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View Full Version : PRN - Shouldn't I be paid for all of my work time? Georgia


GA1998
12-29-2010, 08:28 AM
I'm a therapist working for a home health company. I am PRN status and typically work 2 days a week. We are paid by the patient (not by the hour) and receive different rates per visit depending on the care being given (i.e. therapy visit, evaluation, etc.). However, there is a good bit of extra work outside of the actual patient visit that I don't get compensated for and it does not seem fair. I can spend anywhere from 1 to 3 hours a day after my patient visits calling doctors, medical equipment companies, typing patient notes, etc. On my off days I sometime receive return calls from doctors and can spend 30 minutes to an hour dealing with various issues concerning the patient and the call from the doctor. My employer does not compensate me for these additional hours outside of the visit. Is this correct and is it fair? Recently, my employer began paying full-time employees for the extra effort outside of patient visits only after they exceed 40 hours in a work week. Full-time employees are also paid by the patient. It does not seem fair as I will never go over 40 hours since I'm a PRN employee, yet I do many of the same things my co-workers who work full-time do outside of a normal treatment visit. Please help me and provide some guidance as I'd like my employer to compensate me fairly and accurately.

DAW
12-29-2010, 10:44 AM
What is a PRN? I know what a RN is, but PRN is new to me.

Past that, I am including a pointer to a FLSA factsheet for the rules on Nurses. Since I have no idea what a PRN is, I do not know which rule relates to you.

http://www.dol.gov/whd/regs/compliance/fairpay/fs17n_nurses.pdf

Betty3
12-29-2010, 11:12 AM
She might mean she works when needed - PRN (pro re nata) Latin.

GA1998
12-29-2010, 11:18 AM
I'm a physical therapist. PRN stands for as needed basis. I may work 10 hours one week or 15 the next. There are no set minimum hours as there are with part-time and full-time employment.

Worriedspouse
12-29-2010, 11:27 AM
Possibly a Practicing Registered Nurse. Betty's description is also used.

TSCompliance
12-29-2010, 11:44 AM
Yes, PRN in the healthcare field means "as needed."

I'm not in home health, but when I supervised an outpatient therapy clinic (mental health) we paid the therapists only for the face to face time with clients, i.e. the time billed to Medicare, Medicaid, or other payer.

The job description specified that the expectation was that the therapist will deliver the billable session for a certain pay rate, and that this included any supporting work that made the session possible, such as managed care paperwork, phone calls & rescheduling.

The therapists were not paid for phone calls, or things they did in between appointments. Those who chose to write their session notes after the session were doing this without pay, but we did a lot to assist the therapists in writing their notes within the billable session.

I never thought much about the legality of this regarding wage & hour laws, but I can at least say that it is pretty common. The therapists earned well over minimum wage, so that's probably how it was legal. For instance, the therapist may have been getting $40 for an hour of therapy, and this also covered the 10 minutes it may take to write a note, or the 5 minute phone call that was involved in the client changing the time of the session. I'm sure they could have nit picked and tried to do a wage claim for the 5 or 10minutes, but then we probably would have dropped their hourly rate, and they wouldn't be getting $40 an hour anymore:)

Betty3
12-29-2010, 11:46 AM
Per OP's posts, they are a physical therapist & PRN means they work on a as needed basis.

DAW
12-29-2010, 01:06 PM
A therapist may or may not be Exempt under the Professional exception (http://www.dol.gov/whd/regs/compliance/fairpay/fs17d_professional.htm).
- If the employee is non-exempt, then under federal law (FLSA), the employee must be paid minimum wage (on average) for all hours worked in the workweek, plus probably overtime for hours past 40 in the workweek. Although there are certain potential overtime exceptions (such as 44/36) associated with some health care employers.
- If the employee is exempt, then the rules can be found in the factsheet I cited.

TSCompliance
12-29-2010, 01:14 PM
But working PRN automatically means you're not paid on a salary basis. Doesn't that mean they are automatically non-exempt?

The way we did it with our therapists was we paid them a sum of money for a "unit" or a "job" which was usually an hour of psychotherapy delivered and billed. But if the hour of psychotherapy also required a few phone calls to set up, and a few minutes of paperwork, we considered that all part of the package. And since therapists got around $40 for this "package" of work, it was allowed.

I'm just saying that this practice of paying PRN professionals in healthcare is pretty common, and if it were illegal, all these companies wouldn't be doing it, right? I hate to just assume that because my old company did it, it must have benen legal, but with so many clinic-based and home-based healthcare entities doing it, there must be something to it.

The OP seems to be getting paid for a "visit" which is what I'm calling a "unit of service" or a "package" which includes face to face time plus supporting activities like phone calls and paperwork. (I'm leaving out the half-hour required doctor phone calls for now, because I would advocate to my company that those be paid at least MW). But it appears the OP beleives she is being paid only for the actual time spent with the client, but she may be getting paid a lump sum for a "unit" of service. As long as it works out to over MW (which I'm sure it's way above) then what's the problem?

DAW
12-29-2010, 01:28 PM
But working PRN automatically means you're not paid on a salary basis. Doesn't that mean they are automatically non-exempt?

Probably. But probably and certainly are not the same thing. From the factsheet I cited:


Practice of Law or Medicine

An employee holding a valid license or certificate permitting the practice of law or medicine is exempt if the employee is actually engaged in such a practice. An employee who holds the requisite academic degree for the general practice of medicine is also exempt if he or she is engaged in an internship or resident program for the profession. The salary and salary basis requirements do not apply to bona fide practitioners of law or medicine.

Which beggars that question is a "therapist" a "bona fide practitioners" or not. I do not know, which is why I suggested that the OP actually read the rules associated with their profession, and not guess.

Betty3
12-29-2010, 01:42 PM
Here's some info from another forum.

http://www.humanresourceblog.com/2009/03/25/physical-therapist-hourly-vs-salaried/

TSCompliance
12-29-2010, 01:46 PM
For most of us licensed healthcare professionals, and I'm sure PT's are included here, we would never call what we do "practicing medicine" as it would be unethical and violate our professional codes of conduct.

TSCompliance
12-29-2010, 02:00 PM
I'm wondering if this qualifies as what other fields call "piece work"? In healthcare we just call it "working PRN" but it's essentially piece work. You aren't necessarily paid for your exact time, but for a "piece" of work.

For example, I can pay the Physical Therapist $40 for a unit of service, which includes time spent with the patient, plus the supporting activities surrounding that session. Let's say this unit includes 1 hour face to face with the patient, 10 minutes of phone calls and 10 minutes of paperwork, making the unit 1 hour, 20 minutes. The PT thinks she is only being paid one hour for 1:20 of work, but she is actually being paid "piece work."
If she complained to me, I could always say, fine, I'll pay your exact time, but I'm dropping you to MW." So what's that, like $7.95/hour? So now for 1:20 she only gets paid like $10.60. The $40 is MUCH higher.

I'm sure physical therapists, even in Georgia, earn more than mental health therapists anyway, so we are likely talking a higher pay rate than the $40 I cite.

DAW
12-29-2010, 04:16 PM
The various rules for medical related professionals are discussed in 29 CFR 541.300-304. If one looks through the entire group of related sections, these rules cover a lot more then just doctors. For example, it is possible for certain "athletic trainers" to be Exempt under the Professional exception.

I am going to again suggest that therapists are not inherently exempt or non-exempt based on the title. That one needs to read the actual rules associated with the exception. And that not all employees who are Exempt under the Professional exception are subjec to the Salary Basis requirement.

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=4aea73970f5c409dd1bbc1d00b299f67&rgn=div5&view=text&node=29:3.1.1.1.22&idno=29#29:3.1.1.1.22.4.85.5

Now IF the employee is indeed non-exempt, then MW/OT is applicable, and many payment methods, including piece work, could be in play. But determining the Exempt status is the dog here, not the tail.

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