Working as Employee of Integrative Practice? Help!!!!

[shadowweavers]

Hi All,

I am finally getting ready to launch. All of my certifications have been obtained and tests passed. Now my first opportunity is presenting itself.

This position is everything I have dreamed of. It is a long story but it is with an Integrative Practice and with a physician that highly respect.

Our first interview went really well. We were throwing around ideas of IC vs. Employee status. They want my massage to most seemlessly meld into the practice so they want to handle all scheduling, billing to insurance, taxes, etc...

At first I was fighting this because part of me has dreamt of having the control and flexibility of owning my own practice but after mulling it over for a couple weeks I realize that being able to solely concentrate on massage and having their marketing resources etc... would be good.

An additional tidbit of info here. I had applied for massage therapy school and was anticipating the first day of school for four months. In that time I moved to the area and got extremely ill. It took me six months to figure out what was wrong and another six months of treatment to get to the point that I could attend school. I got through school with flying colors and handled many hours of massage. I know I can handle four clients a day - three times a week right now physically with the chronic condition I am still fighting. This doctor is fully aware of my condition since he is my physician although I don't see him regularly now.

Upon our initial meeting the doctor said that he felt comfortable if I work somewhere else too or build up my own practice as long as I did not treat his clients at these locations. We were talking part time at that point so this seemed like the only reasonable solution for my making a living. As well, he threw around hourly rates of $30/$35 an hour as an employee giving massage.

Fast forward to today's second interview where we both came to the table with a bit more research under our belt...

He had spoken to another physician in the area who practices a lot like he does and employees two MTs on staff who have 9 years experience and have additional certifications in MLD. Now he has back peddled and the offer has changed a bit...

Now, he wants to employee me one to two days a week starting out...he needs help with his PR and some other administrative duties regarding new patient processing. He wants to pay me $15/hr for the admin work. For the massage he wants to pay me $20-$23/hr. He will be filing my work under insurance and billing out for about $152 for an hour massage. He claims this other physician pays $35,000/year for his MT who works a six hour shift, five days a week.

At first I was completely closed to doing any other work other then massage therapy but in the last few weeks I feel that due to my own health I may have to dial back a bit from the massage and that a mix of task might be great.

He now wants me to only focus on my position with him...so no growing my own practice. I am sure if I left the practice that I could not take clients with me so I would have to start all over if at that point I decided to go off on my own.

I will have my own treatment room which means as I acquire more clients I can work more days. I just will not be able to work those days until I have the clients.

I am ecstatic about working with a physician and especially this one. I like his staff a lot...

but the money thing has me bothered.

I have the Intro. and Basic Vodder classes under my belt already for Manual Lymph Drainage and plan to be certified in this so that I can treat pathology by next year at the latest.

I am good at what I do. I have undercut myself most of my life in the earning category and as great an opportunity this is for me I am feeling like $20/$23 an hour for my massage is just going to leave me feeling a bit undercut. I am not asking for benefits at the moment.

I realize that in reality if I were to practice on my own the first year after all of the expenses I might not even make that much an hour but I would be investing in my practice only not someone elses....

I just really need to feel that this is dualy adveneforum.xxxeous and that we both are getting our fair share...

Feeling torn...but also so grateful for the opportunity....

The population I would work with at this office is the one I have wanted to work with from the moment I contemplated massage therapy three years ago...then I got challenged by a chronic illness and now I feel even more qualified to work with them. I have a unique window into this world from a personal perspective and I believe it is going to make my work all the more potent.

Thoughts? Am I being greedy or realistic?

Thanks so much for your opinions!!!!

Crystal_Compass

 

[aaron b]

Crystal,
First of all, Welcome! Secondly, you are struggling with a topis that we all struggle with. As healers, it isn't in our nature to want to deal with money and the business side of things, so you aren't alone. No, you ARE NOT being greedy. This Dr is doing what many dr's do in the industry, and just because other's do it, doesn't make it right. He is bill $152 an hour for your service!! While yes he has overhead of the office, billing expenses, and has to wait to be paid (which if he bills correctly, he will be paid 95% of the time) he has no right to undercut you at $20-$23 and tell you not to build your own practice. If he is worried about you unethically taking clients, sign a non-compete agreement that specifically states that clients contacted through his office are off limits to you. I can understand that you aren't thrilled with office work, it sounds like a blessing with your health issues, plus it shows your face around the office to the clients, giving you the opportunuity to build your bookings. Now from your posting, I am assuming that both the office and massage work are paid as an employee? If that is the case, thats good as he would be paying a portion of your taxes, a big savings and if he isn't offering/paying medical, I would use these 2 points as negotiating chips. Say to him, "As a compromise, I will do the office work for $12 an hour, and the massage work at $30 (a savings to him the beginning while you are building the massage), no medical benefits at this time (maybe use that in lieu of a raise in 6 mos or a year) and you agree to pay me as an employee, paying the regulated portion of my taxes." Also offer to sign the non-compete, give you room to build your own clients without the fear of anything unethical happening, and giving you ground to stand on if the job goes south. Hope this advice helps!

Remember, you spend atleast a year of your life, $10,000+ of your money, and untold sums of talent to get to where you are as a massage therapist. If you respect that in yourself, others will too!

 

[Jerome]

Thanks billnkaren!!!!

I know this doc was strongly influenced by this other doc he spoke with. The initial perceneforum.xxxe a nurse at the office had thrown around when I was first approached was a 60/40 split...that has changed apparently.

It also doesn't help that the last therapist that worked with him did practice unethical behavior and treated his patients at her home behind his back. She committed professional infidelity and he is still feeling that sting...

Thanks for your opinions. I think they are really sound ideas and I will definitely kick them around.

I just have to decide what is most important to me. I think I am ready for that crazy ride called self employment and I would like to take a shot at it...but then the safe harbour of an established practice at first sounds good as well...

ARGH!!!! Never easy....

Thanks again for the welcome and good guidance!!!!

 

[Babak Kratosbbm]

the question i have is he paying you $20-23 AN HOUR or PER MASSAGE? there's a difference there. if we're talking an hourly rate of $23 an hour whether you have clients or not...that's totally different. if he's paying you $23 for an hours worth of massage the pay is considerably less.

though you may have dreamed of this set-up for quite sometime, you may find it more beneficial to find a new dream set up. there is no way i could or would work for someone who is billing $150 for something he is paying me $23 to do. i'd tell him to get bent. i'd call him out on that fact 'cause that's totally INSANE!

good luck and i wish you good health.

 

[tifquestions]

Thanks for the input terab!

Awake at 5 a.m. and I am ruminating over all of this.

I think it is $23/hour - so that means the hour that is built in to say a four hour shift for setup between clients is paid at that rate too...but I think it is still on the low end.

If I don't have clients then I will be doing PR work for his practice and new patient admissions at $15/hour.

I have gotten pretty clear that I am not willing to do any other work other then massage at this point. I need to focus solely on massage right now and not have a split focus.

Thanks for the good health wishes too

 

[Piplup1011]

Hi Crystal,

Wow, what a decision you need to make!

I agree with the input of both of the other posters. When someone has a problem, I try to put myself in their shoes and see what I would do. From a personal standpoint, I would reconsider the job and the offer. You are a MASSAGE THERAPIST. Not an office worker or a PR rep for someone else. If I was doing office work and PR, I would only do it if it was for MY company. If I was in your shoes, I would only take the job as an MT. Maybe you could have him book your appointments, get your customers and you can be more of an IC a couple days a week. You agree on a pay, maybe 50/50 (or whatever is worth your time), you go in for the appointments, then you leave. This gives you time to build your own business with your own clients and see them when you are not with the doctor. I wouldn't want to be using all my spare time working as an office clerk, building HIS business, when I could be building mine. I know this doctor is wonderful and you've dreamed of working for him, but unless you are desperate, think about investing your extra time for you and your blossoming business...not his. Just my two cents...

Think about all your options, input from your friends and people you trust, and don't forget what your dreams and aspirations were from the begininng.

Jen

 

[Searcher 5.0]

Thanks Jen!

Very wise words you have shared with me.

Yes, that is where I am this morning too. I keep going back to the fact that he now does not want me working part time building up my own business which if I decide to leave down the line will leave me without a practice. I would have to start all over if I decided to go off on my own.

I had already registered a name for my business and I am 36 years old. I have worked so hard doing a lot of work that I was over qualified to do.

What massage school gave me in addition to a great education is self respect like I have never experienced before.

Thank you Jen for reminding me of my own dream from the beginning. I really think I can do this on my own and while working with this physician would be a benefit to my reputation and a turn key situation I think that I also could really dig in here at the beginning all be it difficult and scary and I would have a firm foundation for my own successful practice.

Thanks for all of the input you all have given me - I appreciate it so much.

This morning a wild turkey was calling outside of our bedroom window...awoke the dog and cats....and me....so for two hours I sat and reflected on all of this...

It is the time to invest in me...

I am consulting with a couple of instructors and a codirector at my school today and by tomorrow I will be coming up with some terms hopefully we can all agree on...

Will keep you all posted!!!

Thanks again!

 

[davemorton007]

This morning a wild turkey was calling outside of our bedroom window...awoke the dog and cats....and me....so for two hours I sat and reflected on all of this...

It is the time to invest in me...

Turkeys represent abundance.

Best wishes in going out on your own!

 

[gypsy belle]

Hi Crystal Welcome to the board! I'm so glad you came here for advice; lots of ppl have lots of good things to say

Here's the deal: You're not alone! As someone else said, most--if not all--of us have been there at some point in our massage career. These are all big decisions.

Now, I'm a little hard-headed, stubborn, and fiercely independent, and that's about to show through here, so take what I have to say with that premise in mind.

For me, it was cut and dry. At no time was I going to take the plunge, pay to go to school, hone my skills, and work hard only to have my working life run by someone else. I was going to make my own rules, set my own hours, set my own pay, and call all the shots.

I was also determined not to get screwed by any other healthcare professional with whom I might contract in the future. I've sifted through this and similar boards for 2 1/2 years only to find one horror story after another, some worse than others. Now this was probably overkill, but I even sought an attorney to draw up a simple 2-3-page contract that details a few main points:

1) The fact that I will do massage therapy and ONLY massage therapy. No secretarial, janitorial, PR, assistant, or any other type of work.
2) A space for the modality(s) I will practice
3) A space for scheduling, duration, and pricing
4) A space for details of a standing arrangement (bi-monthly, whatever)
5) The fact that payment for services I've rendered is due immediately, regardless of when or how much the insurance co pays. (Immediately may be waived in some situations...like if we agree on a monthly statement-type thing...but it's still independent of any ins.)

It's written up all nice & legal, and according to our state (TX) laws. So far, I haven't had to use it, as I've worked only out of my home studio and as a renter/IC at a school. (The school had a contract of their own which was quite fair, so I didn't do anything with mine then. But you better believe that if I go work for/with an MD, PT, DC, DO, DDS, ND, etc, that a copy of that contract is coming with me! Many of them seem to think they can just dictate us around like servants instead of professionals while expecting us to ACT like professionals.)

So, that's what I did. Everyone's different. Whether to take the plunge and the risk and make a go of working for yourself or not is totally up to you. It comes down to what you value most. I decided I valued independence, autonomy, freedom, and control over how I did things. I felt I had some good ideas about how to run a practice and treat clients and I wanted to be able to carry those ideas through. I also wanted the flexibility. I wanted to be able to cultivate a certain clientele. I wanted to be able to refuse to work on someone who was sick or contraindicated, or to use whatever technique I wanted to, without anyone overriding my decisions or breathing down my neck. I'd rather have the freedom than the security.

That said, many ppl need the security. Maybe they're in a situation where they need to have immediate or steady income, even if that means sacrificing some income potential. Many ppl simply can't survive on such a variable income. They can't fathom not being able to depend on generating a certain amt of revenue. For these ppl, working for themselves is a bad idea. I guess we all just have to decide which category we fit into. Now it's not strictly a one-or-the-other type thing, either. Maybe a combination would work best for you. Maybe you'd like a mix of freedom and security until you're ready to leap into your own practice completely. That's what I'm doing by being at the school. I supplement my income until I have enough steady, regular, dependable clientele to keep me busy without having to leave the house.

The main thing I would encourage each and every (especially new) MT is, think up possible scenarios (such as the one Crystal has presented) and figure out what you would do. That way, you'll be prepared. Clients (in private practice) and healthcare practitioners (MDs and such) alike will want to lowball you. They know that there are tons of MTs out there and a small but visible minority have not made the best impression. They know that if twisted, some of us will cave and work for $20/hr. What's the lowest you'll work for without feeling resentment? Do not go below that number, no matter what! What do you REALLY want in a practice? Do not work to build clientele at a place (or on days of the week or times of the day) that you don't want to work!

One thing that bothered me about your situation is that you were presented with terms you initially--and rightfully--recoiled at, but then over the next few days/weeks/whatever, you talked yourself into being able to stomach it. Sometimes we try to rationalize a bad deal simply ks we're feeling the pressure to generate income now that we're licensed, instead of holding out for what we really want. Don't fall into this trap! It's not worth it. No matter what, you AT LEAST deserve to come away each day with a certain amount of satisfaction for a job-well-done, you deserve to be able to be yourself, and you deserve to get paid what you're worth! Whether you work for yourself or under/with someone else, at least make sure it's a place that can give you that much.

So, that's my few bucks
Good luck with your decision! We're all pulling for you
Hugs,
~Jyoti

 

[Chauncey Q. Buttercup]

Hey AkB...Turkeys are totems for Abundance...Wow!!! Very cool. I have some totem books and find them fascinating. I have had a lot of birds come to me in the last two years...red tailed hawks, and a hawk with a red breast that I am forgetting the name for. Anyway thanks for pointing this out...

Thanks Jyoti for all of the sound advice. I went in there feeling fiercely independent and in the matter of three weeks after thinking about the 'experience' that I could benefit from feel I have been worn down.

Thanks for snapping me back to my original reality a bit.

I am going to be getting my head together with a list and will be making a desicion this weekend. I think the only way I will be able to consider this is on some hardcore hours that are decided upon and I absolutely am not giving up my right to build my own practice on my own thirty miles away...

Will keep you all posted. I am so grateful to have found this board.

Thanks again!

 

[julie s]

I wanted to Thank you all for your words of wisdom.

I made my decision after talking to some people that had the inside line on the other practice that this physician checked into.

As well, I checked with some fellow classmates that have taken positions in similiar settings.

What I found out is that at $23 dollars an hour this physician is right inline starting salary for this type of position. He will pay me for the wait time in between clients and set up time as well as the massage.

For me I am not in diar need of the stability at the moment, of course who can't use it? For me it is the experience.

I let him know that I will not limit my own practice outside of his practice of course understanding I would never poach any of this patients. We agreed that this is fine.

I got all in my head this morning regarding 60/40 splits and $$$$ and then stepped back after reading some articles in 'Massage Today'. It gave me some perspective.

I am extremely interested in pathology - that is where my interest lies and where my personal experience is so valuable. This is a terrific opportunity and it is turn key.

I asked that I have a review in three months and six months...at that time I am hoping that the $15 dollar admin work will go up to a higher pay...to me that is a training rate.

The bottom line is my plan is to work on as many bodies as I can, learn learn learn, prove myself and my ability, get some more continuing ed under my belt.

At the year mark when I have helped to grow his practice, have a two person massage therapy practice under his roof, and have become more experienced I will ask for more.

The insurance issue does have me a bit bothered. After research I see that this is a hot topic and I certainly don't want to be one of the those that 'sells their souls to the devils' and limits treatment access. So I am still grappling with that.

Anyway, for now I am happy...it is a starting point and a pretty great one at that. I look at it this way....Julia Roberts only got 60,000 for Pretty Woman despite having made Mystic Pizza and Steel Magnolias before it...now she is making movies for twelve million...Gotta start somewhere ;0)

 

[maxy]

I just wanted to add to this, although you've made some decisions by this point, that it can be helpful when working for someone else not to think of how much they're making or how they're spending it. The doc tells you he's billing $152/hr and you're getting $23 and that sounds like a huge difference so you start wondering where he's spending the remainder and is it fair . . . this usually gets nobody anywhere but resentful. If instead you decide on a specific dollar amount per hour or per session that you require, and stick to that, then when you get it you'll tend to feel more satisfied with it. (This also means that if an employer tries to negotiate you down by telling you all about their expenses, you can sort of tune that out -- because it's no longer your problem.)

That said, I totally love being in private practice and wish you the best if that's what you choose to pursue.

 

[Rose S]

I asked that I have a review in three months and six months...at that time I am hoping that the $15 dollar admin work will go up to a higher pay...to me that is a training rate.

sounds like you've figured out what seems fair to you. One comment only... don't "hope," hoping that something will happen in a contract is a sure way to be disappointed and feel taken advaneforum.xxxe of. Figure out what you think is deserving of a raise, and how much. For instance: When I am doing #x sessions per week, or after x months, I get a $4/session or $3/hour raise. Get it in writing, make it part of the contract.

And good luck!

 

[goofy]

Thanks for the advice...Last night I had a dream that my ankle had been slashed while trying to save my German Shepherd from falling in fire pit....all of the vessels and arteries were hanging out...hmmmm???!!!

I am definitely having issue with the compensation....but I am reminding myself that this is part time. I have the right to establish my practice on the side and in six months after he sees my work I will have a lot more to stand on.

I will be talking to him about the fee. I think it will be extremely limiting in a lot of cases for those that do not have insurance and want massage. It will slow my business.

As well, I guess I got a reality check while reading an article in 'Massage Today' about compensation. Basically the woman who wrote it finds it crazy that MTs are complaining about making $25/hour in a turn key situation when her husband who works at a million dollar funeral home is bringing in $20/hr.

Did some checking around an found $23 is about the going rate in this setting...do I think it is right? Not necessarily. While I would love to help change that tide I need a job and I do feel called to this practice.

It will work out and for now I am focusing less on the money and more on the experience.

Thanks for all the input!

 

[Tracy]

I will be talking to him about the fee. I think it will be extremely limiting in a lot of cases for those that do not have insurance and want massage. It will slow my business.

Crystal, I am a bit confused by this... Most Dr's bill insurance companies a much, much higher than what they would charge a cash patient. Insurance billing rates are usally bill 145% of what medicare rates are (its really confusing) but basically they charge more due to A) being able to, which is unethical and sad and B) because when insurace steps in, it means the patient needs more of a deeper/therapeutic work. Does this Dr intend to charge cash patients $150 an hour for your service? Its doubtful, as you would never see a cash patient at that rate.....

 

[kimmie2005hhs]

Hi billnkaren,

No the rate for patients not billing insurance is considerably less.

I started today - just an orientation. It went well. There is a lot going on in the office and a lot of exciting stuff on the horizon.

I will be doing more office work in the beginning then I initially anticipated when I imagined myself working right out of school but I have to tell you at the moment I am ok with this.

There have been a lot of signs that this is where I am meant to be. I am very excited about this opportunity.

I want to THANK YOU all for your input and opinions. It really did help. Take care...

 

[craftypaddy]

Hi All -

Well my update is that the arrangment with this doctor has not worked out. Ok, did you all have a pool going on how long I would last? Who won??? :wink:

With in a three week period the terms we had agreed to (not in a contract) constantly changed and my boundaries were definitely tested on multiple occassions.

The final change yesterday was a total reorganization of the office space which will remove a few rooms from the practice and the room we had designated for massage was nixed. This is after I had bought three gallons of oil, gel, and lotion, five sets of sheets, art for the walls, and a few other things to decorate. It was my fault for having not proposed he pay for it because 1) I wanted to control how the room looked and 2) they weren't necessities but my desire to warm up the environment...more proof I really should just be working on my own in at least part of the time.

I would then have been sharing a room with another practitioner (colon hydro therapist) who has a heavy schedule.

There have been a few scenarios proposed that may work in the future for me working with him but ultimately I explained that I have made a big investment of time, focus, and finances to be a massage therapist and that is where my heart is.

This was an invaluable experience. This doctor is a sweetheart. He really is. He has been very focused on his practice and what is best for his practice because he is experiencing some bumpy times right now but you know what this is not my problem.

It is apparent to me that this doctor does understand the mind/body connection but I do not feel he really values the power of massage therapy or the knowledge I have gained going to school for massage therapy.

I let him know that while the last three weeks have been focused on what his practice needs that I have needs too and they must be met for me to feel happy and productive.

So I am going to start the interviewing process with some other massage practices.

What this has taught me is 1) How to ask for what I want and need and stay true to my vision and focus 2) To ask with grace and dignity 3) Realize that just because someone has years more experience than I do does not necessarily mean that they know what is best in any given situation 4) That my Gut is really perceptive and in the second interview I picked up on a lot and so now I will trust it more in the future...

Thanks to all of you for posting and giving your perspectives. They were all invaluable and when I look back on all of your posts I smile, because you were all right on! I will keep you posted on my next venture

Hope you all are well!!!!

 

[Nicole]

P.S. Jyoti - You were right on the money - no pun intended....I did continue to compromise throughout this process...talked myself into it - You are quite perceptive :wink:

P.S.S. AKB - What I thought was a Turkey making noise in the woods around my house was actually a mama fox and her baby - hmmmm??!!!??

 

[rachelisasquirrel]

I had already registered a name for my business and I am 36 years old. I have worked so hard doing a lot of work that I was over qualified to do.

What massage school gave me in addition to a great education is self respect like I have never experienced before.

Thank you Jen for reminding me of my own dream from the beginning. I really think I can do this on my own and while working with this physician would be a benefit to my reputation and a turn key situation I think that I also could really dig in here at the beginning all be it difficult and scary and I would have a firm foundation for my own successful practice.

Thanks for all of the input you all have given me - I appreciate it so much.

This morning a wild turkey was calling outside of our bedroom window...awoke the dog and cats....and me....so for two hours I sat and reflected on all of this...

It is the time to invest in me...

I am consulting with a couple of instructors and a codirector at my school today and by tomorrow I will be coming up with some terms hopefully we can all agree on...

P.S.S. AKB - What I thought was a Turkey making noise in the woods around my house was actually a mama fox and her baby - hmmmm??!!!??

Hmmm, indeed!

Fox - This animal respresents patience - the ability to wait for the right moment to act. - http://www.spiritofangels.com/poweranimals.html

Good for you for really staying true to yourself and not prolonging anything. Great lessons learned! Best Wishes!

 

[Rose]

Update...

Hi All -

Just an update...

I started working for a small spa. I have been working regularly since February after they provided me with a little further training.

I LOVE IT!!!!

I work with an LMBT who is a seven year veteran who has shared so much knowledge with me and has been so encouraging.

I am happy to not be working primarily with the population I had intended initially to work with. I realize now that it would have been too much at times. I like working with people with all types of pathologies, as well as those who have no health challenges...it gives me a great mix.

What I learned is that being focused and having goals is great but that sometimes opportunity presents itself in beautiful ways you could not even expect or visualize. Be open...

It is funny because all of my life I have lived a very spontaneous existence and beat myself up for not being more narrow in my vision of goals. Massage school taught me the value of setting concrete goals and yet those I set in school I realize now were not the best for me as a new massage therapist.

The position I am in was actually for a more seasoned massage therapist. I was honest when I called initially letting the owner know that I did not have the two years experience the spa was looking for but that I would love the opportunity to interview and give a sample massage...

The rest is history...I was hired and they were willing to invest some time smoothing out some of my new rough edges.

It has been a great experience and I truly love the spa modailities which work with water and mud. I find them so healing and earthy...

Just wanted to update you all. Looking back on my post it is so clear what I needed to do in that first situation...funny how when you are so new and in the moment it is hard to see clearly.

Thanks for all your posts and concern...it means a lot!

Hope you are all well...

My Best,
Crystal_Compass