Travel therapy sounds amazing (especially as a new grad) - but is it ethical?
Introduction
Throughout PT school we invest thousands of dollars into clinical rotations where we learn our craft and gradually develop our own caseloads. Yet some professors and therapists are still advising against travel therapy after graduating (for various reasons).
Using three principles from the APTA code of ethics, along with our personal experiences, we will demonstrate how, when approached responsibly, travel can be an ethical career path for physical therapists.
We strongly believe that new graduates should be empowered with the tools and strategies to confidently build their professional skills and experience while working toward their professional, personal, and financial goals - rather than being discouraged from exploring a viable and rewarding career path.
Principles (From the APTA Code of ethics)
#6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors.
Every new contract and setting is an opportunity for growth. Here are some examples of how we developed knowledge and skills throughout our careers:
Contract A: Private Orthopedic Outpatient Clinic (6 months)
The staff was highly trained in Maitland mobilization techniques. Our supervisor provided training outside of work hours (even on the weekend), and we learned through both instruction and observation. We incorporated these techniques into our own practice - particularly for the lumbar spine, knee, and shoulder.
Use of adjustable Total Gym equipment. We had not encountered this in PT school or during clinical rotations, but here we saw firsthand how effective it was for progressive loading and building patient confidence - especially early on post-operatively.
NMES for the rotator cuff. While NMES is commonly used to address quadriceps inhibition following ACL injury, this experience expanded our understanding of how and when to apply NMES for other regions of the body, such as the rotator cuff.
Contract B: Outpatient Critical Access Hospital (1 year)
Exposure to a range of cardiac and neurological conditions which helped us stay current with protocols and emerging research.
Vestibular therapist specialist worked here and we frequently observed her sessions, asked questions, and applied her techniques to our patients with balance or vestibular impairments. She allowed us to shadow her when we were not working with patients to deepen our understanding of vestibular rehab.
Collaboration with a residency-trained OCS DPT and local professor which provided us opportunities to exchange ideas, observe treatments, participate in research discussions, and continuously ask questions.
Contract C: Home Health (1 year)
Development of wound care skills such as removing staples, drains, and tubes. We received structured training which included supervision initially and always had access to guidance from senior therapists and nurses.
Improved ability to prevent rehospitalizations through monitoring comorbidities, medication management, wound care, and patient education. All skills we have found to be valuable across settings.
Increased confidence in treating patients in the immediate post-operative phase following TKA, THA, and TSA. We also gained a deeper appreciation for the unique environmental factors, barriers, goals, and other contextual factors that influence patient care in the home setting.
#7: Physical therapists shall promote organizational behaviors and business practices that benefit patients and clients and society.
Not all permanent positions are created equal, and the same is true for travel assignments. The key is being intentional and prepared during the decision-making and interview process. Doing so increases the likelihood of finding “a practice environment that truly supports autonomous and accountable professional judgement”.
In one instance, we turned down a high-paying offer in a location we were genuinely excited about. Ultimately, concerns about productivity expectations made us question whether we could deliver the level of care our patients deserve.
Another important factor is flexibility. As travel therapists, we have the ability to step away from a contract if the setting is not aligned with our clinical standards. We’ve had to make that decision ourselves: ending a contract early when it became clear that the environment did not support the quality of care we strive to provide.
#8: Physical Therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally.
Travel therapy exists largely due to nationwide staffing shortages and increased demand in underserved communities. To illustrate this, we can look at Ellensburg, Washington - a lovely town where Taylor and I spend a year working as travelers.
Taylor and I both graduated from Daemen University in Buffalo, New York. In Buffalo alone, there are three DPT programs, with an additional program located in nearby Rochester, New York (about 70 miles away). Altogether, there are 21 DPT programs in New York State.
In contrast, the entire state of Washington has only three DPT programs, with just one located within a 100-mile radius of Ellensburg. As a result, the demand for physical therapists in Ellensburg far exceeds that of more saturated areas like Buffalo. This pattern is seen across many regions of the country, where demand for physical therapists is high but DPT programs remain limited - increasing traveler demand.
Final thoughts
There are five additional principles included in the APTA Code of Ethics, but the three highlighted in this blog post felt most relevant to the discussion of travel physical therapy. For reference, the full Code of Ethics can be found here.
In my view, one of the primary limitations of travel PT is the difficulty of establishing long-term roots and consistently serving a local community over time. However, I would argue that this is less an ethical concern and more a matter of personal preference and lifestyle.
Personally, long-term service to a community is something I find deeply meaningful and plan to prioritize in a future phase of my career. Many therapists who choose to travel can still spend the majority of their careers contributing to and investing in a single community. Others may prefer to remain long-term travelers, continually relocating to support underserved areas across the country and enjoy the nomadic lifestyle.
At the end of the day, we all take different paths - and as long as we’re taking care of ourselves and providing quality care to our patients, they all have merit.
Travel Safely,
Andrew Kneussle PT, DPT