Need Experience to Get Experience? An oxymoronic reality for new grads.

If you’ve been connecting with me in the last, say, 6 months via any social media outlet – you know that I have a deep passion for the future of our profession. Moreover, you know that I firmly believe that our students represent that future.

This post is an unofficial, manager’s follow-up to my Blog @DrBenFung post: New Grad Career Strategies. Speaking of… a post that you should probably read first before to continue on the content below. And, unlike much of my usual quite positive, constructive, and uplifting content – this post will be uncharacteristically and necessarily sharper, challenging, and perhaps disagreeable. After all… this is an opinion column☺.

One thing that has always perplexed me is how poorly we pay (and treat) our new grads. And sure, experience has to count for something! According to the paychecks, experience certainly DOES count for something – a great many somethings! But, does it mean we need to degrade our new grads and pay them rates which are less than some per diem PT assistants? What does this say about how we value our new grads – the very people who represent our future (As a profession? As an industry? As a society for whom they will care for)

In my opinion, as a rehab director, I want to be able to pay well for employees that are productive. I define productivity as high, demonstrated earning power with low cost of labor (and associated employment costs); essentially, anyone who is willing to put forth the effort of giving me quality care that increases my program’s profit margin.  This translates to staff that is efficient; someone seeing a high percentage of billable patient minutes per minutes working; someone who is able to manage their work to not going into overtime; someone who can clinically deliver so that patients benefit the most in the shortest period of time AND delivers lasting results.

This earning power and ability to be operationally efficient is something that EMBODIES new graduates. They are high energy, exceptionally passionate, tech savvy, and are high velocity once they are properly oriented to any setting. In fact, it is my observation that most new grads hold higher rates of productivity (and thus earning power) than many of the “experienced” staff. So why are we paying new grads so very little when their demonstrated earning power is high? Why are we rewarding some of our senior staff to be less than optimally efficient and to be quite costly to the business? Are the experienced staff truly adding that much value to the business to balance out for the lack of earnings?

You need experience to get experience; everyone has to start somewhere. So much talent is wasted simply because experience is not demonstrated on paper. Even more talent is ignored, demoralized, shut down, and ultimately wasted – despite demonstrating stellar contributions – only because an organization’s tradition holds years tenured to magically convert to an employee’s value.

This concept flows dangerously over to promotions, managerial opportunities, research, and pay – want to move up? GET IN LINE! Did you demonstrate potential, ability, or talent? Too bad! GET IN LINE!


If experience is all that is required to capture a higher paycheck (and the above desirables) and no other factors are being considered, our new grads are in for a terrible first five years of workplace experience. Someone needs to put faith in that one new grad and hire them on. But, more importantly, someone needs to begin valuing their education and training; education and training given by the best, brightest, and most experienced of our colleagues. Someone needs to start recognizing it is not best practice to simply take advantage of their business position and low-ball their pay because they are fresh out of school, in debt, and in need of a job.

Someone… needs to start paying new grads what they are truly worth. And, someone needs to start paying more “experienced” staff what they are worth – for what they are actually contributing.

I suggest that pay should reflect both on the contribution of experience AND the contribution of daily operations. In healthcare, we don’t like thinking this way. We don’t quite enjoy thinking about our pure, uncorrupted, and giving profession as a business. Why? Because, healthcare should be a calling! However, the industry is truly still a business – if business fails, clinics close, SNF’s shut their doors, and hospitals get demolished. In fact, a nursing facility just closed down near my facility and I am getting a LOT of calls for job openings – just an example of how physical therapy is still a business.

So let’s talk business! There is absolutely value in the experience of an advanced clinician. There is also value in the freshness and up-to-date science that the experienced professors bestow upon a new graduate. Reimbursement, in part, communicates how much employers value an employee – their expertise, their skill sets, their earning power, their company loyalty, and their contribution to a department as a whole. Where I get hung up is when a member of the staff demonstrates low earning power and poor clinical outcomes; for this, they make tremendously more money than a new graduate (who is working with far more work ethic and gross intensity), simply because of longevity in the industry and seniority with a company (for which I question the basis thereof). I suggest that employees in our profession should definitely be rewarded and valued for their loyalty and years of experience. However, staff should also be valued and paid for their demonstrated earning power; in essence, therapists should be paid in part for the work they do – a type of commission. A commission that reflects upon a staff’s performance in efficiency/productivity as well as clinical outcomes and patient satisfaction. A salary that directly reflects upon the work they do. What a concept?!

Furthermore, experience is almost a prerequisite for upward mobility. Do you want to be a manager or a team leader? Well, first… you have to have been one before. Hmm, that doesn’t sound right. There is immeasurable potential in our new graduates. There is passion. There is ability. There is a humility to learn. And, there is willingness to change. These attributes make some of our new grads excellent choices for future leadership. But, how are we to groom these freshmen to become team captains in the senior year if we don’t ever ease up on them? If we never make them feel like they are part of the team? We risk burning out a great number of newly graduated physical therapists, if as an industry, we do not change our attitudes regarding our new grads. I think companies should begin developing leadership tracks for new graduates for specific training and rearing in clinical and business leadership. I think that new grads that are identified to perform above the norm – especially new grads that make senior clinicians look bad (you know who they are…) – THESE new grads are the individuals we need to rescue from the hazing of being “new”. These are the people we need as our future leaders; empowered, energized, engaged, and under growth from wise counsel.

I think it is high time for a change. I think this change will also cause the market as a whole to recognize the value in our profession. I’ve mentioned several times that market value is all about positioning. Top shelf products are placed on the top because companies value their products as the highest of quality and expense. Successful companies will persuade the consumer of said value and purchases are made. If we pay out poorly to our new grads, it tells our consumer we value OURSELVES poorly. They will value us poorly and as a result we will ALL be valued poorly and paid in kind.

For myself, I am still learning much about healthcare administration. I do not have full control over who I hire and how much I can pay. However, I can assure you that once I do have control over these items, I will begin to influence ways of valuing employees by how they perform and how they contribute to a team – NOT by the simple amount of years they’ve accrued doing the exact same thing in the exact same way.

Now! Do I consider some of our most esteemed colleagues who are ground breaking in their clinical, research, and business practices in the same regards? Absolutely not! Again, if you’ve been with me for some time, you’ve heard me say that I fiercely believe: as a service industry, we should all be valued at what we do and how we do it. Much of the “how” comes with time, life experience, and hours of further education & training. Some of the how also comes from the heart; a willingness to serve, to care, and to go the extra mile – both for those whom we serve, and, for those who provide us with employment.

So I leave you with a challenge: If my words cause you to feel threatened, disgruntled, offended perhaps? Psychology teaches us that if you feel a certain way, there is most likely a reason. Dissonance is one of the first signs of guilt. If my words seem sensible and you are in a position to effect change, PLEASE! Make those changes. And, do tell me on how you implement those changes so that I can learn from you.

Change is never truly welcome. But, guess what? Healthcare is changing. Systems that don’t change to adapt to the environment will struggle, lag, and ultimately fail.

Change is necessary. Gone are the days when experience, alone, is necessary. If this remains the norm, then we have failed our new graduates. What is worse, if this remains the norm – our profession will fail. Now are the days when the experiences in school, residency, and fellowship MUST be more than sufficient in the working world. How will you effect this change? How will you contribute to the solution?


I’ve voiced my thoughts. These are my opinions; what are yours?

Most earnestly & respectfully,