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You Can Always Go Back: Or, How I Changed Physical Therapy Settings

by Julie McGee, PT, DPT


Among physical therapists, there is a tendency to move into a niche and specialize. Some PTs seem to fall in love with a particular physical therapy setting, take all the continuing education offered within that setting, and fine-tune their skills. Over time they become the go-to person in their clinic or geographic area regarding a certain setting, technique, or therapy style.

I am not one of those PTs. During PT school I found my neuro classes to be fascinating and thought that I wanted to work in acute rehab. After graduation, I did a Per Diem stint in an acute care setting. However, I found that the physical nature of the setting (heavy lifting, hours spent on my feet, less time with patients that needed more assistance), and the gravity of my patients’ diagnoses were too draining. From there I settled comfortably into an outpatient orthopedic setting.

The early outpatient ortho years:

For the next eight years, I worked in two different outpatient orthopedics clinics. During that time I took a long-term continuing education course to fine tune my manual skills. I appreciated the fact that most of my patients did not have devastating injuries and very few were a fall risk. Biomechanics fascinated me, and I was proud of how my knowledge of anatomy and biomechanics grew.

Over time, however, things began to feel stale. I was seeing the same types of injuries over and over again. My caseload felt like a never-ending stream of weekend warriors with either low back pain or patellofemoral dysfunction. Thinking that becoming further specialized in orthopedics I would gain more respect from my employer and attract the types of patients I wanted to see, I took the Orthopedic Clinical Specialist exam. Unfortunately, I ended up not passing the exam. From there I started to wonder if I was really working in the correct setting.

A foray into home health:

My colleagues in home health PT described how they could make their own schedules and provide more meaningful therapy because they were in the patient’s environment. While the autonomy and of the setting was appealing, the thought of working with homebound patients was intimidating. What if the patient’s home environment was unsafe for me? What if the patient’s condition destabilized while I was working with them?

I was also concerned about how potential employers would view my lack of experience with elderly, neurological or medical patients. Doing some informational interviews with home health agencies in my area helped to calm my fears.

Potential employers seemed positive about my desire to change settings and supportive of only sending me into homes where I felt safe. During my first few weeks in home health, I was able to shadow another PT. This helped me to better understand the flow of a typical session, and what was expected of me as a therapist. The agency also had an on-call nurse that I could consult with if needed.

Initially, I relished in the flexibility. I was able to run errands and schedule my personal appointments during the day. Home health patients also seemed easier to treat; get them up and walking, give them a few exercises, progress them to a point where they can get out of their home, and then discharge them. I learned a lot about medications and their potential side effects. My treatments became more focused on function.

Going back

However, after a while, I got that stale feeling again. Traffic and parking became a daily headache. My car broke down a few times, and I had to find alternate modes of transportation while my car was being fixed. As a Per Diem employee, I was paid per patient. On days where I had multiple patients cancel, I would have to scramble to take on other patients either that same day, or later that week to ensure that I would make enough money. I felt as though I was being penalized for my patients who canceled or declined my visit last minute.

One summer, I had the opportunity to work Per Diem in an outpatient orthopedic clinic. Going back to outpatient reminded me what I liked about outpatient and what I didn’t like about home health. A few months after my assignment in outpatient ended, the same clinic offered me a full-time job. I happily accepted the clinic’s offer.

Changing PT settings made me better

Going back and forth between two different physical therapy settings was a challenge. There was a bit of an adjustment period on both sides as home health patients tend to have a lower level of function as compared to outpatients. Both a patient with an anterior cruciate ligament repair in outpatient and a deconditioned home health patient with multiple medical diagnoses need to work on strengthening and gait, but their specific needs are different. While it may be feasible to return the ACL patient to their prior level of function, it may not be feasible to do for the home health patient.

Consulting with coworkers, and continuing education courses helped me to gain the knowledge that I needed to feel more confident in each setting. Now that there are so many courses offered online, one can easily take short courses on topics such as fall prevention in older adults, or concepts for the rehab of achilles tendon repairs.

Additionally, my experience bouncing back and forth between settings made me a better clinician. I feel comfortable treating a wider range of diagnoses than I did before. The wonderful thing about being a PT is that you are always practicing and learning. Changing settings and going outside of your comfort zone can be a rewarding learning experience.

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