The PT/PTA Billing Dynamics
Estimated Reading Time: 2 minutes
Sometimes I wonder about the future. Two years from now when I’m a newly licensed physical therapist, I suspect that I’ll worry about remembering all the positions for measuring range of motion, what cranial nerves are affected and when, or what the extensor carpi radialis does. I also suspect I’ll worry about understanding the administrative aspects of our business, like billing appropriately.
The first step in understanding this important process is to become familiar with the factors that impact billing and payment. These factors include state practice acts, federal policies, payer policies, and employer or setting policies.
Some payers will have different requirements based on the treatment setting. For example, in a private practice setting Medicare rules require that services provided by a physical therapist assistant be under the direct supervision of a physical therapist. In other settings Medicare rules require only general supervision. Ultimately, the most stringent requirement must be met, whether that is the state practice act, the payer policy, or the employer policy.
The provision and billing of services when provided by a physical therapist–physical therapist assistant team is complex. It is the responsibility of the physical therapist to know under what conditions certain interventions can be delegated to a physical therapist assistant and how those services must be supervised, documented, and billed. When a physical therapist does delegate components of care to a physical therapist assistant, the documentation must include evidence that the physical therapist established the plan of care and reviewed it with the PTA, and that the care is being provided under the supervision of the physical therapist.
It is important to note that billing is tied to the supervision requirements in each state’s practice act and each payer’s policy requirements, so make sure to look at your state practice act and payer policy for this information. For example, cosignature requirements vary by state, payer, and setting. APTA’s website provides extensive resources related to the PT–PTA team.
In recent news, the Medicare therapy cap was finally repealed after 20+ years of advocacy from leaders in our profession. Unfortunately, along with elimination of the hard cap, a differential payment rate was established for physical therapist assistants that is set to start in 2022. In this new payment system, PTAs will only be reimbursed at 85% for outpatient therapist services. APTA is working to ensure that guidance to implement this new policy does not impede access to necessary care.
I believe that a greater understanding of these issues as students makes us better equipped to enter our clinical rotations and our first jobs. Physical therapy students should know their roles and responsibilities regarding documenting appropriately to get paid for the expertise and services we studied so hard to learn. In the end, we want what’s best for our patients, and knowing how to bill appropriately ensures that we use the correct services to help get our patients better, faster.
State practice acts
Other helpful resources:
The Post-Therapy Cap System: 5 Basics You Need to Know
Use of Physical Therapist Assistants (PTAs) Under Medicare
Hannah Belles, SPT, is a current student at the University of Florida. You can connect with Hannah on Twitter at: @HannahBelles93.
PTA Scope of Work: Skilled PT Service Providers
Estimated Reading Time: 3 minutes
In physical therapy school we have a lot of lab time. Generally, there's a quick demonstration by the professor, then we jump into practicing techniques on each other, sometimes guessing our way through the motions. We get feedback from professors as they walk through the classroom, but with 50 of us in class, it can be difficult to know if you're doing it right at times. One day as I was practicing residual limb bandaging, a classmate offered some very helpful step-by-step instructions. I asked, "How do you know how to do all of this?" She replied, "I learned this in physical therapy assistant school. I spent a lot of time on this and was tested on it."
Prior to that day, I never put much thought into what PTAs are educated and trained to do. This is something that I should know, considering that I will likely work alongside them in the future. Under Medicare rules, PTAs are the only individuals who can provide billable physical therapist services under the direction and supervision of a PT. PTAs provide the treatment that PTs determine appropriate. They collect data, such as goniometric measurements and manual muscle test results, which are important for tracking progress. PTAs are trained to handle emergency situations and to recognize when a patient is not medically stable.
PTAs provide many of the treatments that a PT provides—passive range of motion, electrotherapeutic modalities, mechanical modalities, gait training, functional training, transfer training, wound dressing, airway clearance techniques, and therapeutic exercise for strength, flexibility, and balance. Although PTAs cannot make changes to the overall plan of care, they are trained to make treatment adjustments to accommodate a patient during a session.
PTAs cannot perform selective sharp debridement in wound care management. Depending on state practice acts, PTAs may or may not be able to perform joint mobilizations. Some states do allow PTAs to provide grade V high velocity low-amplitude thrust techniques. Again, the general idea is that a PT can delegate any task to a PTA that they deem appropriate, according to the skill level of that PTA. However, it's important that you refer to your state practice act to determine if there are interventions that a PTA is not permitted to perform in your state. In terms of billing, this can be even trickier. Check out our next blog in this series for more information on billing for PTA services.
PTAs can become skilled in their interested area of practice. APTA's Advanced Proficiency Pathways (APP) program offers PTA members the opportunity to gain advance proficiency knowledge and skill in areas of acute care, cardiopulmonary, geriatrics, oncology, orthopedics, pediatrics, and wound management. To receive APP recognition in a practice area of interest, a PTA must complete an additional 60 hours of continuing education coursework and 2000 clinical hours of work experience. During clinical experience, PTAs are mentored by a PT who is an expert in that practice area, and who will teach, guide, and assess the PTA's skills toward achieving advanced clinical competence.
In summary, PTs must examine, evaluate, screen, diagnose, determine a prognosis, develop plans of care, oversee documentation and care, and discharge patients. PTAs are highly trained in providing treatment interventions for patients and are an asset for patient care, especially when the PT and PTA have a mutually trusting and respectful relationship. If you want more information on PT and PTA scope of work, visit one of the following resources or review your state practice act.
About the PTA Advanced Proficiency Pathway (APP) Program
Leading the Team – A Practical Guide to Working with PTAs: APTA Learning Center Course LMS-353
Katie Kostelecky, SPT, is a member of the APTA Student Assembly Interprofessional Collaboration Project Committee. You can connect with Katie on Twitter at: @katielynnkmarie.
The Adventure Seeking PT
Estimated Reading Time: 7 minutes
Do you get bored quickly, feel a constant need for adventure, or just love experiencing new things?
Does the thought of staying at one job for the next 30 years seem soul crushing?
Maybe you're tired of living where you are, but you're not quite sure where you want to be.
Maybe all of those resonate with you in one way or another. That was me 2 years ago.
After graduating from physical therapy school in 2014, I landed a great job in an outpatient clinic with dreams of becoming the best outpatient clinician there ever was! But after a year I decided that maybe I wanted to live closer to my family.
I moved home to Montana where I, again, sought out an outpatient position and buckled down. A year later I found myself thinking this wasn't quite what I wanted to do, nor was it where I wanted to be.
I had an intense need for adventure that this nine-to-five just didn't satisfy. I was left thinking this is a profession that I love, but I'm still not fulfilled, what do I do now?
You see, I've always had a passion for doing, seeing, and experiencing new things; it's one of the things that drives me, inspires me, and lights my fire.
On August 25, 2015, I received an email that would change everything for me. Randomly, an advertisement for a travel physical therapy position arrived in my inbox.
The email was plastered with captivating pictures of New Mexico and said something along the lines of, "I have an EXCITING physical therapy opportunity that needs temporary coverage. Experience an adventure in lovely New Mexico! Here are a few details about the assignment. Upbeat outpatient clinic, ASAP start date, 13-week contract, NO weekends, flexible schedule, lucrative compensation package, travel and licensure reimbursement, paid housing, food stipend, paid Blue Cross Blue Shield medical benefits."
I remember reading that and thinking, "Is this real life? You mean I can go somewhere for 13 weeks, work, get all my expenses paid, experience all this new area has to offer and then leave, no questions asked?” It seemed too good to be true.
A few months later I met a travel PT and picked his brain about all the questions that had surfaced after reading that email. So how does this actually work? What's the catch? How do you find a place to live? What challenges have you faced? Do you love it? Do you hate it? Give me all of the details!
After talking with him, I reached the conclusion that I had to at least try it, I mean, it's only 13 weeks, there's no hidden contracts and I can quit after that if I hate it. This is how my travel physical therapy career began!
It's now 2 years later, I'm still a travel PT and there hasn't been one moment that I've regretted my decision.
While on this amazing travel journey, I've learned a few things that may be helpful to anyone considering travel physical therapy—even those of you who have a slight interest.
When starting a travel career, focus on picking a recruiter over picking a company.
Your recruiter is your lifeline! Your recruiter is your main way of connecting with job assignments, the one who helps you navigate the logistics of your company, the person you can call when things don't go as planned, and the one who always has your back. This relationship is crucial to your success!
It's important to find a recruiter you connect with, someone whom you trust, is good at communicating, and is willing to work for you.
My recruiter has been amazing. She not only deals with my millions of questions, but she also takes on all of my crazy job requests; she does her best to turn my visions and desires into reality. She has been there when assignments have fallen apart and has helped me create positions from nothing.
Your assignments expect you to be ready on day one.
Admittedly, I don't know if I could have gone into travel physical therapy right after graduation.
When I started traveling, I was so thankful for the experience I had gained in my permanent positions as an outpatient clinician. Those experiences allowed me to develop my skill set and get comfortable with being a PT.
When you travel, your assignment usually has an immediate need, which means they need you to hit the ground running. No gradual ramping up of your schedule or giving you a week of orientation. This is definitely something to take into consideration as a new grad. Everyone is different, but I know that personally I needed time under my belt in order to handle all of these new challenges. When you are being faced with ever changing surroundings, it's hard to refine your skill set. For me, it was nice to have a firm foundation to pull from.
For example, I was the only PT in an outpatient workers comp clinic seeing a high-volume caseload, with no techs. Then, I jumped into a skilled nursing facility treating patients with traumatic brain injuries and “old age.” After that, I went to a hospital where I had patients with rare conditions like Guillain-Barré syndrome and Bell's palsy. I had families whose lives just got rocked because their loved one suffered a severe stroke. I came into contact with patients where I was the first person who came in the room after the results came back showing that their cancer was progressing. In those moments I was glad that I didn't have the stress of thinking about what questions to ask for the evaluation, how to perform special tests, what intervention to start with, and how to document.
Get creative with housing.
There are 2 main options when finding housing. You can have your company find you something, or find it on your own. Either way, you receive a set stipend that will pay for your housing.
Finding housing on your own may take some creativity, but you are usually able to find something closer to your assignment and much more affordable than cooperate housing, which results in going into your bank account more.
I have used a variety of websites such as Airbnb, Craigslist, and Facebook community pages to assist in my housing pursuits. Also, don't be afraid to use your PT networks. Whether its old classmates, someone you met at a course or conference, or someone you follow on social media, I've found that if you tell people what you are doing, they want to help you out. But it's always nice to know that if I can't find anything, my recruiter will be able to make something happen.
Plan ahead and allow yourself time to get your licenses.
Licensure can get really cumbersome. At this present time you need to have a license in each state you practice in. Exciting news on this front is that the Physical Therapy Licensure Compact will make it much easier to get authorization to work in multiple states without going through the traditional licensure process.
The compact will allow you to work in participating states by verifying your eligibility and purchasing compact privileges for any of those states through one online portal. This new process will only take minutes. If you live and hold a license in Mississippi, Missouri, North Dakota, or Tennessee, this may already be an option for you. Seventeen other states have adopted the compact and will make compact privileges available in the near future. But for now in most situations you will need to apply for a license directly through the state where you want to work. you need to give yourself a good month or two to get a license for each new state. This process involves an application, fees, letters of good standing from all your other licenses, NPTE test scores, transcripts, and at times a jurisprudence exam. Be aware of the requirements in each state to save yourself legal trouble and delayed assignments.
Travel physical therapy demands flexibility, but also offers flexibility.
From where you live, to the setting you work in, to the EMR you use, to the patient population you see, everything is always changing.
I've had assignments get cancelled on me after moving 2,000 miles across the country and working for only a couple of weeks. I've also had some assignments that I've been able to extend for 7 months. With all these changes, stress levels can rise quickly! In the end, though, everything always works out, as long as you are able to remain flexible.
Travel physical therapy also allows for flexibility in your life. This is my favorite part about it. You get to choose where you go and when you work. As long as there's a job there, you can go there. Or if you have the urge to take a month off in between assignments and travel to Guatemala for a service trip, you can.
Travel physical therapy has provided me with the means to pursue my career goals while experiencing new things and seeking out endless exploration, and get paid to do it. It has given me a way to allow for space in my life. Space to spend more time with family and space to pursue some of the things I'm most passionate about, like global health and fitness.
Each assignment has helped me learn and grow both as a person and as a PT. I've been able to rub shoulders with some awesome PTs and develop lifelong friendships.
Travel PT is not without its own set of stresses, but it's sure to satisfy those who feel the need for adventure and whose lives were never meant to fit within the nine-to-five schedule.
Alicia Williams, PT, DPT, is a travel physical therapist making her way around the United States. You can connect with Alicia on Facebook.
5 Things Every Student Should Know About The Role of PT in Disaster Relief
As physical therapists (PT), we are valuable members of the health care team on all occasions, but especially during disaster relief situations. If you're interested in global health and are curious how you as a PT or a physical therapy student can contribute during disaster relief response, here are 5 things every student should know:
PTs are needed on the front lines of disaster
- With our breadth and depth of skills, we are just as essential for response two days after a disaster as we are two months post-tragedy.
- The physical therapist's role needs to be clearly communicated to other team members and must align with our APTA code of ethics
PTs need preparation before working in a disaster setting
- Responding physical therapy students should be aided with a mentor and/or have taken formal disaster relief training before responding.
- Know your basic skills, confidence and competence are key
- The environment is constantly changing to manage risks and maximize space, supplies, and time
- Cultural and language barriers are often present and must be respected
Preparation can start as a student
- Interested students should attempt to gain a better understanding of a disaster relief through self-study, mentoring, and training
- Consider continued education related to public health, emergency management, and global health to compliment your physical therapy knowledge and skills
Pick a trusted organization or mentor to volunteer with in disaster
- Even though we want to help, students are not licensed PTs and must be willing to respond as a lay-person under the supervision of an experienced mentor
- A solid organization/mentor will establish what your role is in disaster relief and provide you with the opportunity to contribute in a positive way
- Reputable organizations include: Red Cross, Humanity and Inclusion and Christian Blind Mission
Keep your passion to serve ignited
- Stay up to date on disaster relief research
- Find a mentor who has served in disaster and pick their brain
- Find course work for emergency medicine post-grad
- For more information check out this WCPT resource on disaster relief.
What you prepare for now, will only allow you to respond more compassionately and effectively in the future. Read more about PTs and their role in disaster relief.
Interested in global health initiatives? Contact the APTA Student Assembly Global Health Project Committee to learn more.
Lessons Learned While Serving Others
Estimated Reading Time: 8 minutes
The time leading up to my trip to Puerto Rico was not the easiest. Two weeks before the trip I was rejected by a PhD program that I applied to, informed by a couple of professors that they were not sure I would be successful on my next clinical rotation, had disagreements with my classmates also going on the trip, and to top it all off, I had several finals to take.
This accumulation of events, coupled with my admitted struggle with impostor syndrome, led to a lot of doubt in my ability to be a trip coordinator and a successful physical therapy student right before embarking on this journey, a trip which required a lot of confidence in both areas. However, as they say the show must go on, so it did and the trip ended up being better than I could've ever anticipated.
For a little background, service to others has also been an important part of my life, whether it is in my local community or on the other side of the world, I feel a drive to help those in need, as I am sure many others in this profession do. Therefore, when I found out my physical therapy program did not offer a service trip for students I decided that I wanted that to be the legacy I left behind.
During my first year in school I tried to set up a trip that eventually ended up falling through, but I was determined to make this dream a reality. During my second year, I got connected with one of our professors who was from Puerto Rico and said he would be interested in accompanying a group of students there. Slowly but surely we started planning this trip from scratch. The professor connected with organizations he knew in Puerto Rico, and I coordinated things on our side.
Over the course of the year, planning this trip were many obstacles that we had to cross and many people who doubted our ability to succeed, but in the end, everything worked out.
While in Puerto Rico my classmates and I worked with an organization called La Perla de Gran Percio. The organization has inpatient and outpatient facilities for people with HIV, an orphanage, and did regular homeless outreach—all of which we got to be a part.
At the outpatient clinic there were 2 trainers and 1 PT, and at the inpatient clinic there was a PT who visited twice a week. We spent time in both clinics doing physical therapy evaluations, exercise plan updates, and connected with the patients who were so grateful for any time we gave them. We also got to spend some time assisting with a homeless outreach project, where we provided showers, food, and new clothes as well as haircuts and HIV testing. At the orphanage we had the opportunity to play with the kids. While spending the week in the wonderful place I learned several lessons.
A smile and a handshake can go a long way
In school we are taught so many detailed skills and tested in situations where near perfection is expected, often we feel like we are never going to be good enough to help anyone (or at least I sometimes do). But while I was in Puerto Rico I learned that the little things sometimes can have a huge impact on a person's life.
The participants at La Perla were so grateful just for our presence, as something as simple as standing at the door and greeting them in the morning brought a huge smile to their faces. We were reminded of that same lesson again while working with the homeless outreach, they were so thankful for the smallest gesture of a handshake or even just a smile.
While at the clinic I also learned that sometimes the fanciest, most complex treatments aren't needed. For example, we had one patient who had a previous stroke and had difficulty walking the first day. One of my classmates noticed his shoes looked pretty old so we got him a new pair of shoes that afternoon and by the next day his walking had improved tremendously.
The change I am going to try and make back home is remembering to always have a smile on my face and to keep in mind that the fanciest tools may not make the biggest impact on the patient, but kindness and small lifestyle changes often can, especially in underserved areas.
Teamwork makes the dream work
Teamwork was a constant during our time in Puerto Rico. We worked in pairs while treating patients to allow us to bounce ideas off of each other and to remember to ask the important questions that may have been missed. There was also a lot of teamwork between those who helped us translate, employees, participants, and classmates, all of whom worked with us so that our ideas could be communicated to the patients and community members, and theirs to us.
The teamwork established between the students and the patients was huge. I feel like so often at home we get caught up in a "my way or the highway" mentality and scoff at the idea of receiving input from others. However, the new setting forced us to have so much more communication and collaboration, which led to a much more positive experience for everyone involved. I left Puerto Rico thinking that when I return home I'm going to do a better job accepting and listening to advice from others, and more importantly, ask for it on a more regular basis.
You need no one's permission to make waves
Looking back, I am so glad that I leaned into the doubts I had about planning and executing this service trip (even if I had several good cries about it). I managed to put on a confident face and continued fighting toward my goal. If I had not persevered, so many people would have missed out on such a wonderful experience.
Oftentimes when trying things that may be outside the box, people are resistant and try to make you conform to what is easy. But if we always do what is easy or typical, we will never do anything great, and I think planning this trip was great. So I say regardless of the flurry of doubt, go ahead and make waves anyway, because even if they don't succeed, so much can still be learned. This experience taught me to be open-minded and receptive to other's ideas and goals (including my own), even if they seem lofty.
Along with many other students, I often find myself being type A, always wanting to know what the plan is, what exactly needs to be done, and how long I have to do it. However, this describes the exact opposite of much of our time in Puerto Rico, and I discovered that it was wonderful.
Although we had a basic outline of what we would be doing in Puerto Rico, there were no strict guidelines on what to do or when. We had no patient schedule, no time limits when it came to patient care, and often very little, if any, patient history. Instead, we often just treated whoever walked in based on what we saw and heard.
This lack of information and various constraints led to so much creativity and time to connect with the participants. It was nice to be able to just sit and talk with them without worrying about getting to the next patient or to be able to try several things if the first ideas didn't work well. We even had 2 students who spent more than 4 hours with a patient, which I thought was an amazing opportunity. This experience forced me to want to worry less about the details and take the time to look at the big picture, and if every once in a while the patient needs me to just sit and listen to them, then I'll take the time to do that.
I learned so many lessons from my time in Puerto Rico that I hope to incorporate them into my life now that I am back home.
I think the opportunity to disconnect one's daily life and spend time focusing on the service of others is something everyone should experience at least once. There are so many great organizations who lead trips both specifically for PTs and others just for general service. If given the opportunity to be part of one of these trips, I highly recommend you take it. This service trip has been life changing for me.
I'd like to end with one of my favorite parables that I think really describes the experience of being part of a service trip:
One day, an old man was walking along a beach that was littered with thousands of starfish that had been washed ashore by the high tide. As he walked he came upon a young boy who was eagerly throwing the starfish back into the ocean, one by one.
Puzzled, the man looked at the boy and asked what he was doing. Without looking up from his task, the boy simply replied, "I'm saving these starfish, sir."
The old man chuckled aloud, "Son, there are thousands of starfish and only one of you. What difference can you make?"
The boy picked up a starfish, gently tossed it into the water, and turning to the man said: "I made a difference to that one!" –Loren C. Eiseley
Samantha Ewing, SPT, is a student at Texas Women's University. You can connect with Samantha on Twitter at @SREwing2.
Providence: A Little City Big in My Heart
Estimated Reading Time: 2 minutes
How did you decide what program to attend for physical therapy school?
Was it because of a personal experience? Or did you know someone who went there and loved it? Did you look at rankings?
For me, I first applied to all the in-state programs I wanted and the big names throughout the country. Then I thought about all the states I'd be up for living in, and considered applying to smaller programs within them.
Lo and behold, Rhode Island was on that list. I didn't know much about this state—well, except that it was the smallest state and that it snowed a lot.
I ended up attending the University of Rhode Island, a university located in a small state that now holds a big place in my heart.
Here are just a few reasons why I love the state of Rhode Island.
One of the first things you'll notice on your way to Providence is the Big Blue Bug. Originally built in 1980, this 58' long, 9' wide, and 4,000 pound construction is made of steel and covered with fiberglass. It was originally painted purple and as an exact replica of an eastern subterranean termite, but the sunlight soon faded it to blue. By the way, his name is Nibbles Woodaway. He's the well-known mascot for one of the pest control companies in the state.
With its quintessential New England architecture, Brown University was founded as a Baptist college in 1764, it was the third college in New England, and seventh in the country. Brown has a history of tolerance and acceptance, as they were the first university in the United States to accept students regardless of religious affiliation.
Roger Williams Park is 102 acres of land dedicated to the people of Rhode Island; this park is perfect for nature lovers. Every October there is something called the Jack-o-Lantern Spectacular that I highly recommend you visit. Hundreds, if not thousands, of pumpkins are carved and placed throughout the park; it's a can't miss!
With more than 130 classic arcade games, Free Play Bar Arcade is home to games and local beer and whiskey. Take it from me, you won't regret paying Free Play a visit.
If you're a history buff and a fan of colonial architecture, Benefit Street is colonial New England. When you're walking down this street the houses and look are said to be like "stepping back in time."
Providence is a well-known port city. While in town, take a boat tour around the city with Providence River Boat Company.
Coffee – most people will point you to the nearest Dunkin', but if you want some authentic Rhode Island coffee check out Bolt Coffee, Coffee Exchange, and Dave's Coffee.
While you're in town for National Student Conclave (NSC), I hope that you can get around and see what our state has to offer, and hopefully you'll have time to see what makes this littlest state mean so much to me.
NSC is a conference for and by PT and PTA students. Join us October 11-13, 2018, for NSC in Providence, Rhode Island. NSC registration opens mid-July. Not sure what NSC is all about? Check-out highlights from NSC 2017.
Alex Dien, PT, DPT, is the 2017-2018 APTA Student Assembly Board of Directors Vice President. Connect with Alex on Twitter at: @alexander_dien.
You Are More Qualified Than You Think
Estimated Reading Time: 7 minutes
You and I both have what it takes to become a great candidate for any doctor of physical therapy (DPT) program.
I believe that I can make this bold claim because of the work I put into it to become a qualified candidate.
As a recent undergrad from the University of Rochester (UR) with a BA in psychology, I took almost all of the prerequisites necessary for most physical therapy programs throughout my last 3 semesters as an undergrad.
I applied to 4 physical therapy programs and was accepted by one and offered an interview by another. Here's where I say I'm now on my way to physical therapy school, right? Wrong. I actually declined both schools' offers.
"But you wanted to go to physical therapy school, why would you do that?"
After getting those offers I realized that I probably needed a little more clinical exposure and base-academic knowledge to prepare me to excel in school.
Now, fortunately for me, my journey to become a PT doesn't end there. I'm actually enrolled in prerequisite classes and getting more experience in a clinic as I write this. But after an underwhelming first round of responses from physical therapy programs from across the country, my fire wasn't burned out—if anything, it got bigger.
My need to continue toward my goal of getting into a program and choosing physical therapy as the career for me grew deeper. Those rejections weren't a negative, they were the lesson and motivation I needed to pursue my passion for the physical therapy profession.
Here are 4 lessons learned thus far on my path to becoming a physical therapy student and future clinician.
Lesson 1: Navigate your career path, eyes wide open.
To find your path is to thoroughly explore careers that you are interested in, learn about related fields, and do your research about the journey needed to get there.
While your career decision isn't final—I'm sure we all know people who have changed careers at various points in life—the goal in this case is to understand what you're getting into and to make sure that it makes sense for you.
Consider what happened before I had a clear understanding of my desire to become a PT.
In undergrad I only took courses that were interesting to me personally. I never researched the entire breadth of one profession over another and what it entailed to get there. I was drifting and left indecisive.
Throughout my time at UR, I changed my major 5 times. I dropped many courses along the way and had no idea what I was working toward, and, therefore, I didn't have any goals in mind.
Now consider what happened when I decided to define my career path toward becoming a physical therapist.
I thoroughly researched the profession, what it takes to get me there, and insight on how to be successful as a future clinician. I spent time talking to mentors, friends, and family about my thoughts on this career choice, and received advice along the way.
Lesson 2: Don't let anyone or anything derail you from pursuing your goal.
Along this journey there will be doubters, naysayers, and everything in between. The workload might get menacing. There will be inconvenient aspects associated with your prerequisites. You may feel incapable of succeeding. From experience, I can tell you that none of that can stop you.
You were created with capabilities far greater than you can imagine. Believe this, even if you cannot see the fruits of your labor just yet, exercise your ability to have faith and work toward your goals, whether that's getting into physical therapy school or something else.
For me, when I committed to pursuing a DPT degree, there was a small amount of sand left in the college hourglass. Time was the least of my worries though. I viewed my impending success based on my previous successes. Through this paradigm, it seemed nearly impossible to achieve my goal.
My high school health sciences background seemed weak at best. My highest math was pre-calculus, my highest biology and chemistry were both the minimum needed to graduate, and I never took physics. Furthermore, I had very little experience with the natural sciences in college. I had never taken a collegiate biology or physics course. The last time I took general chemistry course in college was freshman year, and I barely passed it. Finally, because of all of this, most of my friends who saw me as a physical therapist admittedly carried a little doubt on my behalf.
Knowing all of this, how did I move forward? I chose to stop seeing my potential in terms of past successes or failures, and I started to believe in myself and nourish that belief. I soaked up literature and music, which reinforced this notion. I treasured the love and support of my family and it reinforced my worth. I befriended others who were also chasing difficult dreams, and we strengthened each other, like iron sharpening iron. I also embraced the notion of self-care. In other words, if you don´t nourish your body, then it cannot perform at its best every day. This is how I moved forward and started my prerequisite requirements for most physical therapy schools.
Lesson 3: See your failures as a means for greater success.
Rapper Andy Mineo said it best: "It´s win or learn, no losses." The key is to learn from your failures so that you can later meet those goals.
I had many goals, some were as simple as managing my responsibilities, sleeping enough, and mastering my prerequisite courses. I missed the mark on all of my goals at least once. Instead of continually missing these goals, I learned how to improve.
To manage my responsibilities, I learned how to pencil in meetings and appointments in my Google calendar as soon as I learned about them. As a result I became more reliable. To sleep enough, I followed the National Sleep Foundation's guidelines, and I learned that I can function on at least 6 hours of sleep a night. To master my courses I learned many things. I learned that studying with other like-minded peers is a game changer. The topics I found irrelevant were the ones my peers found integral; suddenly, I found myself doing well on tests that I was once failing. I learned how to study for other courses with the help of a tutor who taught me how to save hours of study time by emphasizing conceptual understanding over memorizing processes.
Lesson 4: Remember your original "why?".
You may know the basic, big picture reasons as to why you went down the path to become a physical therapist, but I strongly urge you to remind yourself of these reasons weekly, or even daily. Life gets difficult. School gets difficult. You´ll get discouraged, and you´ll forget why you started this journey in the first place. Times like these are when you need to remember your reasoning to keep your vision clear.
I often have to remind myself of why I'm working so hard. I remember some of my peers telling me that that I studied too much and even labeling me a "workaholic." And I'll admit I've been tempted to give up so I could have time to goof off into the sunset. Some days I gave in and procrastinated, but these times failed to define my year. What kept me focused and helped me make the most of my year was ultimately my goal and desire to become a physical therapist. Whenever I felt like quitting, I reminded myself of my original intent and it helped renew my vision and therefore my determination.
I truthfully believe that I was nowhere near the ideal DPT degree candidate when I first started this journey. Moreover, I truthfully believe that some of you reading this are way more qualified than I was at the time. So find your compass for your career path; no one else can do it for you. Then refuse to let it go. Learn from your failures so you may excel later. Finally, never forget why you are doing this and find ways to remind yourself of that.
As A.A Milne, author of Winnie the Pooh, once put it, "...You´re braver than you believe, and stronger than you seem, and smarter than you think." You can be a great DPT degree candidate. If I can do this, then so can you.
Joshua Klepes is a Pre-SPT student hoping to attend physical therapy school in the coming year.
A Recipe for Growth
Estimated Reading Time: 7 minutes
If you're interested in participating in an international service project but are unsure of what to expect, listen up!
I'm Katie, a #FreshPT, who 1 year prior to sitting for the National Physical Therapy Exam, joined Move Together Inc on an international service trip to Guatemala and Honduras.
When I signed up for this trip I had no idea what I was getting myself into. But I knew that it was an opportunity to combine my passion for physical therapy and service, and I couldn't pass it up.
Although international service was a novel idea for me, community service is something that was ingrained in my life at an early age. I have been consistently involved in my community at the local level and helped form an interdisciplinary service club with a classmate during my time at MGH Institute. I was motivated to help our fellow health care graduate students connect to local projects and, hopefully, cultivate a passion for service along the way.
As we immersed ourselves in this new endeavor, we were also nearing the portion of our program that required us to develop a health promotions project. These projects are student led with guidance of a mentor, and focus on identifying communities, assessing health care needs, and creating programs or interventions to assist a community in meeting their needs. This is when the idea of an international project in the city of Esquipulas, Guatemala, was first suggested, and my heart was set on making it a reality.
Over the next 4 months we researched Guatemala's history and culture, current health care infrastructure, and common health conditions. Since we were unable to meet with community representatives, we spent time brainstorming potential needs and possible solutions. Additionally, with the help of a group member who speaks fluent Spanish, we created translated worksheets with pictures of common exercises and how to perform them. Other preparations included visits to a travel medicine clinic for immunization boosters and talking to students who had participated in past service trips with Move Together. We also contacted local physical therapy clinics to donate basic supplies, like massage creams, TheraBand products, off-the-shelf braces, and used assistive devices.
Fast-forward to departure day. Scrubs, sneakers, lots of bug spray, and a book titled Spanish for the Physical Therapist were packed in my suitcase. When we first landed in Guatemala, it was a bit of culture shock. I stared out the window of our van, eyes wide with curiosity, trying to soak in all of the sights and sounds and smells of this new place. The people of Guatemala were so gracious and welcoming! They surrounded my group with love and made us feel as though we were part of their family.
Our first full day in Guatemala was a day of cultural immersion. We spent our morning touring a coffee farm, learning about the laborious process of growing coffee and the art of tasting it. Coffee is one of Guatemala's largest industries and many of the people we met on this trip make a living growing coffee beans. After seeing the process, I now have a much greater appreciation for my morning cup of joe.
After the coffee farm, we visited a local park to plant a tree. The tree was a representation of the growth of new friendships and connections we would form that week. We then went to downtown Esquipulas to tour a famous basilica and shop at the local street market. We shared most of our meals with our host family, stayed at a local orphanage, visited many local business and community centers, and even took salsa dancing lessons at a local studio. Throughout this entire experience I was able to fully indulge in the beauty and soul of the people of Esquipulas.
We began our week of treating a wide variety of conditions in different community centers. Each day we stuck to a tight schedule, most days starting at 6:00 am for breakfast at our host clinic, and ending well after sunset. Two days were spent treating patients in the very same dining room where we ate breakfast, as we transformed the space into a treatment area. On the other days, we loaded up the van and travelled an average of 2 hours to towns where we treated patients at a local school or community center.
As we pulled up to each new location, there was a line of people patiently waiting to be seen for therapy. At first, this really struck a chord with me and doubts started flooding in. I'm in a foreign country where I don't know the language, still learning how to be a PT, and the people in line are trusting me to help them. Luckily, as soon as this feeling of panic set in, it was eased away by the morning pep talk from the Move Together founders.
After a group cheer and high-fives all around, we set up our makeshift physical therapy offices of 2 folding chairs and a folding treatment table. We worked in teams made up of 2 students, a physical therapist, and a few translators. We also collaborated with our host clinic's local speech therapist and local physical therapist, as well as a few PT students from a local Guatemalan university. There was no set treatment schedule; we spent as much time as needed with each person until everyone was seen. We collected a brief history, assessed the pain, and provided hands-on treatment as well as education and exercise prescription.
I realized quickly that education was going to play a major role in this experience. Knowing that I would not see anyone for a follow-up visit, it was essential to provide them with the tools to take control of their own impairments and show them other strategies for preventing future injuries. I still remember the “physical therapy basics” that the translators taught me on that trip, which has proven helpful in my current acute care position at a local hospital.
It was really amazing how patient everyone in line was; some of them waited hours to spend time with us and were nothing but appreciative when it was finally their turn. I couldn't help but compare this to our own culture and how impatient we can sometimes be.
This entire experience really put things into perspective that many Americans, myself included, often take for granted of how fortunate we are to have access to health care when we need it, without walking miles to a clinic and waiting hours without a promise of being seen that day.
Despite the long and busy days of treating clients, there was always energy left over for another cultural activity. We visited the Mayan ruins in Honduras and a local school, where we delivered donated school supplies. We had an awesome piñata-smashing dance party with the children at the school as well. Each evening we'd sit down as a group to reflect on the day and share stories of the connections we made, while enjoying a delicious Guatemalan meal.
When I think back on this trip, it still seems hard to completely put the experience into words.
I left for Guatemala naively thinking that I was going there to help people. While I'd like to think that our service project had a positive impact on the Guatemalan community, I now realize that the experience had more of an impact on me than I could have anticipated. I remember being overwhelmed with emotions as the experience came to an end, and I often think of our last night in Guatemala as though it were yesterday.
I can still feel the warmth of the sun and the soreness in my cheeks from smiling as our entire team sat in a field of sunflowers watching the sunset over the mountains, reflecting on the incredible week we had shared. I was forever changed. I had all of these new friendships, new perspectives about the world around me, and new ideas as to how I could continue to live a life of service.
I could go on and on, but I think the only way to truly understand how meaningful an international service trip can be is to experience it for yourself.
If you've ever considered international service, or even if this is your first time hearing about it, I highly encourage you to seek out opportunities. As cliché as it sounds, stepping outside of your comfort zone is a recipe for growth. An international service trip, wherever it takes you, will allow you to grow as a person, as a future physical therapist, and it will fulfill you in a way that is impossible to describe.
Katie Burnett, PT, DPT, is a recent graduate of MGH Institute. You can connect with Katie on Twitter at: @kaitlynburnett_.