Interview guide for therapy roles: a loop for physical, occupational and speech therapists and assistants

Therapists work with a degree of independence that most clinical hires do not have. A physical, occupational or speech therapist evaluates the patient, sets the goals, decides the plan, supervises assistants and writes the notes that justify payment, often with a full schedule and little time between patients. A candidate who interviews warmly can still set vague goals, keep patients on the same exercises for weeks or write notes that do not show why skilled care was needed. A good loop confirms licensure the right way, then tests clinical reasoning, documentation and patient communication on a realistic case.

This guide covers physical therapists, occupational therapists, speech-language pathologists and their assistants in outpatient clinics, hospitals, skilled nursing and home health. Recruiter screens are in physical therapist screening questions, occupational therapist screening questions and speech-language pathologist screening questions. Clinical support roles such as medical assistants and CNAs are in the interview guide for healthcare roles, and counselors and other mental health clinicians are in the interview guide for behavioral health roles.

The loop at a glance

Stage 0: licenses, compacts and exclusions

• State license. Verify with the licensing board in each state where the candidate will treat, including telehealth patients in other states. Record status, expiration and public discipline.
• Compact privileges. A compact privilege is permission to practice in another member state based on a home state license. The PT Compact provides a privilege verification tool. The Audiology and Speech-Language Pathology Interstate Compact reported in 2026 that some member states were issuing privileges to practice. The OT Compact said in October 2026 that it was not yet operationalized. Check each site at the time of hire.
• Assistants. Physical therapist assistants, occupational therapy assistants and speech-language pathology assistants are regulated differently by state; some states license or register them, and supervision rules vary.
• Exclusions. Providers billing federal health programs should screen against the HHS OIG List of Excluded Individuals/Entities.

Stage 1: the screen (20 minutes)

• "Our typical day is [example: 11 to 13 visits in outpatient orthopedics with 45-minute slots]. What have you carried and how did you manage documentation?" State the productivity expectation as an example of your real schedule.
• "Which settings and populations have you treated in the last two years?" Pediatrics, neuro, orthopedics and geriatrics are different jobs.
• "Would you supervise assistants here? Have you done it before?"

Stage 2: the case-based plan of care (40 minutes)

Give a one-page referral and evaluation summary written for the discipline. Physical therapy example: a 72-year-old two weeks after a total knee replacement, living alone with a second-floor bedroom, limited knee flexion, a fall last year and a goal of returning to church choir. Occupational therapy: the same patient with dressing and bathing limits. Speech-language pathology: a patient after a stroke with mild dysphagia and word-finding difficulty.

Ask the candidate to:

1. Name two or three additional things they would assess, and why.
2. Write two functional, measurable goals with timeframes.
3. Choose interventions for the first two weeks and say what would make them progress or change course.
4. Describe discharge criteria and the home program.
5. Say what would make them stop treatment and contact the physician, such as signs of a blood clot or infection.

What to score

• Reasoning: links findings to the patient's goal, not to a standard protocol.
• Goals: functional and measurable, such as climbing a set number of stairs with one rail, rather than "improve strength".
• Safety: recognizes red flags and the fall history.
• Discharge thinking: plans for independence from the start.

Stage 3: the documentation sample (15 minutes)

Ask for a short daily note for the case's third visit, using details you provide. Score whether the note shows why the skills of a therapist were needed, ties the treatment to the goals, records objective measures and avoids copying the previous note. A note that describes services the case facts do not support is an automatic fail; inaccurate documentation is a billing integrity risk, not a style issue.

Stage 4: manager interview (35 minutes)

1. "Tell me about a time the schedule pressure conflicted with what a patient needed. What did you do?" Listen for: protecting the patient's care and raising the issue, not quietly shortening sessions or padding notes.
2. "How do you supervise an assistant you have not worked with before?" Listen for: knowing the state and payer supervision rules, checking competency and staying available.
3. "Tell me about a patient who was not progressing. How did you decide what to do?" Listen for: re-assessing, changing the plan, or discharging with a home program.
4. "Describe a disagreement with a physician or nurse about a patient's plan." Listen for: evidence-based, respectful advocacy.

Stage 5: patient education role-play (10 minutes)

A staff member plays the patient from the case, who is anxious and says they did not do the home exercises because they hurt. The candidate teaches one exercise or strategy and checks understanding. Score plain language, teach-back and how they respond to pain without dismissing it.

Scorecard competencies and weights

Example weights for a staff therapist. Lock yours before the first candidate.

For assistants, replace goal setting with following and reporting on the plan of care, and score when they would contact the supervising therapist.

Legal and regulatory points to check

Checked against the linked primary sources as of October 2026. Not legal advice; state practice acts, payer rules and your counsel decide.

• Licensure and compacts. Practice requires a license or a valid compact privilege in the state where the patient is located. Compact status changes; check the compact sites above at hire.
• Supervision of assistants. Rules come from both state practice acts and payers. For Medicare outpatient physical therapy, 42 CFR 410.60(a)(3)(ii) covers services furnished by, or under the general supervision (or as specified otherwise) of, a physical therapist in private practice. State law may be stricter, so check both before you describe the supervision model to candidates.
• Medical questions. Under 29 CFR 1630.13, do not ask about disabilities or health conditions before an offer. Describe the physical demands, such as assisting transfers, and ask whether the candidate can meet them with or without accommodation. See pre-employment medical exams under the ADA.
• Background checks. When a consumer reporting agency runs the check, 15 U.S.C. 1681b(b) requires a stand-alone disclosure, written authorization and pre-adverse action notice. See the FCRA background check process.

The decision rule

1. Gate: license or compact privilege verified in every state of practice; no exclusion.
2. Floor: at least 3 on clinical reasoning and no inaccurate documentation.
3. Weighted total: in this example, 2.8 or higher on a 1–4 scale is an offer.
4. Contingencies: background check, references from a clinical supervisor and a written orientation plan.

Mistakes that weaken therapy loops

• Interviewing only about personality. Patients need reasoning and safe plans.
• Hiding productivity expectations. State them early, with real numbers for your clinic.
• Assuming a compact covers every state. Verify the privilege, state by state.
• Letting a non-therapist score the case. Only a senior therapist of the same discipline should own stage 2.