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Why Being a Physical Therapy Generalist is a Good Thing.

by Justin Johnson, PT, DPT, OCS


The 2017 Tour de France was a nail-biter. The winner beat the second-place contender by a mere 54 seconds. That is not much, considering it was a race that spanned three weeks and 3540 kilometers (2199 miles).

This article is not about cycling, it is about being a Generalist (yes, I’m going to capitalize Generalist) in physical therapy. Chris Froom is just that - an exceptional Generalist. He just happens to also be a professional cyclist.

Chris Froom is a contender for winning the Tour de France because he is a well-rounded cyclist. Being a professional cyclist means being able to sprint, climb, descend, and time trial (along with eating your body weight in Gu packets and Clif Bars for 5+ hours). You might say he’s an Expert Generalist.

Now, let us look at a Specialist. Peter Sagan, who was actually disqualified from the Tour de France this year, is a Specialist. He is one of the fastest bicycle sprinters on the planet. He is not in contention to win the Tour de France because he does not have all of the other attributes to win the entire three-week tour.

Peter is not a good climber and he is not a particularly good time-trialist. Froom and Sagan are both needed in the world of cycling and both of their attributes play to their success. The point is that the world is awash in examples of professionals who are Generalists - and they make a big difference.

In physical therapy, as with cycling, being a generalist is a good thing. After over 9 years of countless jobs around the country, I’m comfortable walking into almost any situation and doing my best to make a difference.

Being able to provide your best advice and treatment is far better than the patient receiving no treatment at all.

Not sure how to help an elderly person with dementia mobilize because you are not a geriatric specialist? No problem, just mobilize the best you can and you will figure it out.

Not sure what the best treatment for back pain is? No problem, just treat as best you know how and remember that you are giving deserved attention to the problem. Your treatment will likely be better than no treatment at all.

In all of healthcare, there are Specialists and Generalists. I work with some wonderful physicians, some of whom are Hospitalists (Generalists) and others who are Surgeons (Specialists). They rely on each other, taking care of what they know best and turning what they don’t know over to the other.

Let us view this “Generalist” theme from two more angles


1. Being a generalist is like playing the stock market with index funds.

Stay with me here. I recently read The Little Book of Common Sense Investing by John C. Bogle, the founder of Vanguard. John’s premise throughout the book is that we as investors are horrible at picking stocks, so the best thing to do is buy the market.

I like this approach, not only because I am truly a horrible stock picker, but because why focus on one aspect of the economy (by buying an individual stock) when I can own the whole market? John suggests becoming a stock market Generalist. It’s a good bet! I recommend the book to everyone!

2. My second example is “Geeks Who Drink." Yep, that fun drinking game at the pub.

Who do you generally want on your team? Someone with only precise knowledge of a specific topic, like astronomy or engineering? Or do you want that one buddy who knows a little bit about everything - they know how to fix a car, they are up to date on the latest music, and they are an overall well-rounded guy/gal?

You want the “Knowledge Generalist” on your team, not the astronomy expert.

Top 3 Generalist traits that I notice


1. They have a wide breadth of interests

If you are only interested in treating certain conditions or body parts such as the spine, the hand, or working with kids with Cerebral Palsy, then maybe being a Generalist is not for you. However, if you find lots of different diagnoses and treatments interesting, then being a Generalist may be right for you.

I cannot tell you how bored I would get if I have to treat five patients with total knee replacements in a row…boring!

My first job out of PT school was great. I worked 2 days a week in an awesome skilled nursing facility. I saw patients who had suffered orthopedics and trauma at a level 1 hospital.

The two entities were owned by the hospital system, so my transition back and forth every week was flawless. It was an awesome job for a young therapist who liked variety. I was well on my way to becoming a generalist.

2. They ask for help when they need it

Recognize that you don’t know everything. I’m not a vestibular specialist, but I know one. When I am able to, I refer to her expertise to help me evaluate vestibular patients. Everyone knows I’m not the vestibular therapist and I readily admit it.

On the IT front, I ask for a lot of IT help. I am not great with computers. Therefore, I refer to my coworkers who are well versed in that area. Being able to use more than WebMD and Epic is a great skill to have!

3. They don’t stop trying because of small failures

This is more of a general life lesson, and it goes for Generalists and Specialists alike. It comes into play when you have a patient who is not getting better.

You will make mistakes or have some rough days at work. Maybe you were having a patient perform an exercise that irritated their back and one of your specialist colleagues questioned you and gave you some unsolicited advice. Or maybe friction with an older and more experienced therapist put you in a bad mood.

Sometimes you just have a bad day. Specialists have bad days and so do Generalists. Do not stop trying just because of small failures.

A note about travel physical therapy

If you are thinking about getting into travel therapy, being a Generalist has its benefits.

First, you have the ability to take jobs in outpatient settings, acute care settings, or schools. What an amazing opportunity to work in various settings around the country or even the world.

Second, being comfortable with treating various diagnoses is key to being a successful travel therapist. It is beneficial to have confidence when working with all different types of diagnoses. Treat as best you can and remember, your attention and effort are better than your patient receiving no care at all.

Be proud of being a Generalist

Are you comfortable with being a Generalist? Maybe becoming a Generalist is the new specialty? I might argue that being able to treat almost anything with moderate effectiveness is more important than being able to treat only a few things with maximal effectiveness.

You cannot be an expert in everything, so being a Generalist, is a great start to any career. Being an expert in everything is impossible (remember that, new therapists!).

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