By: Mathew Hilton, PT, DPT, MS
University of Delaware Physical Therapy Class of 2017
A physical therapist (PT) is a healthcare professional on the rehabilitation team. The PT specializes in the diagnosis and treatment of movement disorders of the neuromusculoskeletal system. Do you have pain that you feel during movement or after maintaining certain positions? Does this pain limit you from performing certain activities? If yes to both, then you most likely could benefit from physical therapy.
The education of a physical therapist includes a three year doctoral degree that consists of didactic, clinical, and in some cases, research components. After graduating from physical therapy school, a PT will be trained to work in a variety of settings, including: outpatient orthopedic (most prevalent and popular), inpatient acute care (hospital), skilled nursing facilities, rehabilitation hospitals, home health, schools and industrial settings.
Before I started my DPT education at the University of Delaware, I graduated from UCLA with a Physiological Science B.S. and I acquired hundreds of hours of physical therapy volunteer and aide experience before I applied to DPT programs. I had experience in an inpatient acute care hospital, skilled nursing facility and several private outpatient orthopedic clinics. I elected to take a gap year before starting graduate school in order to gain many of these experiences. In my gap year, I also worked in a variety of other experiences as a private tutor/college consultant, a manager for a CPR training company and a physical therapy aide in a private outpatient orthopedic clinic.
Outpatient Physical Therapy
In an outpatient orthopedic physical therapy setting, a PT can work a schedule that may range from 4-10 hours per day. The PT will treat one patient every 20-60 minutes, depending on the payer mix of the clinic and whether the appointment is an evaluation or regular treatment. For the patient, their appointment will typically take 45-75 minutes to complete. Since this is longer than the face-to-face time allowed between the PT and patient, the clinic will typically employ physical therapy aides to manage the other patients in the gym while a PT is working with one patient.
During an outpatient orthopedic physical therapy evaluation, the PT will first take a subjective to learn the patient’s reasons for therapy while also developing hypotheses about the primary cause of the patient’s complaints. The PT will analyze the patient’s movements by observing their gait, transfers or other functional movements that exacerbate the patient’s pain or put them at risk for falls. The PT will then decide to measure range of motion, strength, joint mobility and other special tests based on their findings.
The PT is trying to answer several questions, such as “what is the offending structure (muscle, tendon, ligament and/or bone)?” and “what brought on this pain? (ex. Poor posture, overtraining, pathological movement patterns and/or weakness).”
After the initial evaluation, the physical therapist will prescribe home exercises, determine the frequency of appointments (usually 1-3x/week) and advise the patient on potential activity modifications.
At the patient’s follow-up visits, the PT will typically see a patient for 20-30 minutes face-to-face and then pass off the patient to a PT aide/tech. The aide will supervise the patient through the prescribed exercises and provides cues to correct the patient’s form. For someone who is potentially interested in becoming a physical therapist, a PT aide position is an excellent opportunity to acquire hands-on clinical experience. Beyond exercises, the patient may receive other treatments that include manual therapy, heat, ice and/or electrical stimulation (“e-stim”), depending on the patient’s diagnosis and presentation.
The patient population and services of the outpatient orthopedic clinic can vary depending on the facility. Typically, clinics will cater to a broad population and treat patients at all ages of the lifespan: pediatric, middle-aged adult and geriatric. Some of these patients are weekend warriors, who become injured from improper training, while others are recovering from surgeries such as hip or knee replacements.
Many people ask me if I work with athletes and my answer is "yes," but probably less so than people would think. The vast majority of patients in a standard outpatient orthopedic setting is comprised of middle-aged people with low back pain, knee pain or shoulder pain. I have worked in some clinics that cater more to athletes and I would say that 25-30% of the caseload included athletes, but I would say that this is slightly higher than most general outpatient clinics. For people who want to exclusively work with athletes, athletic training may be a better fit.
The clinic may advertise specialized balance training programs for geriatric patients or sport rehabilitation programs for younger athletes. Clinics will often share gym space with other professionals that can include occupational therapists, speech language pathologists, athletic trainers, personal trainers, massage therapists, pilates instructors, yoga instructors and more; the possibilities for partnerships and collaboration are endless!
Skills Necessary for a PT
As a PT, you need to develop certain skills in order to provide the best care for your patients, some of these include:
Communication - Some argue that having good communication skills and being able to build a rapport with your patient are far more important that your knowledge or manual skills. If you cannot fully understand a patient’s goals for therapy or the full circumstances of their lifestyle, then does it really matter if you’ve memorized all the muscle origins and insertions?
Team Player Attitude - Regardless of the setting that you decide to work in, you’ll need to be able to demonstrate that you can be a good team player. In an outpatient setting, this means communicating to your aides how you want certain exercises to be performed for certain patients, sharing gym equipment with other patients on the floor and mentoring younger members of your PT family. In an inpatient setting, teamwork is crucial because you’ll need to communicate with interprofessional team members, such as doctors, nurses, OTs, RTs, SLPs and family members in order to coordinate the care of patients. You will rely on your team and vice-versa.
Physical Skills - As the name of the profession implies, you will need to develop a certain set of physical skills. You’ll need to refine a therapeutic touch that will allow you to find the painful anatomical structures of interest, while also allowing you to provide a sense of comfort to your patients. Some level of strength and sound body mechanics will also be crucial to performing manual techniques and transfers.
Commitment to Life-Long Learning - The physical therapy profession is continually improving the way that clinicians provide care to patients and this is a result of rigorous research. As PTs learn evidence-based practice in school, they must also be committed to learning and applying evidence-based practice throughout their career. This means attending continuing education classes, reading scientific journals and pursuing postprofessional programs, such as residency and fellowship.
Empathy - Patients who seek physical therapy not only experience pain, but also a loss in function. Their injury may be preventing them from working, playing a sport or taking care of themselves or their family. In order to be effective, a PT must seek to understand what the patient is going through by feeling what they feel. By demonstrating empathy, the therapist can build a greater rapport with their patients and be optimally effective in helping patients achieve their therapeutic goals.
Positives of the Profession
Physical therapy is an incredibly rewarding profession. Our work not only helps patients return to the activities that they love, but it also empowers and educates them to prevent future injuries and complications. Other positive factors include:
Patient-Therapist Interaction - You spend a lot of time with your patients. In orthopedic settings, you’ll have at least 20-30 minutes of face to face time per day for 1-3 days per week. In inpatient rehabilitation settings, you could be spending 1-2 hours with a patient up to six days a week. If you want to see your patients frequently and build meaningful relationships, then you’re striving for the right profession.
Not a Desk Job - In this profession, you will be on your feet and moving. This is something that drew me to the profession. When I first walked into a PT clinic after my meniscectomy following a knee injury, I immediately took note that these healthcare professionals are working in a gym. They’re not in small offices or at a lab bench all day, they are active and using their bodies.
Dynamic Work Environment - No two patients are the same. Even if two patients have the same surgery, they will likely have different goals, personalities and functional levels that will force you to personalize their treatment plan. For someone who loves to problem solve and not become bored with routine, this profession is for you.
Flexible Job Market - According to the Bureau of Labor and Statistics, the PT profession is slated to grow about 34% from 2014-2024, which far outpaces the average growth rate of other industries. If you simply Google "PT jobs", you can be confident that you’ll find a job wherever you'd like to live. If you’re willing to take on travel PT jobs, you’ll also earn 25-40% more money by working in underserved areas. PT is also flexible because you are not required to specialize in a certain field so you can change your mind to work in a different setting or even alternate working in two different settings in the same week.
There are of course some drawbacks and trade-offs that come with being a part of this profession. Here are a few based on my perspective that you should consider:
Physically-Demanding Work: Though I value the physical nature of this profession, I also recognize that this work can be strenuous. Performing manual techniques on 8-16 patients per day, five days a week can take a toll on your body, especially your hands. In inpatient settings, you may be performing mod-max assist transfers multiple times, everyday. If you’re not practicing sound body mechanics, you risk becoming injured, which can put you out of work. As we try to educate patients to develop the safest body mechanics for their jobs and activities, we must also practice what we preach.
Non-ideal Patients: Some of the patients that you will have to treat will not be the most pleasant people to work with. Patients who are receiving workers compensation may be exaggerating their injuries to avoid returning to a job that they do not enjoy. Other patients may not understand your role as a movement specialist and they might just be expecting a nice massage, heat pack and some e-stim to help them feel better temporarily. Lastly, you will likely encounter patients who simply are not ready to change and do not buy in to the plan of care. These cases are expected in many healthcare professions, but a key thing to know is that as a professional, you cannot let personal biases or preferences affect your relationship with your patient--you need to be who your patient needs you to be to facilitate their recovery.
Ethical/Political Challenges: PTs always want to provide the best care for their patients. Sometimes this will clash with the financial bottom line of management and as a result, PTs can be caught in ethical dilemmas. For example, a PT may want to treat a patient for 30-45 minutes face to face to ensure that they can monitor their progress through exercises. However, a clinic may force a PT to be more productive and treat new patients every 15-20 minutes. This can result in lower quality of care and also burnout for the clinician. The key for a PT is to find a good match with an employer who will uphold strong values and not favor profits at the expense of patient care.
Overall, this is a great profession to join and I feel that PT is very unique when compared to other healthcare professions. This is also an exciting time to join our profession as we are growing in our scope of practice and promoting our role in serving critical healthcare issues such as the opioid epidemic. PTs also have a high quality of life and job satisfaction.
This has been a bit of an extended summary of the PT profession, but do you have any questions about the profession? Let me know if the comments below!