I’ve had a few weeks to now reflect upon another one of the great Missouri state association conferences – MSHA. The 2012 MSHA Annual Meeting and Convention was once again a hit. Over 1000 attendees, great speakers, and a wonderful variety of vendors from Missouri and Nationally.
So let’s get right to it…what do I and so many other professionals find unique about the MSHA Annual Meeting and Convention?
First off, in comparison to the Missouri Occupational Therapy Association and Missouri Physical Therapy Association Annual Conferences, the MSHA is the giant of them all. Over 1000 attendees – from seasoned speech language pathologists, to new grads, to current students. All wanting to learn, network, and contribute to their profession. It’s something that you absolutely feel in the air at the MSHA Conference. Which may be why I thoroughly enjoy my conversations with speech therapists…these professionals are vibrant, flexible, and very down to earth. Much like you and me!
Secondly, the variety of vendors are pretty amazing. Sure, there are therapist employers, such as Metropolitan Health Staffing Network, but there are also book vendors (something very cool since I have 3 little boys at home), jewelry vendors, handbag vendors, app vendors, and more. Start up companies. Seasoned companies. Companies from Missouri. And National Companies. This makes for quite the dynamic environment in the exhibition hall…you’re bound to find something or someone that you like!
I spoke with one particular vendor, whom I consider friends in the business. The conversation brought out a wonderful idea (not mine, I’ll admit) of combining the MSHA, MOTA, and MPTA annual conferences. Not each and every year, but what about once every 2-3 years? Think about the attendance boost, the greater number of vendors, the higher quality of speakers, and the collaboration that it could bring. Why not do this? More therapy settings are increasingly emphasizing communication and collaboration across disciplines – PT, OT, SLP, nursing, and more. This would be a perfect setting to enhance and emphasize that concept and more. It just makes sense, and yes, I’m sure there is a way for MOTA, MPTA, and MSHA to share the profits. So get going and make this happen people! ;)
Next, I noticed something this year at the 2012 MSHA Annual Meeting and Convention that I hadn’t noticed the previous year that really got me excited. (We’ve only exhibited in 2011 and 2012). It’s something that I have noticed in general about speech therapists, and I mentioned above that SLPs are for the most part flexible and vibrant. (No offense, but much more so than PTs and OTs) We’ll, this year, I noticed that more SLPs are open to any of the following: picking up PRN work in a setting other than their “specialty”, SLPs near retirement looking to stay active in their retirement years, students not committing 100% to either a school or medical setting, and more SLPs that either have their own business or those that are piecing together the equivalent of full time work with a few part time or PRN opportunities. The humble nature of their flexibility and enthusiasm in being able to work in many settings is energizing. And quite refreshing to see.
Lastly, a couple of things to note. I eluded to this above, but I witnessed fewer students that were adamant about working in either a medical setting or a school setting. A big shift from the previous year. Another interest worthy of mentioning was Vital Stim. There was a bit more “buzz” about this treatment option this year – especially from the younger generations. More SLPs desire to become Vital Stim certified, but have not yet for several reasons. And deservingly so, but not because of their fault or lack of desire. See why here…
So there you have it! The 2012 MSHA Annual Meeting and Convention was a fun, informative, and exciting time. It was our second consecutive year as part of the event, and we are already seeing trends changing in the field.
Hats off to MSHA for a job well done once again!
Were you at MSHA this year? What are your thoughts on the conference and the observations I listed above? It’s OK to agree, and disagree – so please, leave your opinion.
It was 2004, and I was loving my work as an athletic trainer in Northwest Tennessee industrial clinic. To say we were busy would be an understatement as fifteen patients in an eight-plus hour day was the norm for each of us on staff. I was the constant face of the clinic, but it also included a full time PT, PTA, and OTR. We were young, energetic professionals, and humping it to take care of the injured workers!
Our timesheets were due weekly – on a Tuesday if I remember correctly. One day it hit me…I hadn’t turned in a timesheet for a couple of weeks. Had I gotten too busy to remember it? I panicked, because as with many young professionals, my wife and I were living paycheck to paycheck. This certainly presented more than a couple problems, to say the least.
My initial frightened reaction was to call my boss…and to say the least, she had my back. This kind soul had submitted my hours for me – she knew I had been working like crazy, and didn’t even have an ounce of doubt about it. So she just submitted my 40 hours for me. God bless you Tammy!
Moving forward to present day, I make sure our therapists’ timesheets are submitted each Monday by noon, or they don’t get paid in a timely manner for their work. Submitting timesheets past the Monday noon deadline could result in at least one week’s delay of receiving their paycheck.
Notice I said “make sure”…and not “responsible for turning in therapist timesheets.” There’s a difference, albeit subtle, but I find myself explaining this concept time and time again. So, here are some recommendations to ensure this process goes smoothly, and our therapists get paid timely.
- Therapist should submit their timesheet to the facility or home health agency along with patient documentation.We process timesheets on a weekly basis, so this should be completed as soon as possible after the last day of service provided for the week. This is often accomplished via fax or in person. If your last day is on a Wednesday, submit your timesheet that Wednesday, or Thursday at the latest.
- If the timesheet is submitted via fax, the therapist should contact the facility or agency to confirm receipt of their timesheet and documentation, and ask them to fax to our office ASAP. Our timesheet requires approval (signature) by the facility or home health agency for the therapist to be paid. This system of checks and balances ensures the accuracy of the hours or visits completed. This is often where the process gets delayed – possibly a fax that didn’t go through or was misplaced.
- The facility or agency will review, sign, and fax the therapist timesheet to our corporate office. The timesheets received by Monday morning are crosschecked with our scheduler to ensure we have received everyone’s timesheets for the previous week of scheduled hours and visits. For those timesheets not in, we make the appropriate contacts to ensure their receipt. An assertive therapist should contact our office by Monday at noon to confirm the receipt of their signed and approved timesheet.
So there you have it. As I’ve said with other things, it’s not rocket science. But sometimes technology does fail and delay the process. Ultimately, as contract therapists, it is the therapist’s responsibility to submit their timesheets in a timely manner. We’ll fax those as needed for the approval and signature of the facility or home health agency, but that delays the process and risks a delayed paycheck.
If you’re a contract therapist, how do you handle your timesheets to ensure you get paid for your services? Or if you’re an employer that utilizes independent contract therapists, how do you verify accuracy of hours and consequently pay them?
Call me old fashioned if you’d like…and it’s quite possibly true. Or maybe it’s just the fact that I’m the type that still values relationships – and this doesn’t’ just go for the PTs, OTs, and SLPs that I recruit and staff. Talking with someone over the phone, communicating via social media, texting, and email are prevalent tools for communication, but certainly different than meeting someone in person. The comparison is close, but definitely not the same, because there’s great value in meeting someone face-to-face.
I’m proud to say that I’ve met nearly all of our therapists; something I feel emphasizes the importance relationships hold with us at Metropolitan Health Staffing Network, not to mention the facilities which we help staff on a temporary or supplemental basis.
Meeting with people is a lost art in today’s all-too-busy society. I’m often floored by stories I hear – some recruiters not meeting with the therapists they recruit or never even setting foot in the facilities for which they’re recruiting. Such inattention boggles the mind.
So how valuable is the face-to-face meeting? Extremely important! It goes beyond putting a face with a name; it’s the personal connection, the awareness and involvement of others’ personal and professional lives.
It’s knowing how many kids they have, their ages, their names, and what they are doing in school…it’s knowing where the family vacation is this year.
It’s knowing when their kids are ill, and actually understanding and caring about that situation. It’s knowing when someone has lost someone close to them, and sending them a personal sympathy card…
It’s knowing when someone has to drop off and pick up their kid from school…it’s knowing someone else’s daily schedule so well that it’s like yours…
It’s valuing someone in your life so much, that you “friend them” on Facebook.
The list goes on and on, but you get the point. Relationships are valuable and much easier to form when you actually know someone.
So, therapists – have you met with your recruiter? This got me wondering, so I did the math. (I’m a numbers guy BTW) ;) What were the results, you ask?
To date, I have personally met with better than three out of every four therapists that work with us. The same goes for facilities that we help staff. Pretty darn good I’d say, given the following two facts:
1) We staff across all of Missouri and portions of Illinois.
2) Most of our therapists and/or facilities are two-plus hours from my office.
I’m not telling you this in an effort to pat myself or MHSN on the back. I’m telling you this because I find immense value in the service we provide to our therapists and facilities. Quite simply, it helps us provide a better service…and we have fun doing so – not to mention I get to sample coffee shops all across the state.
So what about the other quarter with whom we haven’t met? You’re on our calendar, and I’m pretty sure you know it. It just hasn’t worked with everyone’s hectic schedules – we’ll meet someday soon…I promise!
So, what have you experienced? Recruiters – if you could, would you meet with therapists that work with your company? Do you Skype with them instead? Therapists – would you prefer to meet with your recruiter?
Building Your PRN Pool of Physical, Occupational, and Speech Therapy Staff: The Most Obvious but Overlooked Strategy
Finding PRN therapists who are actually available and willing to help. We’re not talking rocket science, but at times it may feel like trying to find a needle in a haystack. Especially so in those rural areas that we here at Metropolitan Health Staffing Network often get requests for. But enough about us…
I’ve had the pleasure of developing some excellent relationships over the past nearly two years of work with Metropolitan Health Staffing Network. Some of these folks in HR, Recruiting, Administration, Therapists, and more have become real friends. Not just business friendships – but FRIENDS.
With that said, I’d like to share a simple tip with my friends in the recruiting and HR world. We often bounce things off each other, brainstorming if you will. I’ve come across the following scenario regarding building PRN Pools of Physical, Occupational, and Speech Therapists more than once…so I have to share.
Everyone is building their PRN pool of therapists. With regulation changes, weekends, vacations, sick days, and you name it – it just make sense. And facilities do this pretty well. But one resource is often overlooked during the daily “treadmill of life” experience at work. We often forget a priceless resource to help us out. So, what is it?
Former therapists. Yep – it’s that simple.
Therapists commonly move around from job to job. And for various reasons, their grass may or may not be greener on the other side. Therapists may change employers for a higher salary, better benefits, better hours, a better boss, changes in their family status, a combination thereof, burnout, and more. The reasons are endless.
But a therapist that leaves company ABC may very well go back to company ABC or help out company ABC as long as their tenure with company ABC was favorable. This could mean full time, part time, or PRN status.
So how best to make sure you are taking advantage of former therapists…that are no longer anywhere near your payroll roster?
My suggestion is to simply stay in touch. You choose the method. Email, phone, Facebook, and so-on. See – it’s simple. As we say here at Metropolitan Health Staffing Network when a therapist chooses to accept a perm position: “We never lose a therapist, our relationship just changes.” If you take that approach with your Physical, Occupational, Speech Therapists, COTAs, and PTAs, I’ll bet you will be pleasantly surprised someday. It may be this year, next year, or 5 years from now. No one knows really when it will happen, but chances are, it will.
What have you got to lose? Like I said, it’s not rocket science…simply relationships.
So how do you build your PRN pools of therapists? Am I way off here, or dead on?!? If you already use this method, how successful has it been for you? I would love to hear your story!
Believe it or not, but every Physical Therapist, Occupational Therapist, or Speech Language Pathologist has not worked PRN before. I know so, because I get the following question quite often. It goes something like this:
“How do PRN therapist opportunities work with Metropolitan Health Staffing Network?”
In short, physical, occupational, and speech therapists that work with Metropolitan Health Staffing Network are their own boss. Our therapists get to decide which opportunities they accept, and which they decline…without any negative consequences. Let me repeat that – without any negative consequences.
After completion of our thorough vetting process (which allows therapists to work in any setting at any moment), Metropolitan Health Staffing Network brings opportunities to our family of highly skilled therapists as they arise in our network of facilities we assist with temporary staffing. Information such as rate, mileage, drive time, location, number of hours, setting, and more are provided to the physical, occupational, or speech therapist so that an informed decision to accept or decline can be made. If a particular opportunity does not exist, we will find particular opportunities for our PTs, OTs, SLPs, PTAs, or COTAs.
Pressure to accept an assignment does not exist, as we don’t force therapists with Metropolitan Health Staffing Network to work anywhere or anytime. The most “pressure” experienced by a therapist will be “Were in a bind here, and could really use the help. Can you try this?” Most times, our therapists do try the opportunity, and are thankful they did!
If an assignment is not accepted, it does not negatively affect the therapist relationship with Metropolitan Health Staffing Network. For instance – a particular therapist waited approximately one year before accepting an assignment after completing the vetting process with us. Throughout that time, the relationship remained without pressure and dialogue was open ended. The result is a fantastic working relationship, and a true friend – as we have often talked about family, holiday gatherings, and more. The therapist has since completed a few assignments in which she has enjoyed providing excellent service.
If you are a Physical, Occupational, or Speech Therapist that has worked PRN opportunities, how does this differ from your experience? If you are a therapist considering PRN opportunities, how does the idea of being your own boss sound?
Please post your comments – we love hearing what’s important to our readers!
I received a voice mail the other day from a therapist interested in opportunities through our network. The first question this person had was certainly not unique; in fact, it’s the first question that nearly everyone asks: “How much will I be paid?”
And knowing therapists like I do, I’d be willing to bet that those that don’t ask first about pay rates and benefits, they’re thinking it, and are just too darn nice to ask. And until now, we’ve been too darn stubborn to freely offer. ;) So, here goes nothing!
Therapist: “How much will I be paid?”
Answer: “It depends.”
Now, understand that I’m not just trying to be vague, but those in the industry are aware that certain factors may dictate the answer. Here in Missouri, where we conduct the majority of our business, I can tell you what range that will be, but not until later.
First, let me explain how the hourly wage of a contract therapist truly does depend upon several factors:
- The location. Take Missouri, for example. If you’re in Kansas City or St. Louis, your hourly wage will be lower due to saturation. I promise.
- The setting. I think most would agree that home health has the highest salaries among therapists, but in the same breath, not all therapists enjoy the home health environment. Ironically, a close cousin to home health, outpatient rehabilitation is likely near the bottom of the scale, with the other physical therapy settings falling in between.
- Experience. An experienced physical therapist is obviously going to yield higher pay. In theory, they should be able to walk into most situations and function with little orientation. That doesn’t mean a recently graduated physical therapist can’t work as a contract or PRN therapist, but it likely means they would immediately make less than their more experienced peers in the field.
- Tax Status. Yep, that’s right – tax status, which is something I’m guessing was not covered in physical therapy school. If you’re a physical therapist acting as an independent contractor (1099), then you will simply make more money – usually at least ten percent more on an hourly basis. And you can keep even more of this additional income if you choose to incorporate yourself.
So here are a few take-home points for those therapists looking to maximize their income in order to pay off those ginormous school loans, which is what I would do if I was a PT. Work as a 1099 independent contractor physical therapist in the rural part of Missouri for one or more home health agencies. I have seen multiple postings online where individuals in this case are easily making upwards of $100,000 annually. And trust me, I have friends in Illinois doing the same thing as well.
Now, for those of you still wondering what you can make as a PRN or Contract physical therapist, here you go…and hopefully you didn’t just skip to this part ;). In Missouri, your hourly range will likely range from $40 to $55 per hour, depending upon….well, you know.
Is this right on? Have I missed anything? Is anyone experiencing higher PRN rates that hold a DPT? Let me know how this has helped you in your decision of whether or not to do PRN work. It will likely help others to decide as well.
I had the urge this morning to share how PRN work has helped transform my family’s life – quite literally. It’s obvious that I think PRN work is superior. More family time, higher wages, flexible schedule, and tons of experience are just a few that both my wife and I have experienced, or are still experiencing. And then there is the immeasurable factor of quality of life.
You see, my wife and I are both health professionals. Both Athletic Trainers by trade, but have since moved on to greater interests for various reasons. (My wife has her PhD, so she can do just about anything ) PRN work has truly shaped our life, and our boys’ lives too – they just aren’t old enough to realize it yet! Let me share a couple stories to better help you understand why I am biased and believe PRN work is superior.
Time travel to 2004. Living in Union City, TN at the time, my wife and I longed to start a family, but that wasn’t the place we wanted to raise one. We both had great jobs (mine in Industrial Rehabilitation with STAR Physical Therapy and hers teaching at UT-Martin), but family was our priority and we took a leap of faith. In October I accepted a “traditional” athletic training job at Southeast Missouri State University in Cape Girardeau. It was my wife’s hometown, our alma mater, and where we wanted to “settle down”. My wife stayed in TN until December, then moved back and took a clinic job. As you recall – we both had great jobs in TN, and now we were both in jobs that were not necessarily our passion at the time.
Long story short, we now loved where we lived, but wasn’t too fond of our jobs. My wife handed me a newspaper clipping of a PRN or Contract Industrial Rehabilitation job in the Spring of 2005. By June, I had started this Contract job, and it payed huge dividends for our family. The PRN wage was spectacular, and the immense flexibility was priceless. You see, in February 2005, we purchased a small house on a 6 acre stretch of land outside of Cape Girardeau. By late summer, we were breaking ground on our dream home, and we were going to be doing a lot of the work – from General Contracting to a majority of the subcontract work too!
That’s the way it was for about a year, until the fall of 2006. We had just moved into our finished dream home. My wife had managed to survive the clinic job until then, but then she started her bouts of contract work. Which was about the same time I went full time in the Industrial Rehabilitation field. She started contract work at Southeast Missouri State University as adjunct faculty, as well as at a local gym – starting to lean more towards her interests of health and wellness. She has been full time at the university for about 3 ½ years now, but will depart that position this Summer, as we are to have our 3rd boy in February. And guess what she is going to fill her work days with?
Yep, you guessed it. Contract work. During her time at Southeast Missouri State University, she has continued contract work at the local gym, but has also picked up a few other contract assignments. She experimented with wellness coaching (the real stuff, not this bogus telemarketer crap the insurance companies boast), and has gigs as adjunct faculty at other universities too. She’ll continue on with Southeast Missouri State University as adjunct faculty too. And it will all be fantastic…because of PRN or Contract work.
So there you have it, Contract work has helped shape our careers, our family, our home, our finances, and our future. And it will continue to do so. Why wouldn’t we? In addition to everything positive I mentioned above, Contract work has also quickly eliminated car payments and any other debt other than our mortgage, and allowed “Santa” to bring our boys one heck of what of a swingset this year for Christmas. It’s a no-brainer for us.
Now I want to hear your personal stories…how has contract work helped you in the past? Or better yet, how are you going to use Contract work to better your career, your family, your finances, and your future? It may seem like a leap of faith at the time, but looking back, I guarantee you that Contract work will be priceless.
The ever-changing LTC landscape is in upheaval once again. Select Rehabilitation has acquired EnduraCare. The acquisition will be effective on January 31, 2012. Terms of the deal have not been disclosed at this time. While this merger is not quite on par with the Kindred acquisition of RehabCare, it will affect a number of facilities and rehab professionals leaving many questions to be answered…
What is the magnitude of this deal?
Select Rehabilitation, founded in 1998, is privately owned and independently operated. Boasting over 4,000 employees, serving 300 facilities throughout 20 states, Select has become a national leader in the LTC setting. Select provides comprehensive physical, occupational, and speech therapy services in a variety of geriatric settings.
EnduraCare , founded in 2000, is also privately owned and operated. Serving an undisclosed number of LTC facilities throughout 21 states, EnduraCare has become one of the fastest growing contract therapy companies in the United States. EnduraCare provides physical, occupational, and speech therapy services across the spectrum of LTC settings in the Unites States.
What will happen to the employees of EnduraCare?
Details have not been disclosed regarding EnduraCare employee status. Will Select Rehabilitation absorb and create positions for the professionals in HR, Recruiting, and Management roles? Will Physical, Occupational, and Speech Therapists simply become employees of Select Rehabilitation? Or will the thousands of EnduraCare employees be looking for the next best thing in their careers? With all of this yet to be seen, one has to think and hope that Select Rehabilitation will at a minimum retain all of the Physical, Occupational, and Speech Therapists.
What does this mean for other LTC Therapy Providers?
With this move, Select Rehabilitation is without a doubt solidifying themselves as a major player in the LTC setting of physical, occupational, and speech therapy. What about the other LTC Therapy Providers? Are they next on the list to be acquired by these larger corporations? Will we someday see only 2 or 3 major providers of therapy in LTC settings? Does this acquisition (or those like it) make therapists desire to work for larger corporations? Or will therapists be more likely to seek out the smaller providers or “in-house” opportunities in LTC?
With the LTC setting in such a dynamic state of acquisitions and regulation changes, how does this affect you as a therapist? Is your job in jeopardy? Will your job responsibilities change? Will productivity become an even bigger factor in your daily tasks? Or does it not affect you at all? Please share your thoughts and opinions.
During the average work week, I talk with quite a few speech therapists (OTs and PTs, too, for that matter)…and each seems to have their own preferred method of communication – which is fine. Technology offers us a variety of ways to communicate, but the effectiveness of one’s communication can have a profound impact on their job performance – including a PRN speech therapist.
PRN can mean a little something different for everyone. For some therapists, it may mean schedule flexibility, “work when I want to”, or “I’ll help when I can”. To others, it simply equates to a higher hourly wage. And to those who think out of the box, it may be envisioned as a professional investment in themselves. No matter what PRN means to you, there are 3 things a therapist should remember, but you likely won’t find it in their job description:
1) PRN does not mean “no responsibility”. You still have a responsibility to be punctual, be professional, provide superb care, and work as part of anintegrated team for the best of the patient. This really shouldn’t need to be said, but some therapists need to be told this.
2) PRN does not mean “I don’t have to communicate”. Just because you’re working in a PRN capacity doesn’t afford you the right to be late or not show up at all, especially without communicating – or worse yet, communicating after the fact. Times may exist when an e-mail communication will suffice, others where texting the client is feasible, but in certain situations, nothing less than a call will do. When in doubt, however, you should always call. It will leave no room for interpretation and provide the personal touch that is necessary.
3) PRN does not mean it’s “OK to be disrespectful”. As I mentioned in the first point, you must work as part of an integrated team for the better of the patient. You have to respect other experts on the team, the patient, the patient’s family, and your supervisor. And make no mistake – experts on the team should include administrative assistants, scheduling assistants, or other support professionals that can make or break your day. Be thankful for what they do for you!
These are just three of many “intangibles” that you probably won’t find on therapist’s job descriptions – not just speech therapists, but PT, OT, and therapy assistants as well. And while we’re on the topic, these simple rules apply to just about any professional. If you’re not responsible, don’t communicate well, and act disrespectfully, you won’t be around for very long, and soon, your reputation will begin to precede you.
Hopefully you and your employer care enough about your reputation to take notice!
What do you wish you could place on a job description for a therapist at your facility? Or better yet, as a therapist, what do you wish your employer did a better job of screening for in the therapists on your team? Leave your comments below – we all can learn and enjoy each other’s professional perspectives.
During my conversations with physical therapists interested in our opportunities, I’m always surprised if I don’t get a specific question in regards to the 1099 tax status. Most people wonder – “Does this mean I have to pay my own taxes?”
This is a topic that is typically foreign to most people, and the answer, simply put, is YES. But with it comes a myriad of benefits, which we’ve previously outlined, and will continue to discuss. And these are benefits that don’t commonly cross people’s minds.
1099 is for everyone, but W2 is not, and here are 3 reasons why:
1) W2 isn’t your tax status, but to employers it stands for “Where-To” and “When-To”. As a company’s W2 employee, they will tell you where to be and when to be there. On the contrary, 1099 is “code” for having the freedoms and luxuries of being your own boss – most importantly of which include you maintaining the rights to determine where you will be and when you will be there. I can’t tell you how many times I’ve had a therapist tell me that they just don’t want to deal with that stress anymore and would rather work on their own terms. It’s impossible to put a price tag on freedoms like this.
2) 1099 means the government treats you as self-employed. This is fantastic for tax deductions and more, but even more so because it protects you. How so, you ask? Well, as a self-employed physical therapist, occupational therapist, or speech therapist, you need to carry your own individual professional liability insurance. Most W2 status therapists rely on their employer for liability insurance, which unbeknownst to them comes with many loopholes in the protection; one of which is likely your professional license. How can you continue to practice and provide for your family if your license is challenged, or worse yet, suspended? In today’s society, litigation is becoming more common, and the rewards are becoming more sizeable.
3) Marketability. Most therapists don’t consider building their marketability until it’s time to find a job – and even then, most just turn to Monster to find their next gig. How nice would it be to never have to worry about your marketability again because you’ve worked across a variety of settings and in a multitude of locations? By providing great care in these venues, you’ll find that you have become a desirable team member that others seek. You’ll find yourself turning down job offers without even actively searching for them. You’ll be like a superstar free agent in baseball (aka Albert Pujols), but without all the negative media hype. Pretty cool, huh?
So there you have it – three reasons why you should be a 1099 physical, occupational, or speech therapist. The complacent naysayers may disagree with these, but what are your thoughts? Employers, what are your thoughts on a 1099 vs. a W2 staff of therapists?