The wage question in a physical therapy business

What to take away

What the pay figures actually are

The Bureau of Labor Statistics on physical therapists publishes the current numbers, and they are the ones to quote in a hiring conversation.

The May 2024 medians: $99,710 a year and $47.94 an hour for physical therapists. Assistants: $64,520 and $31.02. Aides and attendants: $34,410 and $16.54. The middle half of therapists earned between $82,610 and $120,700.

The same page breaks pay out by state and metro area, which matters more than the national figure. A therapist in a rural market and one in a coastal metro are not in the same labor market. The local posting is the only thing that tells you which one you are hiring in.

The Bureau's Occupational Employment and Wage Statistics program publishes state and metro tables by occupation code, and every state labor market information office reprints them. Indeed and LinkedIn postings give the asking range this month. Glassdoor gives self-reported numbers. All three are noisy, so write down the figure and the date you read it.

Some pay structures come with published ranges of their own. Travel and contract therapy assignments typically advertise $40 to $60 an hour plus a housing or meals stipend. Per-visit outpatient contracts typically run $35 to $60 a visit, and home health per-visit pay typically runs $60 to $90, with the clinician absorbing drive time.

Loaded cost per sellable hour

A wage is not what a visit has to cover. Loaded cost per sellable hour adds employer taxes, benefits, professional costs and paid time the schedule cannot bill.

A worked example

Take a therapist at $95,000 base, and fill in your own figures:

Loaded cost per paid hour: C = (S + T + B + P) / H = $112,750 / 2,000 = $56.38.

Loaded cost per sellable hour: K = (S + T + B + P) / (H - U) = $112,750 / 1,500 = $75.17.

Where the 9 percent comes from: FICA at 7.65 percent, with Social Security capped at the annual wage base and Medicare at 1.45 percent with no cap. Federal unemployment costs up to $42 per employee a year after the credit.

State unemployment taxes apply to a wage base that starts at $7,000 in some states and tops $50,000 in others. Workers' compensation and any state paid leave program sit on top of that.

That visit has to cover $75.17 before the room, the front desk, the billing software or the owner's time. Owners who compute C think they are paying $56 an hour and find out a year later they were paying $75.

The gap between C and K is U, and U is mostly documentation and supervision. The schedule template decides labor cost as much as the offer does.

For an assistant, run the same formula and add the supervising therapist's minutes per assistant visit to the therapist's U. An assistant's K looks low until the supervision it consumes is counted.

Pay structures and how they fail

Beyond base pay, sign-on bonuses for clinicians typically run $3,000 to $10,000, usually with a repayment clause if the hire leaves inside a year. Continuing education stipends commonly run $500 to $2,000 a year, and the $1,200 in P above assumes a modest one. Count both in B and P, not as goodwill.

If you use a productivity component, three conditions belong in the design. It counts delivered visits, never billed amounts. Same-day notes are a condition of earning it.

A compliance adviser should review the design against payer rules and the state board's position on fee splitting. The licensing and compliance guide covers finding one.

The rules with authorities

Overtime and timekeeping start with the Department of Labor's compliance assistance for new and small businesses. Your state labor department may set a higher standard.

Whether a clinical role is exempt from overtime is a legal classification question for an employment attorney. The federal salary threshold for the exemption has moved twice in recent years and has been in litigation, so check the current figure before you use it.

Pay equity and non-discrimination obligations are explained at the EEOC's small business resource center. They apply to how pay is set and adjusted, not only to hiring.

Required employer contributions and workplace postings come from your state's own list. Ask a payroll provider who works in your state.

The clinic-specific trap runs through all three. A clinician who documents at home is working. If hourly, that time must be paid. If salaried, it is a workload the template failed to hold. Either way, it is a record the practice should be able to produce.

Pay and the calendar

Labor cost is decided twice: at the offer, and every week in the schedule template. A template with documentation blocks, buffers, evaluation slots and supervision built in gives a clinician a day they can finish. That is what the operations and workflow guide is for.

A template without them raises U and K, and sends the clinician looking elsewhere. That is why how to hire reliable staff for a physical therapy business treats the job advertisement as a description of the calendar rather than a figure.

At $75.17 per sellable hour, a 45-minute visit has to collect about $56 before the room, the front desk and the billing software are paid. A schedule of 11 visits at 45 minutes fills 495 minutes, more than an eight-hour day, before a single note is written.

Onboarding weeks, when a hire is paid and delivers nothing, belong in the labor cost too. A new graduate clinician typically needs two to six weeks before carrying a full caseload, and the hiring and training guide covers how long they run by role.

Fees have to cover K on every delivered visit. Where they do not, the fix is in the template or the fee schedule, not in the offer.

The referral flow that fills a new column is the subject of the marketing and growth guide. A column that does not fill makes every K on this page worse.

Common questions

What should I pay a physical therapist?

Start with the BLS median for your metro area, then check what local postings are asking this month. Set the offer from those two numbers and from what your calendar can actually pay. A therapist at the national median of $99,710 needs visits that cover roughly $75 an hour loaded, which is where most offers go wrong.

Is productivity pay a good idea?

It is common and it is hazardous. Tie it to delivered visits, make same-day notes a condition, and have a compliance adviser review the design against payer rules and the board's position. Never tie it to billed amounts.

Should documentation time be paid?

It is work. Hourly staff must have it recorded and paid. Salaried staff must have room for it inside the paid day. Documentation at home is the sign the template is broken, not the sign the clinician is slow.

How do I compare a salaried offer with a per-visit offer?

Compute K for both from your own template: paid hours, unsellable hours, and for per-visit pay, the cancellations the clinician will absorb. The lower K for the same delivered visits is cheaper. The one that pays documentation is the one that keeps the clinician.

What does a physical therapist assistant cost per sellable hour?

Run the same formula with the assistant's own numbers. At the national median of $64,520, plus roughly 9 percent in employer taxes, $6,000 in benefits and $1,000 in professional costs, the loaded figure is $77,327 over 1,500 sellable hours, or $51.55 an hour.

Add the supervising therapist's minutes per assistant visit to the therapist's U, and the real gap narrows.