Experiences: By Dr. Seth Watson, PT, DPT, Cert. DN, CSCS

Huge thanks to Dr. Seth Watson, PT, DPT, Cert. DN, CSCS who is a UT Southwestern Orthopedic Physical Therapy Resident. His advice and experience is remarkable. Fine him on twitter @texagswat12.
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• How was the transition/learning curve coming out of school and starting your first job? 

This is a great question and something that I think is huge with many entry-level physical therapists. Obviously, how steep the learning curve is unique, personal, and greatly dependent on the quality of your rotations as a student and the quality of education you receive. Luckily, I was fortunate enough to have clinical rotations with 3 clinical instructors that were either former residents or current residents finishing up their residency. I also received an exceptional education at UT Southwestern, which effectively prepared me for many of the difficult transitions that entry-level PTs face.

However, no matter how well you are didactically prepared, there are certainly areas where you are not going to be ready. One that certainly sticks out to me is learning the intricate details behind billing & coding, especially when each insurance company is different and there are daily changes occurring. This can be quite the headache early on and the intensity of the headache is largely dependent on the helpfulness of the front-office staff and the electronic medical record documentation system used. (PS This is something to consider when contemplating taking a job, ask about what EMR is used!)

Another aspect of beginning clinical practice as an entry level PT that is certainly a transition is developing your own critical thinking skills without the input of a clinical instructor. I am fortunate to have a mentor with me for 1 half day/week, but really beginning to synthesize all of the information you have gathered from school, continuing education courses, and research is something that takes practice and is very dependent on experience and your personal drive to be better each and every day.

• What is your work load like and what is typical day is like for you?

As a resident in an academic setting, my schedule is quite a bit different than most entry-level physical therapists. I treat patients 28 hours/week (4 hours in collaboration with a mentor), have 4-8 hours of teaching/research/office hours, and 4 hours seeing patients with an orthopedic surgeon in his office. I also attend weekly Orthopedic Surgery Ground Rounds, attend/present at weekly Brown Bag journal clubs, help 1st and 2nd year students at a supplemental lab hosted by residents on a weekly basis, attend/present at monthly collaborative journal clubs, and have other optional, outside opportunities that I typically try to attend. The residency also includes a 5 weekend series of courses that cover just about everything orthopedics in order to advance clinical practice and prepare attendees for the Orthopaedic Clinical Specialty examination in March.

I see patients in 30 minute slots and try to keep most of my care one-on-one. I will have our technician take a patient through one or two more exercises dependent on the patient’s stage of rehabilitation, insurance requirement, level of independence, etc. I am a big believer in one-on-one care, so while I often times get behind on notes, I am right there with the patient the majority of the time. The long-winded point of this is to give the fact that I can treat up to 16 patients on a full day with no initial exams. I get 1 hour for most initial examinations, which is usually more than enough.

• What do you wish you would have known/been prepared for after graduating? 

As I mentioned before, I do feel I was prepared didactically from UT Southwestern and my clinical rotations. I also felt prepared to manage a heavy caseload due to my managing this many patients as a student on my clinical rotations.

One thing I do wish I had done better as a student is be more organized with the course and supplemental materials I received during the courses I took in PT school. Often times, when something comes up that I have not seen in a while, I find my self-digging through computer files or paper documents mad at myself because I should have been more organized. I have taken that to heart since I started the residency so that I don’t deal with this issue again in the future.

Like I said, another thing that takes some getting used to is handling the different aspects of billing/coding that comes up and is frequently changing. Learning how to get out of making notes a performance like it was in school/rotations takes some time. You must get the critical details in the note to protect you and make sure the patient is being progressed each treatment, but cutting down on the “fat” per say and only writing what is crucial will save you from many headaches down the road.

• Coming out of school what was compensation is like/managing student loans, etc? 

This is an important question that needs to be understood as one finishes up school and contemplates the next step. I was fortunate enough to have the opportunity to begin an academic based residency as my first job, which meant taking a “pay-cut” relative to many of my classmates’ starting salaries. UT Southwestern actually pays their residents approximately $50,000/year, which is probably in the upper 10% of residency salaries. When applying/interviewing for other programs, many offered anywhere from $25,000/year to $37,000/year, dependent on the setting and geographic location. In my opinion, making less for 1-1.5 years is totally worth the benefit I will receive from advancing my clinical practice during that time. I wouldn’t hesitate to do this again if I were to have the same choice in front of me.

In terms of loans, I was fortunate in that I was blessed to have supportive parents that helped me through school. However, I am also fortunate to have married my beautiful wife a week before we graduated from school, who has student loans. We are approaching her loans utilizing the Dave Ramsey motto “Live like no one else, so later you can give like no one else.” We are trying to use my salary for each month’s loan payment so that we are paying around 6x the required monthly payment. Luckily, most loans give you approximately 6 months after you finish school to begin paying, so we had time to get our feet under us after graduating. However, the first few months were definitely tough between graduation and passing boards, so we lived on wedding gifts, gift cards, peanut butter, and extremely helpful family for a few months.

• Additional Thoughts  

Being a Physical Therapist is not just about prescribing exercise and doing notes. Physical Therapists are in an integral role where we are able to change our client’s health status in a positive manner. We spend more time with our patients than any other healthcare provider. We have an expansive (& expensive) amount of knowledge, not just about that patient’s specific injury/diagnosis, but nutrition, strength/conditioning, etc. Spending the entire patient visit talking about yours or your patient’s weekend is a waste of that patient’s time and valuable health care resources. Take these opportunities to introduce health and wellness concepts to these patients with the mindset that if you change even one aspect of their lifestyle in a positive manner, you can significantly impact their quality of life many years down the road. If we are truly to be a patient centered profession, we need to leave our most of our personal lives out of patient care and place value in each of our patient interactions through patient education.

Just a final thought, when you come out of school, you will be rightfully motivated to become as excellent of a physical therapist as possible. My best advice to any entry-level PT is to get really good at what you “know” before trying to dive to deep into continuing education courses or the literature. By no means am I saying avoid these resources/opportunities; just remember that you are coming out of school with what should be the latest, greater knowledge. Solidify this knowledge base and then build on to this foundation as you become more experienced. Just my two cents!

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Thanks again to Dr. Seth Watson, PT, DPT, Cert. DN, CSCS. Grateful for his words of wisdom!

If you are a PT/SPT and you are interested in sharing your experiences please email me at dalinhansen@yahoo.com

Click HERE to read about other PT's experiences.

Experiences: By Dr. Meredith Victor, PT, DPT, CSCS

I would like to give a huge thanks to Dr. Meredith Victor for sharing such great advice and experiences. Also please take the chance to check out NewGradPhysicalTherapy.com, its a fantastic resource.

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Bio:  Meredith graduated from University of St. Augustine in San Diego in 2010. She has worked in multiple settings and strived to experience as many environments as possible. She currently works as a rehab intake liaison at South Bay Rehab Center in San Diego, and runs NewGradPhysicalTherapy.com.

• How was the transition/learning curve coming out of school and starting your first job?

My first job was pretty interesting, actually. In many ways, I had a pretty nice situation at a hospital-based outpatient clinic. We had charting time included both before lunch and at the end of the day, so I almost never had to stay late or work through lunch. That was awesome!  

The patients' diagnoses ranged from fibromyalgia and chronic pain to the occasional total knee replacement or orthopedic condition. We even saw some TMJ patients and had a pool to offer aquatic therapy to our spine and arthritis patients.

The toughest part for me was feeling like I was losing some of my ortho skills, since I really didn't get to use them that often. We had an HMO, so our patients were subject to capitation spread throughout all the HMO patients. That meant our clinic had chosen to provide 5 visits per patient, unless they were post-op or special circumstances. That could be frustrating, since new grads like to see patients for longer than 5 visits to gauge whether their treatments are effective.

Another challenge was the language barrier. We had quite a few patients who either didn't speak English, or came from cultural backgrounds where treating pain with exercise was unheard of. It was pretty difficult to convince them of the efficacy of PT if we only had 5 visits to do so, and most of our 30 minute treatment was spent fumbling with an awkward translation phone. It was very frustrating, and the combination of those factors is what ultimately led me to seek employment elsewhere.

I do really miss my coworkers, and the patients were quite sweet. 

•  What is your work load like and what is typical day is like for you?

I have two really unique jobs right now, and I love them!!! I work as a rehab intake liaison for South Bay Rehabilitation Center (at Paradise Valley Hospital). The job involves no direct patient care, but there is quite a bit of interaction with patients and their families, as well as collaboration with other disciplines in the hospital.

My role is to market and promote our fantastic sub-acute inpatient rehab program. We spend a lot of time educating doctors, case managers, patients and their families about the intake criteria for admission to our facility. It is a perfect match for my personality, so I feel incredibly blessed to have the job!

A typical day involves a combination of speaking with case managers and physicians, filling out intake paperwork, brainstorming with the team about marketing efforts, going to various hospitals around town to meet with potential candidates (and their families) and working on our social media and web strategies. Before I was a PT, I was a web and graphic designer, so I've absolutely loved being able to merge my two careers this way.

My other "job" is running NewGradPhysicalTherapy.com, which is a website devoted to helping new PTs with the transition from student to professional. I love the opportunity to help new PTs carve their own paths and provide resources that to help them tackle the mundane tasks that take away from the joy of being a physical therapist.

While those two gigs keep me pretty busy, I don't want to leave patient care entirely. I do some per diem PT work to keep my skills sharp :)

• What do you wish you would have known/been prepared for after graduating?

I wish I had known that acute care was out there. I never had a clinical in acute, and rushed into outpatient when I graduated. I found that having a set schedule of solo treatments was not for me. I didn't hate it, but I felt very drained by the end of the week. I was also pretty sore from doing manual therapy.  

A PT school classmate suggested I apply to an acute care job at his facility, and it was such a great move! I much preferred the flowiness of acute care, and I loved the interaction with OTs, nurses, MDs, pharmacists, etc. I do much better in a collaborative environment, and I find that acute was my favorite setting. I loved being able to help people take their first steps after surgery, and the fact that my patient load was always changing kept things interesting and fun.  

However, once I was out of school for about 5 years, I really found myself missing the creativity of design work, so it was time for a real change, which led me to my current positions with South Bay Rehab Center and NewGradPhysicalTherapy.com. I'm extremely happy, so I also wish someone had told me that you don't HAVE to do patient care to use your DPT to the fullest.

•  Coming out of school what was compensation is like/managing student loans, etc?

Because I work in a large city with two PT schools, compensation is not, shall we say, "competitive." I didn't go into physical therapy for the money, but rather for the flexibility. I am lucky in that my husband has a stable job with benefits, which has enabled me to create a work schedule for myself that fits my personality. I am also able to work at a higher per diem rate, since I opt out of benefits. I strongly urge therapists to check out per diem work, if they're feeling burned out. With the Affordable Care Act as an option for health insurance, you can choose to work at several positions at a higher hourly rate, with more flexibility. Of course you don't get paid time off with per diem, so make sure to consider that when you make your decision! 

•  Additional thoughts.

PT is an excellent career for anyone who can be creative about carving a path for themselves. It is not unusual to get burned out at some point in your career. Some therapists work 40 years and never feel burned out. Others are ready to leave patient care after a year of treating. Don't judge yourself for where you land on the spectrum. Just take stock of your strengths and your passions and life will present opportunities to move in the right direction. Good luck, everyone! 

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Thanks again to Dr. Meredith Victor for her contributions to www.creatingapt.com. 

Feel free to write any questions or comments in the comments section. If you feel you have something pertinent to share on www.creatingapt.com send me an email at dalinhansen@yahoo.com.

Click HERE to read about other PT's experiences.