Job Interviews and SNF Questions

[kcrat21]

So, I graduate soon and am interested in working in neuro, preferably outpatient but open to other options (I really like my current trauma/surgery acute care affiliation!). I have had two interviews so far, one for outpatient neuro and one for neuro AIR. The outpatient one was at the clinic I did a six-month affiliation at and there aren't currently any jobs open but they are "keeping me in mind". The second interview with AIR was much more discouraging. According to the recruiter, they don't like to hire new grads, but she pushed my resume through anyway. When I went into my interview they made it very clear that they want someone with significant experience by basically making me take an on-the-spot oral neuro rehab exam, which I was completely blind-sided by.

So......to my questions:

1. Is it reasonable to assume that I need to STUDY for all my interviews? And I'm not talking about making sure I know about the company and whatnot, I'm talking like STUDY. How many of you had to answer questions regarding hypothetical patients and your hypothetical treatment strategies for them, and the different presentations of patients with different types injuries/diseases (some very obscure)? Is this a common occurrence?

2. It seems as though the majority of neuro facilities (outpatient, AIR, etc.) want a PT with experience. I have ZERO SNF experience, but it seems as though they don't require as much prior experience. I'm interested in learning some more from you all! Would anyone with SNF experience be able to tell me the percentage of time spent working with patients with neuro diagnoses?

3. If you are pro-SNF, can you give me some of the benefits you found working in a SNF vs other rehab settings? Why do you enjoy working in a SNF? Can you describe a typical working day?

I appreciate your help in answering some of these questions, guys! THANKS!

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[jblil]

kcrat, good to see you back. You guys beat us fair and square last night...

As for your questions, I may be able to shed some light on #3 as I shadowed/volunteered at a SNF for 2 years before starting PT school; also, my mother was at a SNF for some time before she passed away and I did a lot of poking around the PT dept when I visited.

The good part: patients are mostly very compliant and the actual PT work is easy, if monotonous. Lots of exercises for fall prevention, gentle core strengthening (e.g., bridging) and teaching patients how to ambulate with a rolling walker. The pay is also generally higher at SNFs than in other settings.
The bad part: your PT skills tend to become rusty (this was evident in one of the PTs I shadowed). There is a lot of pressure to provide PT to the patients because SNFs want to suck as much money as possible out of Medicare A. So you may be asked to work with comatose patients or with patients with conditions such as Alzheimer's. From private conversations with PTs and checking glassdoor.com, two of the larger SNF chains have a rather poor reputation for patient care and are seen to put $ before everything else.
This thread talks about working in a SNF:
http://forums.studentdoctor.net/threads/medically-unnecessary-pt-services-in-snf.1057966/

In the SNF that I volunteered at, most patients were recuperating from hip/knee replacements, or were just discharged from a hospital stay. I'd estimate the percentage of neuro patients there to be around 10%. At the SNF where my mother was, I'd say it was around 25%. I am sure it varies widely among SNFs.

I also have a couple of questions for you:
- Are you looking mostly in the Triangle area? The folks from the class of 2014 at my school reported having a tough time finding jobs around here and in Charlotte. I think saturation is very real for us. Several recruiters whom I talked to said that if you are flexible and can move towards the eastern part of the state, you would find a job fairly easily - except in Wilmington, because everyone wants to go there.
- You refer to "neuro AIR"; that's the first time I see that acronym. What does it stand for?

Take care, and let's keep in touch.

 

[kcrat21]

Hey jblil! sorry not sorry for that loss yesterday! 😀 y'all had me on the edge of my seat all night though. I couldn't go to sleep for hours afterward! Made getting up at 5:30a (read: 4:30a) for work REALLY difficult. It was a second (and third) coffee kind of day...

So my original plan was to stay here! My husband has a good job and my daughter is in school so we were hoping to put down some roots! I spent six months at Duke's outpatient neuro clinic and everyone already knew me from the DPT program and wanted me to stay on, but the outpatient clinic manager just doesn't have a position for me right now which is really disappointing. With so many PT schools in the area (what is it, 6? All within like an hour of each other?) I'm definitely feeling the market saturation issue. There are simply NO jobs out there in the Triangle. I REALLY like it down here and don't want to go back to VA so that's why I was looking into working at a SNF in this area, and then just continually checking in with Duke/UNC to see if they have any openings down the line. I read through that SNF post and it definitely has me concerned though which is why I posted. I've loved the freedom of being able to create the POC and d/c patients as I see fit and I value that autonomy so I don't know if I could willingly submit myself to working in an environment where I don't have that. Everyone keeps telling me that PTs are needed everywhere, but its slim pickings (especially for new grads) as far as the job market is concerned for what I personally want to do (outpatient neuro). So, I'm struggling to figure it out right now. I've worked really hard to tailor my clinical affiliations and my extracurriculars to a career in neuro rehab only to find out NOW that new grads are basically not welcome. It's discouraging. I have an interview in VA (meh) this week for a 75% neuro, 25% oncology outpatient caseload....so we'll see...

People keep saying that you "lose your PT skills" by working in SNFs? What do they mean by that? Are we talking MSK skills? Because I never really had those to begin with. My greatest skills are geri/neuro-related and while I am fully aware that people with neuro diagnoses also have muscles and bones, my ortho skills have never been my strongest asset, or even something that I've aspired to be great at (sorry). Falls prevention? NDT? amplified movement? YES! So if that's what SNFs are all about, I could potentially get down with that!

So what are your plans post-grad?

Oh, also...AIR = acute inpatient rehab!

 

[jblil]

kcrat, I'll answer your questions in reverse order ;-)

- My plans post-grad: I got the FELS for 2 years, so I'll be working in an "underserved area" for 2 years or I'll have to pay off 38K + 8% interest. From what I've gathered so far, there are places within 90 mins of the Triangle that are still in need of PTs. Have you looked at any? As an aside, I've lived in pretty desolate places (like in the middle of the Sahara desert - I am serious), so even Hicksville is going to feel like Manhattan by comparison. I don't have a preference as to the setting (acute/outpatient/etc), at least for the first year or two.

- Losing PT skills by working in a SNF: yes, I think most folks are referring to ortho skills, e.g., how to perform special tests for acromial impingement, etc. But sometimes it could be more than that; one of the PTs I shadowed had completely forgotten what the muscles of the rotator cuff are and what they do. Considering the importance of those muscles, I think for that person all the MSK stuff learned in PT school had evaporated into the mists of forgetfulness...

- May I ask where you'll have your interview in Va? I lived in Annandale and Arlington for several years and have no desire to go back. Too expensive, too much congestion. But I wouldn't mind Roanoke or its surroundings. I got my undergrad at Va Tech and have fond memories of that area.

- At least you & I are a few months from graduation. Folks who will graduate several years from now will have it even worse if they want to stay in larger metropolitan areas. To prospective students who may be reading this thread: be skeptical of what the schools tell you regarding the job market; they will always paint a rosy picture because they need to fill up the classes. As for the oft-cited BLS statistics, take them with a grain of salt too as the BLS is very optimistic.

- Have you considered Home Health? I hear the demand in the Triangle is still ok for that, may be because not too many new grads seem to like that setting.

 

[starrsgirl]

I completely agree with both of you on the job market. I'm a non traditional student, so probably had a very different perspective when considering the job market and going back to school. I often feel like I am the only one in my class who is concerned with this. I can't tell you how many times a conversation will end with "don't worry about it, the demand is so high and salaries will rise too as more of us graduate with the DPT". Whaaaat?! I knew what I was getting into, but I fear some of my classmates didn't (and many will have very hefty loans too).

 

[kcrat21]

Well, I can't lose ortho skills that I never had to begin with! Though I can definitively say that I know the muscles of the rotator cuff....at least for now, anyway 🙂

I grew up in Fairfax, so basically right where you lived. I don't want to go back there because of the RIDICULOUS cost of living and traffic. What I pay now for my 3 bedroom, basically brand new house in Durham, will get me a crappy, one bedroom apartment in Alexandria. The AIR job I interviewed for was in Mount Vernon. The job I'm interviewing for tomorrow is in Lynchburg, VA. I'd be more excited about it if the school system was better...my daughter will be in first grade next year. I definitely don't want to go back to NoVA, but I could see us in the Richmond-and-south part of the state if the school systems are good. I've heard great things about the schools and the health system in Roanoke! I'm also looking in the UVA area as my sister lives there. Not sure if they'll want any Blue Devils though! 😉

My understanding is that home health is not for new grads. Duke is adamant about No New Grads for their home health positions and I guess I can see why. There is zero mentorship and its just a tough side of the profession. So I haven't really considered it...

I definitely think that PT schools over-inflate the fact that PTs are needed everywhere, because I'm not seeing it and I feel like I'm forever sending my resume into the black hole that is online applications, never to hear back...

starrsgirl, I am a non-traditional student as well, and while most of my classmates are taking the NPTE in July and looking for jobs with no real urgency, I need to figure this crap out yesterday because I have a family and I can't go live with my parents in order to "enjoy my last summer before adulthood". I'm taking my NPTE in April, graduating early May, hoping to start working mid-May. Maybe that's overambitious...

 

[jblil]

kcrat - I was at CSM last month, and talked to a recruiter from UVa Health in Charlottesville. I picked up one of their brochures, and the work environment and benefits sounded very very good (they all do, on a marketing flyer). You certainly ought to give them a shot. They won't hold your being a Blue Devil against you, although they may do it for me, an ex-Hokie... Have you considered any other state outside of NC and Va? Having a family does make it a little harder as you have to consider your spouse's job and the kids' schooling. As for me, I am fine with spending some time in the boonies to pay back what I owe.

starrsgirl - kcrat, you and myself are non-trads as well as at least one other regular member (okramango). It would be interesting to compare our job search and options especially since we finish our degree at staggered dates: kcrat in May 2015, me in October 2015, okramango in 2016 and you in 2017 (am I correct?). May be we should start a non-trad networking and support group.

 

[BlueBlue8]

Fortunately I was not given a mini oral and practical on my interview, but it know of two classmates who had one. Both were ortho outpatient. One was asked to demonstrate her manual therapy skills on the interviewer. The other had to answer case scenarios. I wonder if this continues beyond being a new grad.

 

[okramango]

starrsgirl - kcrat, you and myself are non-trads as well as at least one other regular member (okramango). It would be interesting to compare our job search and options especially since we finish our degree at staggered dates: kcrat in May 2015, me in October 2015, okramango in 2016 and you in 2017 (am I correct?). May be we should start a non-trad networking and support group.

Thanks for the nontrad shoutout 😀
I'm definitely watching these types of threads closely as I move closer to graduating in May 2016.
jblil - I was at CSM, too! It would have been great to meet up in person. Maybe next year?

 

[kcrat21]

@BlueBlue8 - It was really tough, and I wonder if this is the way that employers will start going in the future to suss out the people who know their stuff. My questions were as such:
"What might you expect a patient with a XXX CVA to present like, aside from hemiparesis?"
"What does a patient with a complete C5 SCI need to be able to do before they can be discharged home from AIR?"
"Give us 2 STGs and 2 LTGs for a patient with a complete T6 SCI in the AIR setting."
I feel confident in my neuro knowledge, but I was really caught off guard by this interview. I've never worked in an acute neuro setting before as all my neuro experience has been chronic, so I had no experience to draw from. Needless to say, the interview did not go well. I was very flustered. But....

...That just made way for the WONDERFUL interview I had today! Outpatient neuro where I can do wheeled mobility and seating evals all day everyday if I want (squeeeee!), affiliated with a local DPT program that I can assist in as I please, at a facility that is building a brand new neuro center. It was basically a perfect fit. Hopefully it works out! (fingers crossed)

@jblil, you must have read UVA's mind, because they emailed me back today for an interview! They specifically said in their email that they won't hold it against me that I'm a Blue Devil (only minor harassment)! Maybe they'll do the same for a Hokie, you should apply!!!! 😉

I wish I was able to go to CSM this year! I heard its great for networking. Would have been very timely...

 

[NewTestament]

I've said this on several other threads, but it's worth iterating. There are plenty of job opportunities out there. I've contacted several recruiters and they've found me plenty of well-paying jobs ($80k+ for a new grad with tuition reimbursement, sign-on bonus, etc.) all over the country, but they are not in popular areas. You need to be willing to work in any state in any type of setting. Don't limit yourself. Your first job is not going to be your dream job.

Don't move to expensive areas, like DC, NY, any city in California, or Boston. You can't afford to live there as a new grad. Live in a rural setting or a small town. Not only will the COL be lower, but your salary will be higher.

You can also consider travel therapy. You can work in several settings in several states in one year. Your skills will not atrophy. Instead, you will probably learn more because you will be exposed to more therapists than you would if you worked in a single setting. The worst thing you could do is work in one place your entire career.

As for outpatient neuro, yes, most neuro clinics want previous experience. If you haven't done a rotation in a neuro clinic, you probably will not find a job in a neuro clinic. Those kinds of clinics are limited to rehab hospitals and there aren't too many positions in these places.

 

[kcrat21]

@NewTestament

1. I had a six-month rotation in outpatient neuro at Duke, and I tailored all my extra-curriculars and research around neuro as I knew going into PT school that that is the patient population I want to work with. So, I have the experience. In outpatient, anyway. Also, outpatient neuro clinics are not limited to just rehab hospitals, Duke's is a standalone clinic.
2. Travel is pretty much out of the question as I have a husband and a daughter who kinda want me around.
3. I grew up in DC, it is my home, which is why I was originally looking to work there. I'm not against working in a small town at all.

With all that, I interviewed in a more rural area of VA this week for an outpatient neuro job, which I was offered (and accepted) today. I would say that for me, it IS a dream job. It pays really well (including sign-on bonus, tuition reimbursement, and relocation assistance) and the COL in the area is low. So I would say that while your points and advice are generally helpful, maybe specifically for traditional students, its not the end-all-be-all for new grads in their entirety. I didn't spend the ton of money that I did to go to PT school (a different point entirely), to settle for working in a setting that I'm not interested in. Especially as a non-traditional student...

 

[jblil]

kcrat, congrats! Is the job in Lynchburg?

 

[NewTestament]

@NewTestament

1. I had a six-month rotation in outpatient neuro at Duke, and I tailored all my extra-curriculars and research around neuro as I knew going into PT school that that is the patient population I want to work with. So, I have the experience. In outpatient, anyway. Also, outpatient neuro clinics are not limited to just rehab hospitals, Duke's is a standalone clinic.
2. Travel is pretty much out of the question as I have a husband and a daughter who kinda want me around.
3. I grew up in DC, it is my home, which is why I was originally looking to work there. I'm not against working in a small town at all.

Then I stand corrected. But outside of rehab hospitals, neuro jobs are hard to find and most require prior experience. Take a look at any job newsletter or job list and almost all jobs will be in skilled nursing, home health, or outpatient orthopedics. I'm glad you found what you wanted. I grew up in near Washington, DC, too, but I would never live there as a new grad. You have to consider economics. The COL is high, and you're much better off working in a rural area or small town in MD or VA. At least you're within driving distance (four hours from Lynchburg).

 

[kcrat21]

@jblil Yep, good ol' Lynchburg! I had never been there previously, but I enjoyed my visit and the health system is doing great things! I poked around the town a bit and there A LOT of mountains and open fields. It'll be a nice change of pace. I'm really looking forward to it! Starting in July!

@NewTestament Oh for sure the COL in NoVA is just too high! I have no real desire to live there at all, more like my mom and my husband were hoping we would end up back there. My husband and I were both born and raised there....he misses his friends, ha! $2300 for a crappy apartment is just not up my alley though, nor is sitting in traffic for an hour to go 5 miles down the road. ALL THE NOPE.

I've noticed that most job postings are as you said: SNFs, HH, OP ortho....and acute care, as well. I only came across TWO outpatient neuro jobs during my search -- the one in Lynchburg and one in Longview, WA (which was part-time). Other than that, there were pretty much no neuro jobs in any setting that welcomed new grads. It sucks, in a way, not wanting to go the typical ortho route.....and not having any real PT work experience...

I'm glad it worked out for me though, and my search was only a few months long.

 

[ktachiba]

I've said this on several other threads, but it's worth iterating. There are plenty of job opportunities out there. I've contacted several recruiters and they've found me plenty of well-paying jobs ($80k+ for a new grad with tuition reimbursement, sign-on bonus, etc.) all over the country, but they are not in popular areas. You need to be willing to work in any state in any type of setting. Don't limit yourself. Your first job is not going to be your dream job.

Don't move to expensive areas, like DC, NY, any city in California, or Boston. You can't afford to live there as a new grad. Live in a rural setting or a small town. Not only will the COL be lower, but your salary will be higher.

You can also consider travel therapy. You can work in several settings in several states in one year. Your skills will not atrophy. Instead, you will probably learn more because you will be exposed to more therapists than you would if you worked in a single setting. The worst thing you could do is work in one place your entire career.

As for outpatient neuro, yes, most neuro clinics want previous experience. If you haven't done a rotation in a neuro clinic, you probably will not find a job in a neuro clinic. Those kinds of clinics are limited to rehab hospitals and there aren't too many positions in these places.

What do you mean by tuition reimbursment?

 

[NewTestament]

What do you mean by tuition reimbursment?

If you work for certain employers for a certain amount of time (e.g. one year) they will actually pay for part of your loans. Don't ask me about the logistics because I don't have a job yet but some of these rural employers will offer it.

 

[ktachiba]

Thanks for the info!

 

[kcrat21]

Yep! In the interest of full disclosure for others looking into this, they offered $25000 over 5 years.

 

[ktachiba]

Yep! In the interest of full disclosure for others looking into this, they offered $25000 over 5 years.

So $5000 a year? Or do you have to work all 5 years in order to get it?

 

[kcrat21]

5 per year, I dont have to work the whole 5 years.

 

[jblil]

That's very nice, I thought that signing bonuses and tuition reimbursement in our field had gone the way of the dodo.