The productivity quota is a clinical problem, not a business one

I spent years in settings where the expectation was clear even when it was never written down. Keep the schedule full. Overlap where you can. Document between patients, or after hours if you have to.

The argument for productivity targets is that they keep a clinic solvent. Fair enough. What nobody wants to say out loud is what they do to the actual clinical work.

What gets cut first

It is never the exercise. The exercise is visible and easy to document. What gets cut is the part that is harder to bill: the conversation where you find out she stopped going upstairs three months ago, the 20 minutes watching how she actually transfers rather than how she performs a transfer when asked, the phone call to the daughter who has been quietly worried since spring.

Those are the parts that change outcomes for older adults. They are also the parts that disappear first when the schedule tightens.

What 60 minutes buys

A full hour with one patient is not a luxury. It is the minimum unit of time in which you can evaluate, treat, educate, and adjust in the same visit. It is also the amount of time it takes for someone to stop performing for you and start showing you how they actually live.

We built this practice around that hour because we could not find another way to protect it. Every therapist who joins us gets asked the same question in the interview: what would you do with a full hour that you cannot do now? Nobody has ever struggled to answer.