Q&A With Travel Occupational Therapist Cheryl Mendoza

I’m excited to share to share this travel therapist interview and Q&A with travel occupational therapist (and my OT school classmate!) Cheryl Mendoza, OTR/L.

In our interview, Cheryl shares why she began traveling as a new grad and offers lots of tips for both new and seasoned occupational therapists interested in travel therapy.

Before we get into travel details, tell us a bit about your background. 

First, I want to thank you for allowing me to share my experience with you and your members. I have been practicing occupational therapy since November 2015, approximately 3 years, in long-term care. I started out as a traveler straight out of school. I traveled each year, as well as held full-time positions at times when I was taking a break from traveling for a portion of each year.

I was drawn to occupational therapy in a unique way. I have an associates degree in Health and Physical education, and at the time when I applied to OT school, I was in the process of obtaining a BA in Exercise Science. I ended up bridging into the MSOT program at Brenau University in Georgia. Before I applied to OT school, I was considering a career in Physical Therapy in addition to several degrees in Public Health. I studied each profession to see where I could make the greatest impact in the lives of others. I was really drawn to PT.

However, I found the field lacked a handful of ideals that, at the time, were keeping me from applying to PT school. I don’t remember specifically what they were now, but I remember talking to someone at my school about my grievances and they stated, “That sounds like occupational therapy. You should be an occupational therapist”. I said, “What’s occupational therapy?”

That day, I took home about 10 books on occupational therapy from my school’s library. After reviewing those specific books, I felt like I had the mind of an occupational therapist for almost my whole life. There was no question, I was already pretty much an occupational therapist. I just had to go to school for it. At the time, I was also rehabilitating a dog, and I had also rehabilitated myself from an illness that crippled my life at the age of 25.

What made you decide to become a travel occupational therapist?

I decided to become a travel therapist because I wanted to learn, theoretically, where our profession was nationwide. I wanted to gain a larger perspective on the differences between occupational therapy practices and interventions across state lines. I wanted to gain an understanding of the needs that are in our field so I could make a contribution later on. I also wanted to see the country, as I have traveled very little over the course of my life.

Travel therapy is also an excellent way to find your setting of preference as you are only bound to your contract for 3 months and can terminate that contract in 2 weeks or 30 days based on your contracts stipulations. For me, it offered flexibility without a long-term commitment at a time when I really did not know what I wanted to do with my license.

What cities and settings have you worked in? Do you have any favorite cities or settings?

My only contracts so far have been in Skilled Nursing. I have also dabbled in Home Health as a PRN occupational therapist. After my very first contract I fell in love with the older adult population. I also saw, and continue to see, many areas of opportunities in Skilled Nursing. Originally, that was not the plan. I wanted to work across many different settings, but I decided to settle on one setting to concentrate my efforts.

To date, I have worked in Texas, Nevada, and Washington State. I am currently licensed in the state of Georgia, where I went to school and where my family lives, but I have not worked in Georgia yet I have worked all over Texas from North to South.

I would advise against South Texas during hurricane season, and West Texas in general because it’s very remote and, from what I hear, not a good place to go if you are traveling alone.

However, all the major cities in Texas have unique identities and there is plenty of opportunity in Texas for OTs. My favorite cities are San Antonio and Dallas. The best thing about Texas is, you are always a road trip away from a fun city like Shreveport or South Padre Island if you want to get away for the weekend.

In Nevada, I worked in Las Vegas for 8 months. In Washington State, I worked near Vancouver for a very short time. I have really loved all my experiences especially because in each place, I was exposed to different cultures and different ways of life. My favorite would be Texas because throughout all my travels, it became my second home.

What is your favorite aspect about travel therapy?

My absolute favorite aspect about travel therapy is reinventing myself after every contract. I always start a contract with the idea that I will learn from this experience and apply it to the way I practice. I also want to leave each facility better than I found it. I personally do not care what type of facility it is.

I have worked in Special Focus Facilities where they were in danger of being shut down. I have worked in 1 star facilities to 4 star facilities. 5 star facilities are very hard to come by, but they are out there.

What I found is it does not matter what facility I go to, every facility has its own unique set of problems. Really, it’s all situational. For example, a 4 star facility has a better reputation than a 1 star facility, but which facility is working toward improvement? A 1 star facility or a Special Focus Facility may have a poor reputation, but it may also be looking for someone to do the right thing because they just replaced their entire staff. A 4 star facility might have a good reputation, but it may also be on its way to winning a 1 star rating. You really never know what you are walking into and that is why I love it.

What I have found is some places need a leader, and some need a follower. I try to accommodate each facility based on their needs at the time. But, in general, I have found that many places need leaders or a combination of both. So, flexibility is key. I also enjoy fixing problems and enabling change. I look at each contract as a project. That is really what I enjoy most about it.

What is the most challenging aspect of travel therapy?

The most challenging aspect of travel therapy is you don’t know what you are walking into, despite all your questions you asked on your telephone interview. It may be in your contract to go to one facility, and you find yourself being bounced around to multiple facilities.

Housing can sometimes be hard to find and you may have to commute at least an hour to work. You will be putting some good miles on your car. And you will be traveling without all of your things. So, take what is essential for you to get your job done, and live your life the way you want. Just remember when you load the car, you will have to carry that plus everything you accumulate on the way to each location.

I would say travel lightly, but I never had. I just treat it as some good old fashioned exercise every time I change locations.

Then there is mail. That has been the biggest headache of all. Originally things were going to my parents, then a friend’s place. I finally bit the bullet and got an online mail service with a Texas address. All my mail is virtual and packages either go to my work or to the hotel I am staying. Lastly, trying to keep/maintain a tax home status. I will talk about that separately.

Any plans to “settle down”? If so, do you think you’ll return to travel therapy in the future?

I do have plans to settle down. I am actually ending my current contract in a few weeks and I signed on full-time in a position in Waco, Texas. I will be signing a year’s lease at a local apartment complex for the first time since I got out of school in order to work on some professional development. I would absolutely consider traveling again in the future. If I do, it will most likely be in an RV. I am excited to see what the future holds for me.

What advice would you give to new grads interested in travel therapy? 

I actually have a lot of advice for new grads. First, it does not matter if you sign on with a mentor or not as long as you have someone in your corner that you can call to help you out.

Make sure that person knows they are your go-to and/or mentor. I signed on with a company that paid me less to be in a new grad program, and I called my mentor twice. I mostly reached out to the people I worked with at the time, or people I went to school with.

It is also important to go into a facility that supports you as a new grad and is willing to
train you. That means a few things:

1. You are not the only OT. And if you are, is there a full time PT to help you every day? The PT could be a contractor or have full time status. But if the PT is PRN only, I would think twice about signing that contract. You do not want to be completely alone on your first contract.

2. They should expect your productivity to be lower initially and for a longer period because you are learning.

3. They encourage you to ask questions and they genuinely care about your well-being. My first facility was “New Grad friendly”, and they truly were. They were also getting billed less money for my New Grad status. I was also making less. So, forgive yourself now for not knowing everything you need to know before your first day on the job. My confidence level didn’t get to a good point for me until I was at least 6 months in. And your
confidence will continue to improve after that.

It’s been 3 years for me, and I am pretty confident at most things. And the only way it truly improves is over time and with experience. So don’t beat yourself up about how you feel about yourself. It will get better.

Tracking Your Time

You may be encouraged to work off the clock and engage in unethical billing to compensate for low productivity. For both, don’t do it. I have showed up a week early to a contract and on my own time, asked to be trained by the previous OT practitioner who was also a contractor, on maybe their last few days on the job.

This was only when I was new for my first few contracts. They showed me how to input evaluations on a new computer platform, they passed on treatment ideas for problem patients, and they were honest about what difficulties I may have looking ahead.

Then I spent the weekend preparing. This is more like “volunteering” as opposed to “working off the clock.” Working off the clock means you are employed with a contract, and you clock out to complete paperwork to meet your productivity standard. This is only hurting our field if you engage in this practice. Productivity used to be lower for everyone, but standards continue to rise and they are unachievable with best practice at most places.

I recently worked a contract where the facility was centered around rehab. We all had tablets, internet access was throughout the building, and I made 90% productivity without any problems the whole entire contract. That is few and far between. Your best bet is to write down why your productivity is lower than expected each day and touch base with your recruiter about it. Once you learn what you need to do, it is your job to be as productive as possible.

If you make a phone call, are eating, take a break, find yourself chatting about nonsense with your friends at work for a longer period of time and are not doing work, then clock out. But do not clock out when you are truly working. Also, it is illegal. All documents are time stamped and if someone wants you gone, they can run an audit and dismiss you for it. Because after all, if the situation was reversed and you showed the labor department you were made to work off the clock, you would have a good lawsuit on your hands and guess what? You would win.

Ethical Dilemmas

The only way to tackle unethical billing is to know what you can bill for. The SNF setting is known for its shady practices and many companies have been convicted, found guilty, and/or have made huge settlements with the government recovering billions of dollars. Not frequently. Not every so often. But every single year. You can check the status on all those lawsuits on the website for the Office of Inspector General. I also recommend Googling the company name to see if lawsuits pop up.

Now, if you find yourself going into a position where this has happened to a rehab company, do not be scared. They are most likely under sanctions to prevent further abuse, and this can actually help you walking in. There will be more training, more requirements, more documentations, more follow ups, and more audits.

Do not be scared of an audit by the way. All my documentation has been refined by the many audits that have been done over my work. Because with an audit, you will get feedback and they will ask you to change what you wrote. You can change almost everything except a daily note. Mostly, that’s because no one can remember what they did weeks ago in a session. And when you are changing another note, you are not changing things likes dates and writing something that isn’t true. If it doesn’t feel right, don’t do it. But it can be a great learning experience.

Lastly, you may walk into a paperwork nightmare. People may ask you to complete discharges on people dating back before you were employed there. Some software won’t let you do it. Some will. If it happened before you came, it is not your responsibility. If management cannot complete their work (called a “close out”) each week or by the end of the month, that is not your problem. That solution is quite simple. Just say no.

Regarding saying no, get used to it. If you are a passive person, occupational therapy will turn you into an assertive person in no time. I actually recommend looking up professional ways to be assertive or read a book on it. You will need those skills. And really it’s not because there are a bunch of bad people out there wanting you to do something you know you shouldn’t.

Most of the time it’s about someone asking you to do something they think is “okay” for you to do, and it’s not. That is because after you are a new grad, you will most likely be the only OT in your building. You may be the only full-time therapist present in the building every day and no one knows the laws governing your license except for you.

You are going to be the only person who really, truly cares about your license. Everyone else is submerged into their roles and responsibilities as well. It is okay to say no and, in the future, you will learn to say no in combination with offering another solution to the problem. After all, you don’t say no because you are not a team player, you say no because you are one. When you protect yourself, you protect everyone.

People that don’t know law and ethics like they should may not necessarily be bad people. They could be people who choose to stay ignorant because, honestly, doing the right thing is hard. Denial is not just a process for insurance claims. It is also an unsolicited response from our brains when we are overworked, overwhelmed, avoiding conflict, or simply just because it’s easier than facing the facts.

A director may ask you to do something they know is wrong, because they are being told to ask. They might not have the skills you have to be okay with saying no. But when you say no, your director will report back that you said no, and they will feel better because it wasn’t them who said it. The buck should have stopped with them, but it didn’t. So don’t feel like the bad guy.

You are never obligated to break the law or do anything unethical. You are obligated to uphold the law and practice ethically.

Do you have any other general advice you would give to a seasoned OT interested in travel therapy for the first time?

The advice I would give to a seasoned professional wanting to travel would be fairly simple. Evaluate your motive for embarking on a travel adventure. Travel therapy can be the way to go when exploring a new geographical area where you may want to live, taking a break from the monotony of everyday life, and/or exploring a new setting. Whatever your goals are, make that clear to your recruiter. If you don’t have any direction on where you want to go or what you want to do, make that clear as well. They can help you and you can work together to make sure your needs are met.

I would be prepared to bring your own assessments and some treatment items because some places you may go, will literally have nothing for OT. I usually keep fine motor kits, a binder of assessments, and odd and ends that I need to do my job specifically based on how I have been practicing the last few years. That way, you can walk into a building and not skip a beat. Mostly all places will have the basic adaptive equipment you will find in a hip kit. If not, then request to order some. Most likely, they will not object.

Do you any tax home tips for those unaware of what it is?

I definitely suggest getting an accountant that is knowledgeable in travel therapy to help guide you in your unique situation. For me, I declared a tax home, and return to it to work for the majority of the year. I never abandon my tax home by working a contract then signing on full time with that contract/and or facility. If I like the contract/and or facility, then I will seek employment at a later time.

Once you set out to travel the most important concept to consider is what it means to abandon your tax home. If you are audited, this is the most detrimental factor to the IRS in regards to proving that you were in fact a true traveler and received tax breaks and stipends legally.

I urge you to look into your tax home situation and review it carefully to make sure if you are audited, you are not liable to pay back any money to the IRS. If you look up the criteria and feel like you do not meet the guidelines to declare a tax home, which would make you ineligible to take tax breaks and stipends, you can have full taxes taken out of your check.

[Disclaimer: Be sure to speak with an accountant and a trusted recruiter for further information on tax homes and the tax components of travel therapy.]

How do you answer when people ask you, “Which companies should I sign on with?”

In travel therapy, your recruiter can be more important than the company they work for. So ask around. Who loves their recruiter the most? Go with them. Otherwise, it is very common for companies to offer CEU reimbursements, first day insurance, short and long term disability, and 401K. If you have friends that are traveling, keep in mind they get a bonus for the referral if you use their name.

So make sure you like what the company has to offer and don’t get sucked in only because someone will be making money off the referral. Also, it is very common for travelers to sign up with more than one company to get the highest rates.

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I want to give Cheryl a huge thanks for being a part of the Travel Therapist Interview Series and sharing so much helpful information! We will be featuring more travel therapy content and would love to hear what you’d be interested in learning more about.

If you have any other travel therapy tips you would add, please share them in the comments below.