Benefits of Residency and Specialization

[bjjpurplebelt]

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All,

I am interested in the cost benefit assessment of completing a residency and fellowship training. I feel there are a few factors I would be interested in hearing about: is there a salary difference and how significant is it between DPT, DPT w/ residency, DPT w/ residency and fellowship (I plan to negotiate a salary); I am looking at orthopedic and sports residencies and feel they are both close to one year in length--is this accurate; fellowship training has many benefits however what are the financial benefits and does job placement in your area of expertise become more challenging?

Thanks in advance for your contributions to this thread.

 

[Bluecase]

I work in a big hospital system. It doesn't make a difference if you are a new hire with a residency in terms of salary - only if the hiring manager looks favorably on that. What it does get you (or any specialization) is more boost when it comes to go for a promotion (not to manager, but as a treating therapist). Salary is the same potentially at the next level up but you just get more points towards the promotion with the specialization.

 

[DesertPT]

is there a salary difference and how significant is it between DPT, DPT w/ residency, DPT w/ residency and fellowship

I can't speak from experience, but from a number of other threads that have asked this question, the answer appears to be a big fat no.

 

[PTMattI]

I am considering doing a residency after graduation in a few months and my main motivation is that it will provide me with more education, guidance and mentoring in my first year as a clinician.

I think if your goal is to be as good of a clinician as you possibly can be, then completing a residency is something that should definitely be considered. Not saying that doing a residency is the only way towards becoming an `expert clinician` but from what I have heard it definitely accelerates that process especially if it is completed shortly after graduation.

As far as pay, if you do the residency immediately after graduating you will actually most likely make LESS than your peers because some of your salary will go to the residency program. But I think you wont feel it as much because you will go from making 0 when in school to making something haha

I think when considering the cost-benefit analysis you also have to consider things such as being able to help a wider array of patients, being considered more of an expert in your field, possible opportunities in education, etc... money should not be the only factor. If money is the only factor then why not become a dentist or something? haha just my two cents

 

[BlueBlue8]

I am not sure if it would really bump up your starting pay on your first job offer. Residency would make you a more skilled clinician under the guidance of structured mentorship. A lot of jobs will offer mentorship to new grads but that will likely consist of asking questions here and there and learning as you go. Or it could be that you're completely on your own and running a clinic by yourself like what happened to my friend (her boss promised mentorship too).

Like someone said...money isn't the target focus here. However if you were to then sit for the OCS or become certified in something else... That may lead to a higher salary. At my job we get rated higher if we have a certification. Apparently very few therapists in our hospital system (combo of acute, outpatient, and inpatient services) have any certification. They have started a therapy career ladder trying to encourage more people to seek certification. Of course they will pay for it if you guarantee them more time.

So in that regard...residency to OCS/certification may lead to more money.

 

[Sheldon]

I've completed a residency, have a board cert, another manual cert, and am in a fellowship program. I've not gotten a pay raise based on any of those accomplishments.
However, the experience of learning and the mentorship and networking have been invaluable and priceless. Indirectly, having these things may open some doors and may lead to a higher salary, but personally I'm not counting on it.
If you're going to do it, do it for the reasons I've listed and perhapy as a secondary benefit, you may have a higher salary than others but don't count on it.

 

[NewTestament]

I think if your goal is to be as good of a clinician as you possibly can be, then completing a residency is something that should definitely be considered.

This is an admirable reason, but this should be the only reason you do a residency. If you're coming out of school with >$100k in loans, you need to start working and generating income ASAP. I think a mentorship is all most new graduates need. Working 50 hours a week and learning more in your free time will make you an expert clinician in a few years.

 

[NewDPT31]

This is an admirable reason, but this should be the only reason you do a residency. If you're coming out of school with >$100k in loans, you need to start working and generating income ASAP. I think a mentorship is all most new graduates need. Working 50 hours a week and learning more in your free time will make you an expert clinician in a few years.

I absolutely agree. I do 4-10s and then supplement that with 10 hours of PRN every week on my day off. I do hospital outpatient. My friend, who is a brilliant PT, spent a year at residency and became a brilliant OCS, works for a big box PT clinic(think athletico/ati), and makes $14k less than my BASE salary for my 4-10s(he makes about $40k less when you figure in my added PRN for working actually less than him each week) We are the same age, same graduation year, and I would go to him for my own PT. Another friend works for the same company(big box), and is doing their residency program, which takes several years and you can do after work but requires you to pay back >10k if you leave within 3 years.

I think the key for the residency is >5 years or so, when you start to get onto your 2nd or 3rd job(this is fairly usual). It might not make much difference early but you should have a little more leverage with future jobs, but not too much. Places want to hire good fits, not just letters after your name. I think residencies and fellowships will ABSOLUTELY make you a better clinician, but the financial reward is little to nill.

 

[jesspt]

This is an admirable reason, but this should be the only reason you do a residency. If you're coming out of school with >$100k in loans, you need to start working and generating income ASAP. I think a mentorship is all most new graduates need. Working 50 hours a week and learning more in your free time will make you an expert clinician in a few years.

Maybe. But you need to WANT it. Reading a few crappy articles in Advance magazine over the weekend won't cut it. You need to be an engaged, thoughtful learner, reading applicable research critically. I have rarely seen this happen. The usual scenario is as follows:

New PT graduate, sick of having to read research, tells themselves they'll get around to reading once they get the hang of how the clinic runs. They get comfortable in how they currently practice, like the 40-50 hr work week, and haven't had many weekends to themselves because of schoolwork, so they put off the reading/learning that they were going to do on the weekend. Their patients are happy, so why do they need to critically appriase the literature. This tends to lead to them pursing the treatment fads that are prevalent in our profession, and soon they've taken a myofascial release course, are slapping kinisiotape on anything within a 5 mile radius, and become intrigued with craniosacral therapy.

This is not a good outcome people. Dont be the example I've laid out above.

If you are going to do a residency, do it early after you graduate. You're used to the impovrished student life. The longer you wait, I think the less likley it is that one would pursue it.

 

[DPTinFL]

Speaking of OCS, anybody taking it in March? I am and started to seriously study/review this Month. Any tips/strategies from already board certified PTs or current PTs who are studying??

 

[bjjpurplebelt]

Excellent comments. Other threads discuss some of the benefits and drawbacks of residency/fellowship. I agree the essential motivation needs to having expert level knowledge and providing services you would seek out for yourself.

I wonder if there is a difference between recent graduates beyond location when they acquire jobs. This graph (https://dptfinances.files.wordpress.com/2014/12/survey-results-dec-2014.pdf) is listed on another SDN post and shows a a normal distribution after graduation. It appears there is a large earning difference between new practitioners. It would be a shame to leave money on the table after investing in residency/fellowship training.

Does residency/fellowship provide negotiation leverage, for the applicant, during the hiring process? I wonder how much new therapists can effect their salary when the location of the job is taken out of the picture? Beyond practice location what other factors contribute to increased earning potential for new graduates?

 

[NewTestament]

This is not a good outcome people. Don't be the example I've laid out above..

As someone who started a journal club and did an in-service on applying research to clinical practice, I don't think this will be a problem. I enjoy reading research, but I understand most of my classmates despise it. What advice do you have for staying up-to-date, Jess?

 

[jesspt]

As someone who started a journal club and did an in-service on applying research to clinical practice, I don't think this will be a problem. I enjoy reading research, but I understand most of my classmates despise it. What advice do you have for staying up-to-date, Jess?

I didn't say that it would necessarily be a problem for you, only that it may be a problem for anyone.

As far as my recommendations, I'd recommend you consider the underlying theory of the intervention being studied (here is a great editorial regarding theory from the late Jule Rothstein, former Editor in chief of PT Journal), and also consider prior plausbility when appraising literature (here is a link discussing this very concept). Niether of these link to a particularly long read, but they may change the way that you choose to look at literature moving forward.

In particular for you New Testament, you may want to begin to consider (and perhaps you already have) how the traditional Paris aproach to MSK assessment fares when looking at its underlying theory and its prior plausibility. I came from a strongly biomechanical/palpatory/motion assessment background and have significantly changed the reasons "why" I do things with patients as well as my understanding of "how" these things typically work.

 

[noyceguy]

I didn't say that it would necessarily be a problem for you, only that it may be a problem for anyone.

As far as my recommendations, I'd recommend you consider the underlying theory of the intervention being studied (here is a great editorial regarding theory from the late Jule Rothstein, former Editor in chief of PT Journal), and also consider prior plausbility when appraising literature (here is a link discussing this very concept). Niether of these link to a particularly long read, but they may change the way that you choose to look at literature moving forward.

In particular for you New Testament, you may want to begin to consider (and perhaps you already have) how the traditional Paris aproach to MSK assessment fares when looking at its underlying theory and its prior plausibility. I came from a strongly biomechanical/palpatory/motion assessment background and have significantly changed the reasons "why" I do things with patients as well as my understanding of "how" these things typically work.

That Rothstein article reminds me of my favorite criticism of PT school...we are taught almost all practice and so very little theory. "There is nothing so practical as a good theory." If a person wants to be a thoughtful PT, they need to continually ask "why," look for the answer in the right place and not just consume PT literature for the sake of being "evidence-based."

 

[NewTestament]

Thanks, Jess. W

In particular for you New Testament, you may want to begin to consider (and perhaps you already have) how the traditional Paris aproach to MSK assessment fares when looking at its underlying theory and its prior plausibility. I came from a strongly biomechanical/palpatory/motion assessment background and have significantly changed the reasons "why" I do things with patients as well as my understanding of "how" these things typically work.

Can you elaborate a little more on this? What do I need to know about Paris's approach?

 

[jesspt]

Thanks, Jess. W


Can you elaborate a little more on this? What do I need to know about Paris's approach?

I was going to wrist a somewhat lengthy reply, but Joe Brence, on his blog (great site, BTW), has already addressed most of what I would bring up. Here's the link.

 

[Sheldon]

Except a lot of the studies that look at specificity of say, spinal motion palpation, are poorly done in and of themselves. Crap in = crap out. See this: http://www.dynamicptmichigan.com/dr-peter-huijbregts-insight/spine-joints-8.html

Additionally, a recent study in JMMT demonstrated that PTs attempting to be specific with HVLAT in the c-spine and l-spine demonstrated improved outcomes with more specific c-spine techniques; the l-spine did not show a difference. To me this makes sense, there is more agreement on coupling in the c-spine than l-spine...

There is work to be done on both sides of the fence, the generalists and the "specificists." There is a growing group of "theraeputic neuroscience educationists" that, while necessary (we all ought to be educating our patients re: pain in the most up-to-date matter), I think we've, as a profession, have jumped to the "next big thing" that has become rather trendy, and have thrown the baby out with the bath water. We are not psychologists AND even though some may approach with a specific palpation or technique, does not mean we don't use the BPS and the neuromatrix in our approach and reasoning.

Cheers.

 

[DPTinFL]

Except a lot of the studies that look at specificity of say, spinal motion palpation, are poorly done in and of themselves. Crap in = crap out. See this: http://www.dynamicptmichigan.com/dr-peter-huijbregts-insight/spine-joints-8.html

Additionally, a recent study in JMMT demonstrated that PTs attempting to be specific with HVLAT in the c-spine and l-spine demonstrated improved outcomes with more specific c-spine techniques; the l-spine did not show a difference. To me this makes sense, there is more agreement on coupling in the c-spine than l-spine...

There is work to be done on both sides of the fence, the generalists and the "specificists." There is a growing group of "theraeputic neuroscience educationists" that, while necessary (we all ought to be educating our patients re: pain in the most up-to-date matter), I think we've, as a profession, have jumped to the "next big thing" that has become rather trendy, and have thrown the baby out with the bath water. We are not psychologists AND even though some may approach with a specific palpation or technique, does not mean we don't use the BPS and the neuromatrix in our approach and reasoning.

Cheers.

I was a student of Dr. Peter Huijbregts and he was all about the lack of inter-rater reliability with PIVM.
RIP Dr. Huijbregts

 

[Sheldon]

I was a student of Dr. Peter Huijbregts and he was all about the lack of inter-rater reliability with PIVM.
RIP Dr. Huijbregts

Understood, and agreed. And not to derail the thread anymore, just simply saying lots of the research, either for OR against, PIVM (part of what Dr. Huijbregts alluded to in his study), PAVM, and specificity of technique has a lot to be desired.

I had a few good yet brief interactions with Dr. Huijbregts. He impacted a lot of people in a positive way, me included.