Adventures in Scheduling

With all the crazy scheduling that is required as a therapist, you'd think they'd make you do logic puzzles as part of an entrance exam. Here are a few general thoughts on the mishaps inherent to scheduling. (this is a bit scattered since I'm still jet-lagged, so please forgive any dangling modifiers or unresolved thoughts)

First off, I think that there is this cultural norm of what a "workday" entails. If your parents worked non-medical white-collar jobs then you can probably identify with a 9-5 workday as we see in so many shows and movies (at least those that actually indicate that people WORK for a living, as opposed to being independently wealthy enough to just sit around and talk). Even in college, actual "working" time for me did not get up to 40 hours/week until the end of OT school (at which point we raced right on past 40 and never looked back). I know that there's tons of people out there doing simultaneous job and college, or 2 jobs regularly, all I can say is more power to you. But I had this expectation that a "normal job" would have normal hours and that the schedule would not be that bad.
I have realized that was complete BS.

This enlightenment took its time coming. On my phys/dys fieldworks, I had a hard time adjusting to a 7-330 schedule, especially with a nonexistent lunch that was dominated by meetings and paperwork. Despite that, people almost never left on time, needing to stay for one reason or another. It was frustrating as a student, waiting at the end of the day to get your notes signed and be told to have to redo them (now) when it was already past "quitting time." The woes of being a salaried employee- you will often work over the expected time.

Scheduling within your day is another insane proposition. In acute rehab, we had to work as a team to make sure (each day) that the client had their required time in all services, minimal time wasted sitting in the gym between services, at least one ADL per week, and so forth. In the hospital, coordinating cotreats was the biggest scheduling portion, and knowing that your whole day was likely to be derailed by patients going to tests and whatnot. The hazard of hospital work is ending up with a back-heavy day because not enough could get done in the morning. School scheduling had to work with the class schedule to make sure that they weren't being removed from important learning opportunities or special classes or being overbooked in a day. (We did pull-out services and I could not even conceive of how to schedule push-in during my year balancing so many different schools. I would love to hear experienced therapists' tips on that.) However good your schedule is, it is likely to get derailed by an IEP meeting or school assembly or lockdown drill. Outpatient scheduling might be assumed to be the easiest, but often you are dealing with people who need to be seen outside of their own working hours or school hours, so fitting in times can be tough.

I'm great at logic puzzles, but daily scheduling is a monumental frustration to me. One of the few beauties of being a prn employee is that I can just show up and do what is already assigned... and if the patient needs to schedule for their next time, I usually turf that to someone else.

Good coworkers will also adjust their schedules to help one another, even if it means balancing inpatient and outpatient work in the same day, or taking something difficult. But that is another thing that will wreck your schedule... and productivity if you have to track that.

My most common work now is as an independent EI contractor. I'm still trying to get into a good groove for getting the kids scheduled out right. Part of me doesn't want to over-analyze it because I don't have a huge caseload (yet?) or time demand, but my left brain would love to just have regular times for each kid each month. Evals have to be scheduled within 15 days of hearing about them, which is not really a lot of time to work people in if you do have a lot of other engagements... like holidays, which we have a few coming up.

Holidays are a whole issue all their own. Remember getting days off in school for holidays? And long Christmas breaks? That does tend to go out the window. Hospital and SNF people have to rotate through holiday coverage... when you start out, especially if you're young and childless, expect to work some of the biggies. I remember a boss telling me when I was interviewing that they paid so well for big holiday coverage (it was good- effectively 3x normal pay plus a PTO day to be used later) that they never had to force people to work major holidays. 6 months later, when those of us who were under 30 were all sitting there on Christmas day, I found those words to be particularly irritating.

Another fieldwork instructor would be laughing at the turn my life has taken. She had her own business, and I remember being aghast when told that we would be working on a major holiday. To student-me, I could not even conceptualize why you would be working on a national holiday. Well, now that I am mostly self-employed, I get it. I just scheduled a kid on a major holiday without even thinking twice. Major reasoning- I no longer get paid to take holidays... or paid regularly at all. If I have a "day off," it's just another day making no money whatsoever, and I've had plenty of those days for awhile. 

Now with my EI kids I would like to schedule multiple visits in a day in a geographically sensible way, but it hasn't worked well yet. If I do a community outing, it's hard to say exactly how much time that will take, so planning the next visit can be tricky. Accounting for travel time is hard sometimes as well. But there's just the general Murphy's Law that comes into effect here also: the people who live near each other will have opposing personal requests, one will want morning and another will want evening; one can only do Thursdays and another Tuesdays; everyone will want 10am; on and on it goes.

Is there a moral to these scheduling woes? (is there anything logical written by someone whose personal time changes have zapped her ability to do anything but stare like a zombie?) I guess the overriding theme would be that you have to be flexible. No matter how nicely laid out your schedule is, it is likely that it could all go to pot anyway. No matter your personal preferences for workdays, if you want to get paid and your employer decides you're working weekends or holidays, that's what will happen. Until you go into business for yourself, and then you'll probably work those days anyway. And if you like the freedom of "set your own schedule" prn work, it's probably good if you have a backup income and a good budget. 


heatherscreativeconcoctions said...

I just found your blog and its a great sneak peak into the world of OT. I just finished my first semester in school so I have a long way to go, but I just subscribed so I can continue to learn through your experience :) thanks for a great resource!

Christopher Alterio said...

Here is a tip for EI scheduling: don't let the schedule of everyone else become your schedule problem. What I mean by this is that being flexible is one thing - being a contortionist is another. For all the conversation about the EI model as being 'family friendly' and occurring in 'natural environments' it is important that the recipients of this societal largesse (FREE services delivered IN THEIR HOMES) understand that there are many other people (other children included) who have needs at play that require accommodation. This kind of conversation can devolve into an interesting debate on the impact of entitlements - but it is important that you don't destroy your own ability to meet people's needs while you are attempting to respond to their requests and demands. So - be as flexible as possible - but try to instill a sense of responsibility for reason from those receiving those services as well.

Cheryl said...

Ah, I hear ya Chris... but I was so much better at laying down the law when I was salaried. Now I feel like I walk a tightrope since I certainly don't have a large enough caseload to (financially) turn away work and my reputation with the families and service coordinators is how I get future referrals. I definitely don't have it all balanced out yet, my hope is that in the next year I can move my far away appts in county x all to one day, no exceptions. I have a spine comparable to a wet noodle sometimes so we'll see how that works.

Abby said...

I agree with Chris. Families need to understand that they aren't the ONLY person you are trying to accommodate. But on the other hand, I also understand that you are trying to build up a caseload. Hang in there, and I'm sure with time you're caseload will expand and it will be easier to tell clients that you only serve their area on X day.