Dr. Rehab
Los Angeles, CA
Female, 31
I'm a practicing PT with a Doctorate for the past 4 years now. Although it may not seem like a long time, I have gained extensive knowledge and experience in various PT settings. I've worked anywhere from outpatient therapy, home health, aquatic therapy, inpatient rehab, and private clients. I now also instruct on an online prep course for graduates seeking to pass their National Board Examination. PT is a very rewarding job, but can also SUCK, which explains my quest to find the ideal situation
There is definitely overlap between the two professions. OTs help people of all ages to improve their ability to perform tasks in their daily living and working environments. This sounds very familiar to PTs, but OTs can focus on things like showing a patient how to dress, groom, shower, etc. They do this by also working on mobility, strength, and functional capabilities. So there are many similarities, but each profession has a different focus. OTs are trained to modify the physical environment as well as training the person to use assistive equipment to increase independence. PTs are trained to identify and maximize quality of life and movement potential within the realms of promotion, prevention, diagnosis, treatment, intervention, and rehabilitation. Both professions are booming in this healthcare industry.
U.S. National averages are anywhere from $65K to $90K. This, of course, depends on setting, state, and years of experience. I recently read an article listing PT as the #4 Best Paying Job of the Future. Here are some of the stats they included: > Pct. increase: 39.0% > Total new jobs (2010-2020): 77,400 > Median income: $76,310 > States with the most jobs per capita: Rhode Island, Vermont, Maine This is largely in part to the baby boomers getting old. I can confidently say that I've never had a problem getting, finding, maintaining a PT job. They are abundant and you won't have to worry about never finding work. Your everyday Physician makes over $100k on average. And that number increases with how specialized you are. I suppose you will want to consider amount of school, residency, long hours, stress, and the fact that people's lives are in your hands, if you want to be a M.D. PT is flexible and there are tons of settings you can choose to practice in. It's not a ton of money for the amount of school you go through, but it can definitely be worth it in the end. Heck, I now instruct and assist my future colleagues in my PJ's at home. Sweet? I think so.
Patient care certainly doesn't suck, as it is very rewarding and satisfying to work with patients and see them get better! The 'sucky' part is really the insurance aspect of the business. There are a lot of debates going on with the situation of our national healthcare system right now. What I can tell you about Physical Therapy is the ongoing decrease in re-imbursement from insurance companies for rehab services, particularly in the private sector. From my experience in a private PT owned clinic, it was a constant battle to fight for more benefits for my patients. A newly amended Senate Bill No. 924 would bar all physical therapists from treating a patient beyond 30 days (or 12 visits) unless the patient obtains a diagnosis from a licensed physician or podiatrist. If you know anything about rehab, it's not something that can be done quickly, nor should it. It's just another hoop for our patients who need skilled care to go through in order to get insurance companies to loosen their purse strings. It's not fair for an elderly person to have to go back to their physician, wait 45 min, only to get a piece of paper saying it's ok to continue their rehab. And with the constant reduction in insurance benefits, it forces smaller independent owned clinics to have to book their patients in 20 or 30 min time slots just to stay afloat. This reduces the amount of skilled care a patient will get directly with a licensed therapist. This results in an unhappy situation for everyone. For some, this is just part of the business to get through. But I'm spending half my day on the phone with an insurance provider, and writing notes documenting why my 75 year old post total hip replacement patient needs more than 12 visits so she can be functional and mobile again safely. It really isn't fair when I could better use my time on valuable patient care.
Hand and wrist problems are definitely more common these days, particularly carpal tunnel syndrome. Another common problem attributed to all that sitting is poor posture and neck/back issues. Many of these issues can be solved with good ergonomics; so proper desk set-up, chairs with lumbar support, computer screen positioned to maximize proper body alignment, etc. In addition to good ergonomics, daily stretching and strengthening exercises will do wonders for those common aches and pains. It's also always a good idea to take frequent breaks so you can just get up and get some fresh air. It's never fun to be cooped up all day indoors and in front of a computer screen.
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If your special keyboard lets you type 200+ words per minute, why doesn't everyone use them?You can pretty much tell if they didn't do their HEP (Home Exercise Program) if you ask them to show you, and they do it all wrong. I don't ask in a way to make them feel bad or lecture them like a student if they didn't do it. So most will be very honest about it. It's more important that they understand the benefits of doing their HEP and continuing with open communication and education throughout their time in PT. If both PT and patients are taking an active role with the rehab, then it's kudos all around!
There are definitely a lot of big egos to deal with in the health and medical profession. Society seems to label "real doctors" as M.D.s or Physicians. Keep in mind that Doctor is really just a title. A Dentist is a Doctor of dentistry. An Optometrist has a Doctorate in optometry, etc. And it's really a title indicating that someone as achieved the terminal degree in their profession. I've definitely seen colleagues slighted by M.D.'s and feel they don't get the respect they want or deserve. To me, it's not a huge deal. I develop personal relationships with my patients since I tend to see them often for any given injury. So I go on a first name basis. Everyone has their expertise and specialize in something, and I think it's more important to have collaborative effort with good communication with other health professionals for the sake of our patients well-being. And the majority of surgeons and physicians understand and respect that. Of course, there is always going to be that one M.D. who acts like a giant douche. In the end, we are the ones that see and work with the patient. And I can honestly say, we PTs are not afraid to stick to our guns and do what we feel is best for our patients.
I actually welcome it. It's a nice feeling to help people out especially if they are seeking it. PT is a bit like a 'people pleaser' profession, so I don't think I'd be going out on a limb in saying that most PT's don't get bothered by friends/family members asking for advice. It's also a great way for us to share our knowledge and educate people on exactly what PT is all about. Those who haven't experienced it first-hand might view PT as a place to get a massage that insurance pays for. But it's so much more than that. PT's are movement specialists and trained to identify and treat biomechanical faults. so I really welcome any bombardment of questions from anyone :).
Great question! Last year, I had a 20 year old girl suffer multiple injuries from a car accident. She came to me in a wheelchair with fractures to both of her legs, right wrist, four ribs, dislocated left shoulder, and whiplash to top it off. Naturally, her spirits were very low and often cried during our sessions. You can imagine how tough it would be to go from being a super active college kid, to essentially confined to a wheelchair. Well, we worked through her struggles with a lot of encouragement and effort. She essentially had to be taught how to walk again. It's amazing and pretty badass to see the transformation of any patient who gains their independence back by what you've done. Imagine a long montage with Rocky-type music in the background of me stretching her legs, mobilizing her shoulder, having a small celebration when she shakily stands up from her wheelchair alone - to taking her first steps without crutches - to me shouting at her to squat deeper while I add more weights. Yeah, it's pretty much a progression like that, just a lot longer with a lot of patience. She now competes and kicks ass in those cross-fit games!
I wouldn't necessarily say rotator cuff injuries are more problematic than other injuries, unless of course, your job or a big part of your life consists of doing repeated overhead activities (pitchers, tennis players, etc). The healing process depends on many factors including severity of tear, if other structures were compromised, age, lifestyle, etc. If you had a significant tear, no amount of PT will heal it as you will need surgical intervention. If it's still causing you problems or interfering with your functional activities, then you may want to consider seeing an Orthopaedic surgeon for further diagnostic evaluation.
You know, if it's something like a minor back issue or I sprained my ankle, then I will just treat myself. There was a time when my back went out and I could barely walk. Fortunately, I was working at a clinic and just had some of my co-workers work on me. Of course, If I fractured or tore something, then I would definitely need to see another PT. The good thing is I have a lot of my colleagues nearby to help me out!
When I hear unsolicited advice, it reminds me of my mother or mother-in-law telling me baby advice for my little one. Needless to say, it's annoying and I don't like it. So I figure most people wouldn't really appreciate it either, even if I had the best intentions in mind. I also live in LA, where the common mentality is to mind your own business. Maybe it would be different if I lived in a small town or community. Of course, I'm always there to lend a helping hand to an elderly person or someone who's just been injured. But I'm sure anyone, PT or not, would do the same thing. I will only offer advice to strangers if I feel they seem open to some input. But I would never just go up to someone and say, "Hey, you're doing that all wrong" or "your posture is horrendous, you probably have some back issues", even though I may be thinking it. I'm always around to help friends or anyone else, and answer questions, but for the most part, my PT hat is off after hours.
Fortunately, I have never had to come across a situation that would warrant such bad news. Plus, that depressing role really belongs to a Physician, who diagnoses a patient based on extensive tests, imaging, and medical management.
Yes, I do believe that 'massage' has its medical benefits. I put quotes around massage, because I, and probably many of my colleagues, consider massage something very relaxing/soothing that you would get at a spa. What we really do is soft tissue mobilization (STM), that deals with the manipulation of soft tissue, or the areas encapsulating a joints that have restricted range of motion. After an injury, our muscles, ligaments and fascia tighten up, therefore STM is very useful in manually stretching those areas and restoring range of motion. This type of manual therapy can also promote restoration of joint function, improve blood flow, lymph drainage and increase nerve signals to the injured area. More often than not, I'd say manual therapy is not quite pleasurable as we are trying to improve function, not have a day at the spa. There was a running joke at my clinic that PT actually stood for 'Pain' and 'Torture'....affectionately :).
I don't necessarily think that PT is a fall-back from being an M.D. All of my colleagues went into this profession wanting to be therapists. If anything, a lot of them had the initial goal of working with elite athletes on a college or professional level team. Therefore, many of them had experience as athletic trainers. Going pre-med as an undergrad would be beneficial as the pre-requisites are nearly identical. But I think that can be the same for just about any profession in the health industry. For me, I specifically chose PT because of the flexibility and wide range of patients and settings you can work in. I had absolutely zero desire in working 36 hour shifts, being on-call, etc. Plus, hospitals are not my thing. I'm uncomfortable in that setting and I always feel like I need to go into some sort of decontamination chamber after I leave one. I think if someone is able to achieve a higher level of education (masters, doctorate, etc.), then they can do anything with hard work, dedication, and a positive mindset.
Generally speaking, I'd have to say that the most common problem is low back pain. Seems like just about everyone has, at one point or another, experienced some sort of back pain. We are a society now that's glued to our computer or TV screens, which equates to a lot of sitting time. Add on poor posture and a weak core, and you've got back issues!
I have heard of laser treatments, but know they are not as common as your typical therapeutic modality, such as heat, ice, traction, ultrasound, electrical stimulation, just to name a few. The use of therapeutic modalities are most effective in the acute stages of your injury, and can be used as a supplement to treatment to aide in tissue healing. However, it should never be used as a major part of your therapy. PT is most effective in conjunction with manual therapy (joint mobilizations), therapeutic exercises, and patient education. It's also the PT's job to inform you of these treatments and explain why they think you would benefit from it. Whether you are seeing your Physician, Dentist, Optometrist, etc., never be afraid to ask questions about your treatment plan or decision. It's your body and your health, and it's always a good idea to play an active role.
I understand that insurance companies are trying to protect themselves from those that abuse the system. And I'm not saying there isn't abuse of the system or that there aren't those that wouldn't take advantage of their insurance benefits if given the chance. I'm also only speaking from personal experience and have seen first-hand the difficulties of getting benefits for those that I truly feel need it. Blue Shield was one of those companies who required a secondary authorization for PT services. They would often cite that the national average to evaluate and discharge a patient was a total of 8 visits, which is very short. I wish insurance companies would understand that PT is also very much a wellness and preventative care service that can really limit the amount of surgery or other high costing medical procedure that's really costing the insurance companies. Why not spend less money on services that can improve a patient's health and well-being through PT education, rather than wait till it's so bad that they need high costing medical procedures?
It's really a shame when I hear that someone's PT experience was pointless or ineffective. Hearing that leads me to two possible conclusions; a) your therapist was not doing an effective job in identifying your needs and addressing those problems, b) your therapist was trying to keep the schedule full. Both are unacceptable. It is our ethical duty to treat patients until they have reached their max rehab potential, and discharge them to an independent home exercise program. The other scenario is if other issues have come up or there has been a decline in function. This would then lead to referral back to the physician for further follow-up. Half of PT is also patient education, so you know exactly what's going on in your body so that you are able to make the right choices in maintaining the benefits received during your skilled treatment sessions. I'm wondering what it was about your sessions you felt were pointless and ineffective. I don't know of PT's who keep patients on just to stay busy, but those that do, just bring our profession down. Like in any business/industry, there are always those bad eggs who ruin it for everyone.
That's a good question! There really isn't one population that is harder to work with than some others. It's really dependent on someone's personality. There are elderly people who are sweet and do what we educate them on. And then, of course, we come across the stereotypical grumpy old man who thinks exercise is pointless at their age. From my experience, athletes are fun to work with since they are dedicated to their profession, which requires them to be in the best shape possible. I, personally, find it difficult to work with the pediatric population. But that's only because I don't have a lot of experience with kids in general. They need to be motivated, encouraged and entertained in a way that is pretty foreign to me. Asking me to keep the attention of a couple of toddlers for even a few minutes is like the blind leading the blind. The good part about PT is that you can work with just about any population you like and feel comfortable with. There are fantastic pediatric PT's who love kids, and kids love them. Same goes for any athlete, elderly, neurologic, and orthopedic client you may come across.
This is one area that I don't have a ton of experience in. Where I'm located, most veterans go to the veterans hospital for their treatment. I initially had an interest in working with amputees and being a part of helping them learn to walk again. I haven't quite had the chance to check out that part of PT yet. I would think that most veterans have tons of motivation to improve with strong work ethics and determination. However, there is the psychological aspect (i.e. PTSD) that I'm not particularly experienced in that I'd imagine would cause some difficulties. But it sounds like a challenging and interesting scene to pursue next.
No romantic relationships for me since I was already engaged by the time I started practicing PT. Having a romantic relationship with a person that is still your patient is frowned upon, for professional reasons. To be honest, I really don't know if there are any real ethical or legal ramifications to that. I guess I didn't pay much attention to the rule book about this issue. However, I do know of colleagues that are now in serious relationships or are even married to their former patients. I have developed friendships with many of my former patients/clients over the years that I still keep in touch with. PT really is a profession where you can get to know a person rather quickly in a short amount of time. It has been great for networking and also benefiting from their services. I've enjoyed the perks of legal consultation, haircuts, getting into clubs, attending movie premieres, and many more. Even if you don't become friends, many PT's will often get gifts or other small tokens of appreciation for all the time spent together. Another reason why PT can be so rewarding and satisfying :).
Hmmm, I'm not sure if I'd consider PT a lucrative industry. It's no secret that I think insurance companies are making things difficult for our profession, so our salaries reflect that struggle. PT is also a pretty physical job where getting burned out early is not uncommon. In my earlier post regarding PT emerging as one of the best paying jobs of the future, I think it would be more appropriate if it was about job security. While in school, there seemed to be a general consensus that we weren't doing this job 'for the money', as they say. My student loans from getting my Doctorate were also astronomical. So I guess from my viewpoint, it's not quite lucrative. But I'm sure there are others out there who would disagree. Therefore, I do think most people go into PT because they're passionate about it. Most say they chose PT so they don't have to have a desk job in a cubicle, like being physically active, like working with people, and genuinely want to make a difference in other people's lives. It can, at times, get physically tiring and repetitive. But if you have a passion for PT, it'll all be worth it in the end!
Yes, with any patient we must discharge them when they've reached their max rehab potential, achieved their attainable functional goals, or if they plateau. It gets a bit tricky when the don't make progress because they don't follow the prescribed regimen or do their HEP. In this case, it would be best to have open and honest communication about the importance of following the treatment plan. As I mentioned before, half of PT is patient education and teaching them how to take care of their own health and wellness. It's also important for the PT to try and understand why the patient is not following the prescribed regimen, and if modifications need to be made so they will be more successful. Earlier, I griped about the direction Insurance billing and reimbursement is going. They will most likely run out of benefits before anything else. Of course, you can then become a cash paying patient and are free to come as often you like. This happens often for those who like to come in for maintenance, which insurance does not cover. There are a select few who have the holy grail of unlimited benefits. If this is the case and they don't continue to show measurable improvements, I will have a discussion with them about a discharge to a HEP. I make it a point that I'm not abandoning them as they can contact me at any time with questions or concerns. They can always come back to therapy if a flare up occurs or a new injury happens. It is a bit like breaking up since we often develop close relationships through all the time spent together. But as long as you remain honest and open, people often are ok with this. Nothing that a pint of Haagen Daz can't fix.
Yes! That's a very common back issue and can be an 'easy' fix depending on how you hurt yourself, and how well we can identify your biomechanical faults with functional activities. No one will know if you need surgery until you've been seen by an orthopaedic surgeon and had an MRI done. But before you go that route, I'd suggest you see a PT first. Since it has been a 1.5 years, your condition is now chronic, which is harder to treat than an acute condition. I wouldn't quite say you screwed yourself, but had you gone at the onset of your injury, you could have been pain-free that past 1.5 years. Now you body has adapted to your injury and there is more to "fix", which is why I say it will be harder and longer to treat. So go see a PT...soon :).
The saying, "your mind is a powerful thing" wasn't created out of thin air. I most definitely see a HUGE difference in someone's rehab potential based on their attitude. You also have to consider other factors when dealing with those that have poor or negative attitudes. They may be depressed, having a rough time at work, or anything else that can cause lack of motivation or enthusiasm for their treatment. As a result, they tend not to be 100% committed to their rehab program and will not see the same benefits as someone with a positive outlook. I was inspired by this year's first double amputee Olympic runner, Oscar Pistorius. I would often see quotes or sayings such as 'your only disability in life is a bad attitude' or 'you can't live a positive life with a negative mind' when stories about him came on tv. His life and journey to the olympics was probably a huge motivator for anyone who was on the road to recovery from an injury, surgery, etc. It also reminded me of a time when I met a patient with Parkinsons Disease. He mentioned he had been diagnosed for over 15 years but was doing very well. I asked what his secret was, and he replied, "I'm always happy".
I'm not going to lie. When a patient doesn't show their commitment to their rehab, it's tough to stay motivated and positive myself. It can be very easy to get in a rut and start thinking, "well if they don't care, why should I?" But this is really the time to just suck it up and help that patient no matter what. If a patient shows they are trying, then I will try 100x harder to make sure they get the best care possible. But I definitely come across those that truly don't care or get the point of what we are doing. Again, it's a struggle that many therapists face and those frustrations are just part of the job. It's hard to please everyone and we can't fix everything or everyone. At the end of the day, if I can say I did my best, then I did my job well and be proud of it.
The short answer is No. However, I've been told stories of patient's given a certain prognosis by their Physician and beating all odds. It seems a much more common story with spinal cord injury patients or those with progressive disorders like Multiple Sclerosis or Parkinson's Disease. From my experience, I've only had those select few patients who I initially thought wouldn't achieve a higher functional level than they actually did. And this largely had to do with their attitude about their injury, their motivation and level of commitment. I've had some who had initially didn't seem to care much about their rehab, but turned things around dramatically by the end of our time together. I'd like to think it was all because of my PT skills and awesome personality, but credit should always be given to the one actually taking part in improving their physical health. As I've mentioned before in previous posts, the mind is a powerful thing and the human will is undeniable. Even a little hope can change things around for the better and that is what I try to encourage with all of my patients.
Sorry for the late response, I totally forgot to answer this! Typically a day is filled like this: see patients every 30min, document their progress, more paperwork, on the phone with insurance provider. The bulk of the day is patient care and documentation. The phone calls and other paperwork is interspersed throughout the day. A patient usually stays for about 1 hour. At the clinic I worked at, I would see the patient for 30 min, and then hand them off to an aide for the rest of the time while I worked with the next patient. If it was the patient's first visit (evaluation day), then I'm with them for the entire hour. So you are really on your feet and staying active pretty much all day long. I'm rarely sitting as I tend to document while with the patient. But I will still try to steal a few minutes to finish up documenting their visit once they leave. In the end, it can be pretty tiring and I can understand how some people get burnt out doing this day in and day out.
There are a few that come to mind - Instructor/Professor, researcher, and hospital administrator. This is a tough question for me as it's hard to do anything else besides clinical work as a PT, since that is pretty much what we were trained in school to be. Those jobs I mentioned above are positions you have to work up to as they take years of experience, and are still PT related. If you are asking about non-PT related jobs, I suppose you can be something along the lines of a wellness coach, pilates/yoga instructor, private personal trainer specializing in injury prevention, etc. But all those jobs still can be somewhat related to PT. I have heard of a few who have just decided to leave the profession completely and became realtors or web designers. I guess those people really didn't want to be a part of the health industry in any way. But this, of course, is far less common. Sorry for the minimal answer as I really don't know of many who have truly made the switch to do something else, even though they would like to.
Ha, I get this question asked a lot. Not everyone hates chiropractors, I think it's just a different school of thought. Let's take low back pain as an example. Physical Therapists are trained to analyze movement and assess someone's biomechanics during functional movements. PT treatment for low back pain is focused on evidence-based exercises to increase strength and flexibility, incorporating manual therapy to improve joint and soft tissue mobility, and to educate the patient on ways to maintain benefits achieved from therapy and prevent future pain from occurring. The idea is so that the patient can avoid recurrence, or know what to do if that pain should come back again. I think that many therapists feel that a chiropractor's solution to the same problem would be to just use modalities ( i.e. ultrasound, e-stim), and joint manipulations (crack the back). This causes a patient to have to continuously repeat their visit to the chiropractors office for weekly, monthly or yearly adjustments. PT's also incorporate modalities and joint manips in with their treatment, but it is in conjunction with those I described above. We aim to have the patient become eventually independent with their care and not have to make those repeat visits. This is just what I have observed from past patients or from what some of my other colleagues have said. Many chiropractor's offices also include physical therapy care in with their practice. I'm sure they have similar goals for their patients as we do as well. But I also think PT's hate always having to correct society on the fact that we are not glorified massage therapists. Chiropractors marketed themselves very well at the start of their profession and seem to be the go-to place for back issues, or any other joint problems. Both physical therapists and chiropractors have similar training, requiring post-graduate work, and taking a licensure examination. So it may seem a bit like the middle child syndrome where PT's always have to validate their profession. Dr. Oz recently had a segment on cutting-edge solutions to back pain. It was great to get exposure for PT, but many were upset that the cutting-edge solutions were ultrasound, tiger balm, and using bumpy balls. Those are definitely not cutting-edge solutions. Those are solutions I can teach you to use in under 10 minutes, and doesn't require a doctorate degree to learn or understand. So, I believe that hate is probably better described as the constant and frustrating work physical therapists have to educate the public on what we actually do, and the benefits of our profession.
This topic is definitely a sore one for many therapists as the public thinks this is pretty much all we do. We are not massage therapists and our clinics aren't relaxing spas. They are never the main part of our treatment approach. That being said, there are therapeutic benefits with massage. It can help with muscle spasms, allow the therapists to increase range of motion, etc. Someone asked a similar question to this earlier in the thread, so I'm going to attach what I wrote there as well: Yes, I do believe that 'massage' has its medical benefits. I put quotes around massage, because I, and probably many of my colleagues, consider massage something very relaxing/soothing that you would get at a spa. What we really do is soft tissue mobilization (STM), that deals with the manipulation of soft tissue, or the areas encapsulating a joints that have restricted range of motion. After an injury, our muscles, ligaments and fascia tighten up, therefore STM is very useful in manually stretching those areas and restoring range of motion. This type of manual therapy can also promote restoration of joint function, improve blood flow, lymph drainage and increase nerve signals to the injured area. More often than not, I'd say manual therapy is not quite pleasurable as we are trying to improve function, not have a day at the spa. There was a running joke at my clinic that PT actually stood for 'Pain' and 'Torture'....affectionately :).
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