Why It’s Okay to Know What Setting You Want to Go Into Before You Start PT School

Guest post by: Jasmine Marcus, PT, DPT

Physical therapy and pre-physical therapy students often ask me how they can specialize within the physical therapy world. Sometimes they haven’t yet finished their pre-requisites for PT school, but already know they want to be a pediatric physical therapist, or work with a major league baseball team. Before I headed to PT school, my goals weren’t quite as specific, but I knew I wanted to work in outpatient orthopedics – the setting in which I now work today.

Eight years ago, I decided to become a physical therapist, and I have never wavered in my decision to work in orthopedics. Outpatient orthopedic physical therapy may have been the only setting I really knew before PT school, but it was also the reason I wanted to become a PT; it made sense that I wanted to work in an orthopedics setting.  Outpatient orthopedics appealed to me because of the variety of people and conditions I would be able to treat. My job as an aide showed me that no two days are ever alike. I relished the idea of getting to see patients for long periods of time so I could build a rapport with them and see them reach their long-term goals. The setting also appealed to me because I enjoy figuring out what is causing a person’s impairment and creatively deciding how they can best be helped.

Preparations for my career in outpatient orthopedics came even before I applied to a DPT program. I did the bulk of my observation hours (over a thousand!) in an outpatient clinic where I worked as a physical therapy aide. The experience was invaluable – not only was I getting paid and racking up hours, but I was learning a lot about interacting with patients and saw a great model for running an outpatient clinic. In the clinic, the therapists worked one-on-one with each patient for half an hour; the detail-orientated nature of the business impressed patients and helped them get the best care. To round out my application, I also observed for 50 hours in a hospital setting (acute inpatient).

In physical therapy school, I again sought out depth in outpatient orthopedics rather than breadth in a variety of settings. I made the controversial decision to complete three of my four clinical rotations in outpatient orthopedics clinics. While some professors argued that students should experience a variety of settings – and some schools even require you to intern in four different settings – I knew where I wanted to work to gain as much experience as possible. I also wanted to develop contacts since clinical rotations often lead to job offers. Admittedly, I did try to vary my electives: medical Spanish, women’s health, ankle injuries, and sports therapy. This diverse array of courses taught me a lot and provided me with skills I could implement in my preferred setting of outpatient orthopedics.

I ended up being happy with my decision. Upon starting my first job and treating patients independently, I was glad to have 26 weeks of orthopedics experience behind me, rather than the eight weeks I would have gotten had I only completed one of my four rotations in an outpatient orthopedics setting. I also ended up getting multiple job offers from my clinicals and am still working at the site of my third rotation today.

That being said, it is important not to shut out other settings completely. Many PT students do end up changing their minds; some students are not initially certain what setting to focus on, if any at all. PT areas operate differently from those of medical doctors – physical therapists are expected to understand each of the more common PT settings in detail. While you wouldn’t expect a gynecologist to put in a pacemaker, an orthopedic physical therapist could work in a skilled nursing facility. And, at the very least, as a physical therapist you will have to learn about the basic areas of PT – orthopedics, neurology, cardiology, etc. – to pass all of your coursework and the NPTEs. I sometimes read pre-PT students’ posts declaring they won’t like any of the coursework that doesn’t directly correlate to their dream job. To them I’d say: even if you’re dead set on working with athletes, you will still have to learn how to treat someone who has had a stroke.

Another thing I’ve realized in my years of working as a new grad is how closely many settings overlap. While I don’t work at a pediatric facility, children come into our clinic fairly often and I am expected to treat them with confidence and competency. Additionally, while we learned about conditions such as scoliosis or cerebral palsy in pediatrics, children with those conditions grow up to become the 35-year-old patient with CP or the 75-year-old patient with scoliosis coming into my office.

My point is, don’t be afraid to specialize and go after your passion, but remember to keep an open mind and allow space to better understand the multitude of options that make our profession great.

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