Author’s Note: This has largely been an exercise for me in identifying the difficult aspects of my job. I am not attempting to bash the profession, or insinuate I regret my career. However, these are by and large the biggest areas of difficulty that I have struggled with in the seven years I have been a physical therapist. It is also in no way saying that these are all issues at my current employer, merely my observations on the trends for the field, in my honest opinion.
I was never hugely interested in healthcare when I was younger. Sure I bandaged up my bears and other dolls as much as the next kid, and I surely delivered my share of cabbage patch dolls. Yet, pursuing a career in healthcare was not something that I was wholly interested in. However, as I got older I would hear more and more about the benefits and security that came along with a career in healthcare. In tenth grade, I would go on a mandatory job shadowing experience with a physical therapist and I would be hooked.
What initially attracted me to physical therapy was the idea that I could have variety and creativity in my day to day life. There were a multitude of settings that I was exposed too when doing shadowing. I felt like there would always be something new to explore. I also felt that the job was flexible, and did not include blood and guts. Going through school gave me a better sense of what the career would entail, but honestly there are some things that I wish I had known.
I worked in a variety of retail jobs prior to becoming a physical therapist and was no stranger towards sales goals and charts for progress. However, even my clinical experiences didn’t prepare me for being under the gun regarding my productivity expectations when I graduated. In physical therapy we have a productivity minimum, which means that I am expected in my day to spend X% of time in the building doing skilled things that can be billed to insurance, or direct patient care. In theory, I would spend about 80-90% of my time (Depending on what company I work for) treating patients, and in the other 10-20% I have to complete documentation, attend meetings, call families who have questions, spend time with my Physical Therapy Assistants, and potentially working with other departments.
It might not sound difficult, but every minute that I don’t spend with a patient adds up quickly, and a lot of time I do spend with patient’s might not even count per the insurance guidelines. One patient who refuses treatment, or doesn’t show for any reason can bring down the whole day. And if the refusal is for a significantly long treatment, I could even need to leave up to 1-2 hours earlier than expected.
If I am being honest, we spent more time learning how to document in school that we did learning how to treat patients. As healthcare attempts to reform and insurance companies try to cut costs, they need more and more documentation that indicates that what I do can legitimately only be completed by me, and not by anyone else. Every patient gets a daily note every day, and the components of my note have to include: what I did, why it was skilled, how the patient responded, what is my plan going forward, and when to I anticipate that the patient will discharge.
In addition to that, the documentation has to show that the patient is improving, demonstrate a valid reason that progress was halted and expected to return to improvement, or that what I am doing absolutely cannot be taught to someone without my level of education. As an advocate to my patient, I want to make sure that they can continue to receive their therapy to get better and return to functioning, so this is something I want to make sure I get right. Also, remember that documenting is not considered “skilled” so it is time that I cannot bill to the insurance company (see above!).
Therapists are Essential Personnel
Outside of working in a school system or in an outpatient clinic, therapists are considered essential personnel. That means that no matter the weather (and remember I live in New England where blizzards are a given), I have to be there. I have worked for companies that in the light of an impending snow storm try to manipulate the schedule so patients are scheduled with their off day on the snow storm day so staff does not have to risk life and limb to be there. I have also seen managers disciplined for this at buildings who want their therapy departments fully staffed AT ALL TIMES. As essential personnel we are also expected to work all of the holidays, and lets just say that not everyone is thrilled to see me in my elf ears on Christmas Eve.
You Can’t Take No for an Answer
With the productivity standards, and billing often relying on the amount of time you spend with a patient, there is a lot of pressure not to take no for an answer. This really stinks because as a fellow human, I get that there are days that patients just can’t do it. I am pressured to see patients, even if they are in a medical crisis. If a patient refuses to participate in therapy, I have to keep re-attempting throughout my day. This is especially frustrating in the hospital setting when the Doctor is refusing to discharge you because he wants my sign off on the case. Trust me, I’m not making any friends this way!
I May Not Get to Follow You – But I Have to Know Everything About You
In a lot of settings that I have worked, I have had the opportunity to work with some fabulous physical therapy assistants (PTAs). PTAs hold an associates degree and as such there are limitations to what they can do. For example, they cannot evaluate or make any changes to a plan of care. It is also advantageous for facilities to employ them because they do make a bit lower of a rate compared to the Physical Therapist, who goes to school nearly three times as long and now holds a doctoral degree. This means that in a lot of places, I am seeing patients at evaluation, and following up with them only once every ten days when their progress notes are due. In the states I have practiced there are no set ratios for Phyisical Therapist to PTAs. In my last job I over saw approximately 25 patients at a time, with 2 assistants working under me. I have had jobs where I have had to oversee up to 70 patients with 6 assistants underneath me. There is also an expectation that I will know everything about your case, at the drop of a hat.
Our Doctorate is Considered a Joke – And Our Salary Won’t Offset the Cost
Sure I did as much work to earn my doctorate as any other doctoral candidate, but outside of my grandmother bragging to her friends I have never been addressed as Doctor. In fact, I have more often been mocked for thinking that I could possibly be in the same caliber as other Doctoral Recipients. Neither physician assistants, nor APRN s (advanced practice registered nurse) hold doctorates (which is why they are not referred to as doctors). However, though I will certainly make a living wage it is far more likely that a physician assistant or APRN will make a six digit salary in their career than I every will.
There Isn’t a Lot of Room to Grow
As a physical therapist, there are several different settings that you can work in. However, aside from the variety of the different settings there aren’t many other options for physical therapists outside of being a physical therapist. Sure there is the management track, and there is teaching physical therapy courses, but there are very few other opportunities that one could qualify for with a physical therapy degree. Nurses on the other hand have a wide variety of options available to them that no only allow for mobility within their field and challenges to different skill sets, but allow them any number of non clinical opportunities as well.
There is no Light Duty
If for any reason, I become incapacitated in any way, I will be out of work. There is no option to work “light duty” for any period of time. With short term disability taking two weeks to kick in, I need to reserve a two week buffer to bridge the gap. I need to be diligent and careful both in and out of work not to get hurt. If I were to become pregnant and recommended any type of restrictions to activity, I would be just out of luck.
This all being said, this by no means is trying to say that I hate my profession or that I regret going into the field. These are merely the negative aspects to the job, that I wish I had know about before selecting my career. Maybe they would have been deal breakers, maybe not. Either way, being seven years into my career, these are the points that I would bring up to other aspiring therapists to be mindful of when selecting this career. It’s not always peaches and cream!