Advantages/Disadvantages of all PT Practice Areas

[Beach55]

I'm a second year PT student who has completed one outpatient rotation and still haven't decided what area in PT I want to work in. I know I'll have a better idea of the direction I want to go after finishing my clinical rotations but would really like to hear advantages/disadvantages of each practice area from current PT's or students who have finished most of their clinical rotations. One area I'd like to hear about is stress levels in each of the practice areas...personally, I'd rather work in a less stressful environment where I can work one on one with a patient (which I know rules OP in most clinics) and not feel like I'm selling a service to someone who may or may not need it. Salary is not a priority to me. Thanks in advance for any feedback!

Acute/ICU:
Inpatient Rehab:
SNF:
Outpatient:
School:
Home Health:

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[Ndebt]

Outpatient would be best for you. You get able bodied people who benefit the most from therapy although the pay is a bit less. ICU can be a pain because usually you can't do much with them besides try to sit them on the side of the bed/feel bad for them. In patient is roughly the same as SNF except not as many old people and more injuries. SNF is awesome in my opinion, best pay and least stress. Home health is my favorite. You do your own thing all day and take a break when you want and see as many patients as you want for however long you want.


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[Beach55]

Outpatient would be best for you. You get able bodied people who benefit the most from therapy although the pay is a bit less. ICU can be a pain because usually you can't do much with them besides try to sit them on the side of the bed/feel bad for them. In patient is roughly the same as SNF except not as many old people and more injuries. SNF is awesome in my opinion, best pay and least stress. Home health is my favorite. You do your own thing all day and take a break when you want and see as many patients as you want for however long you want.


Ndebt, thank you for the reply. My first rotation was in OP and I had an excellent CI - smart, compassionate, professional and a great teacher. However, I still felt like a lot of the patients we saw did not want to be there and like we hear all the time, only came for the PT to make them feel better without putting in any work themselves. I also felt like it was a numbers game where my CI felt very pressured to meet her target patient hours - which led to her seeing 2-3 patients at once and although my CI would have never tell someone they needed PT when they didn't, I still felt like she was trying to 'sell' a service to a lot of people. Most people will reply to that by saying that we as therapists have a great product that we should be selling to the public (who generally know very little about what PT's do), but selling something does not fit my personality. Am I way off in thinking that a lot of the 'issues' I have with OP do not exist in Inpatient Rehab or a SNF? I feel like patients in inpatient rehab 1) really don't have a choice in that they absolutely need PT 2) it will always be one on one and 3) the stress level to meet client hours doesn't exist at the same level as OP. Any additional thoughts? Thanks so much!

 

[bnwj89]

I'm a second year PT student who has completed one outpatient rotation and still haven't decided what area in PT I want to work in. I know I'll have a better idea of the direction I want to go after finishing my clinical rotations but would really like to hear advantages/disadvantages of each practice area from current PT's or students who have finished most of their clinical rotations. One area I'd like to hear about is stress levels in each of the practice areas...personally, I'd rather work in a less stressful environment where I can work one on one with a patient (which I know rules OP in most clinics) and not feel like I'm selling a service to someone who may or may not need it. Salary is not a priority to me. Thanks in advance for any feedback!

Acute/ICU:
SNF:
School:
Home Health:

I currently work in a SNF.
Cons: At the beginning of the day I'm given a list of patients to see, no real "set schedule" so to me one of the most stressful things is just trying to go from patient to patient efficiently. Sucks when you get to the last pt of the day and they don't want to do therapy because of xyz. But managing this is definitely a skill that is developed over time and I've noticed myself getting better, so probably won't be an issue for too long.
Pro: when I go see a patient for a evaluation, I start with saying that I am the physical therapist, and it is my job to work with them to set up a plan for rehab and a timeline for getting them home, and that's what I do. So it's rewarding in that I'm their advocate to get them home ASAP. Figuring out their barriers to home and helping develop a plan to overcome them is great. Then as soon as they can be safe and successful at home, send them home. Unfortunately, many SNFs try to hold on to pts for too long and just milk them for their Medicare A days...

Acute care/ICU was awesome, patients can make huge progress very quickly as they recover from xyz. But you won't see patients for very long cuz as soon as they're medically stable they'll go to SNF/inpatient rehab/home. ICU/acute can also be stressful with all the lines/tubes to manage...don't wanna be the one who accidentally pulls out an arterial line...
In this setting you'll also see a lot of your patients go through medical decline and death, just comes with the territory of having such sick patients. This can be an amazing learning experience but can also be quite stressful.

 

[Beach55]

I currently work in a SNF.
Cons: At the beginning of the day I'm given a list of patients to see, no real "set schedule" so to me one of the most stressful things is just trying to go from patient to patient efficiently. Sucks when you get to the last pt of the day and they don't want to do therapy because of xyz. But managing this is definitely a skill that is developed over time and I've noticed myself getting better, so probably won't be an issue for too long.
Pro: when I go see a patient for a evaluation, I start with saying that I am the physical therapist, and it is my job to work with them to set up a plan for rehab and a timeline for getting them home, and that's what I do. So it's rewarding in that I'm their advocate to get them home ASAP. Figuring out their barriers to home and helping develop a plan to overcome them is great. Then as soon as they can be safe and successful at home, send them home. Unfortunately, many SNFs try to hold on to pts for too long and just milk them for their Medicare A days...

Acute care/ICU was awesome, patients can make huge progress very quickly as they recover from xyz. But you won't see patients for very long cuz as soon as they're medically stable they'll go to SNF/inpatient rehab/home. ICU/acute can also be stressful with all the lines/tubes to manage...don't wanna be the one who accidentally pulls out an arterial line...
In this setting you'll also see a lot of your patients go through medical decline and death, just comes with the territory of having such sick patients. This can be an amazing learning experience but can also be quite stressful.

bnwj89 - thank you for your reply!

 

[Azimuthal]

Acute Care/ ICU

Pro: It's a good learning environment for many pathologies. You will commonly see CVA, sepsis, ETOH withdrawal, post ops, CHF, PNA, etc., know where they are coming from, learn their Rx, and assist in their transition from facility to facility, or home. Your medical screening skills are aided by monitoring equipment, lab results, etc. and you have immediate access to IM's. Example: One of our PT's recently reported a "new finding" of gait abnormality, left sided weakness, slurring, and afferent presentation. Many things indicating a possible CVA; IM ordered an MRI and it was verified so. There is a strong interdisciplinary working environment, from surgeon to IM to SLP to PT.

There are also numerous roles to fill from CP, wound care, ortho, neuro, oncology, etc. within one department.

Con: Patients pass. Sometimes expectedly and sometimes surprisingly. Planning out hospice care or educating family for comfort care is not my cup of tea. Many times you spend a good amount of time untangling leads and lines, providing suction, helping NSG clean up a code brown, etc. I found a semi detached colostomy bag once and asked nursing to redo the entire thing -- like the smell or the soiled gown wasn't an indicator. Too often an IM orders a PT eval on the day of discharge. If you don't have proper training in the ER for the staff when they order a PT eval there, then they are clueless of PT.

 

[steveyk]

wow so much insight in this discussion! very useful for someone like me who is starting school in the fall.

to the OP. if you are wanting to treat one on one, outpt is definitely NOT ruled out. I worked as a tech/aide at both a private outpt ortho clinic and a hospital based outpt unit. similar but the pace is completely different. many outpatient hospital settings require 1-1 treats so maybe you could look into that! and the other rehab units in that same hospital may need coverage so you'll have opportunities to float over and learn from other settings if you're interested in doing that.

 

[NewTestament]

Home Health

Pros: you can make your own schedule, although this is one more step, but it's not as rigid as outpatient; autonomy- which is not necessarily good if you're a new grad; you meet interesting people; you learn how to think fast and to be creative since you don't have a lot of tools; you can do your errands between patients; home health pays better than any other setting; TONS of jobs available; you can do home health anywhere; did I mention it pays well?

Cons: driving- which isn't that bad if you're driving the company car; logistics can be a nightmare sometimes; some homes are nasty; all your patients are Medicare A- >75+ at least; some patients aren't appropriate but the HHA has to meet a census so it picks up these patients anyway; you don't learn as much in other settings, but that doesn't mean you can't learn anything new. I learn in my free time anyway; Medicare SUCKS- it regulates home health to death. Don't ever be a home health manager. It's a miserable job.

Acute Care

Pros: flexible schedule- you decide the order in which you see patients; interprofessional collaboration like no other setting- I love this; the variety of patients- ages 6-96; the variety of diagnoses; you get to work in a hospital or a medical center, which is a huge concentration of like-minded people; you have to make a lot of fast decisions; acute is more skilled than it seems. There is less emphasis on hands-on skills (manual therapy) and more emphasis on critical thinking. Personally, my favorite setting.

Cons: tubes and lines- you have to be careful; fecal matter and urine- CNA's aren't always available!; you have to be stoic- death occurs here; it doesn't pay as well as home health or SNF.