. Tell me, what's the problem with paying hourly wages to staff that needs people interaction skills? What is the ultimate goal that your font office staff must meet?"

"I get it now!" Peter didn't notice his voice rising. "The front office staff is responsible for patient loyalty and referrals. Working with people requires attention to detail and interest in their problems. Especially when you work with injured or sick people. It's hard work, people feel burnt out. So, compensation and incentives must acknowledge their results, such as new referrals, fewer missed appointments, fewer missed co-pays. I could structure the front office salary so that they get minimal pay for standard work and a percentage of collections to give them incentive to grow referrals and keep patients compliant with their plan of care. Since more referrals, fewer missed appointments, efficient collection of cop-pays and balances increases collections, they could work more and make more than the best paid staff around!

"Right," said Alicia, "and not every person will be ready for this kind of compensation. But that's OK too: why waste time hiring a wrong person for the job and then discovering that they lack the skills and motivation to do the hard work?"

"So, what about the PTA? Should I also pay him a bonus? but for what?" asked Peter.

"Sure, you do not want to pay him for idle hours during no-shows, and you do want to pay him proportionally to the number of patients he sees and for better plans of care. That's called profit sharing," said Alicia.

"...or commission," continued Peter her thought. "OK, I get it - commission and bonus helps people focus on the result of their work and not on its difficulty. The compensation structure helps motivating my staff and improve teamwork, avoiding problems and contributing more to my bottom line."

"So, why don't we move all of my staff on commission?" asked Peter.

"That's the right business approach," responded Alicia, "except most people do not have self-confidence and productivity to work on pure commission. For instance, would your biller agree to work on 100% commission of your insurance collections? Most likely, she wouldn't, because she needs to pay her mortgage and other fixed costs and she cannot make her income dependent on your patient flow and the insurance companies. She expects a steady check regardless of your revenue, which depends on her performance. Actually, do you have ways to measure her performance? If you discovered under-performance, what would you do?"

"Today, I pay her regardless of her or my practice performance. That's not a healthy relationship," lamented Peter, "It's hurting the business."

"The good news is that, like Katherine's office, there are companies that work on commission-only arrangement," said Alicia, "outsourcing your billing would make more sense because a specialized billing company would have processes to manage their employee performance, including correct incentive methods. Actually, if you talk to an outsourcing company, always ask them how do they compensate their employees? Are they all on commission? If not, then you will end up with the same problem with even less control."

"Actually, no matter how big or small my practice is, all of its parts must work together to succeed. If administrative staff allows too many cancellations and doesn't help with referrals, patient visits will suffer and the revenue will decline," said Peter.

"A Pay-for-Performance pay scale rewards the staff who produce and penalizes those who don't. As a practice owner, I am always on Pay-for-Performance pay scale. You pay yourself less when the company's revenue is down. Why shouldn't the staff's income be on the same path? Tomorrow, I will change my compensation setup for my employees," Peter sounded really excited.

"Slow down, Peter," said Alicia. "Before you make any changes, review them with a Human Resource and Compliance specialist to get sound advice," warned Alicia. "We don't need a lawsuit because we missed a legal requirement to make the changes we want."

What do you think? Is Alicia right in her reasoning?

Do you know of a PT-specific staffing system that could make Alicia's and Peter's dreams come true?