Sunday, May 31, 2015

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.
  • 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!

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

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