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Toni Talks about PT Today

Things Have Changed Since I Went to PT School

Published February 18, 2015 10:46 AM by Toni Patt
Lately I've been getting comments on my blog posts from people seeking advice about entering the PT profession, and asking how or why I became a physical therapist. The answers to both of those questions are complex. The medical environment today is significantly different from when I went to PT school 30 years ago.

I like to joke that I went to school "back in the day." I earned my bachelor's of science in physical therapy in 1984. That was so long ago I've had to relearn things at least twice. We don't even do most of the cutting-edge stuff from back then anymore. Reimbursement was different. Patients stayed in hospitals and rehab facilities for weeks at a time. No one complained about going home too soon.

The practice was different. The expectations were different. We had the time to work with patients. We had the opportunity to use our skills. No one entered PT school determined to only work in outpatient orthopedics or own his or her own clinic. You treated whatever came to you. I had the opportunity to watch my patients improve and build relationships with them.

The dynamics between patients, families and therapists were also different. On one hand, therapists were seen as important to the recovery process. On the other, there weren't that many of us. The conflicts between therapies and other disciplines weren't as pronounced. More importantly we charged for individual services performed. This was before the onset of DRGs. The rehab department was considered a revenue-generation source. No one counted minutes except on rehab.

I'm not going to try to describe how things are now. I hope people enter physical therapy programs for the same reasons as 30 years ago. I don't know that I would still become a PT if I had to do it all over again. Most of the reasons I entered the profession have been lost in transition. Back then I could never have afforded three years of graduate school after four years of undergraduate study. The option wouldn't have existed for me if that were the case.

I feel like I make a difference when I work with my neuro patients. That keeps me going. I love teaching others how to do what I do. That makes me feel good. Sometimes I feel like I'm working only to support my horse habit. I've been doing this for 30 years. I must be doing something right.

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I'm in the same graduate age bracket as you, Toni.  I too remember the days of fair insurance compensation for services provided.  Unfortunately, there were those PT's that took advantage of that system.  Now unfortunately the insurance companies dictate visits allowed and reimbursement. This hinders both patient and therapist in the rehab process.  

On the other hand, I have learned many new skills since graduating with my BS and practice evidence based treatment derived from scientific research instead of following anecdotal practices.  I went back to school for a Masters and eventual DPT.  I mentor new PT's and serve as CI to PT interns.  

It has always been about the patients for me.  I hope to convey my enthusiasm to those interested in our profession and its many areas of opportunity.

Kathy, Ortho - PT, Private practice March 6, 2015 11:47 AM
San Mateo CA

Toni!   What's going on here???  You sound like your ready to ride that horse you're working for into the sunset... I hope when you talk to aspiring therapists this isn't the picture you portray.  You sound like you're living in the past.  Of course the environment has changed from 30 years ago!  If it hasn't, we've got bigger issues.  You sound like you and your approach needs a booster shot.   In order for us to advance as a profession, the last thing we need to do is start to talk about what we did "back in the day."  Imagine yourself in that young students shoes as you ask a mentor advice on becoming a physical therapist and that is what you hear?  "Staying at hospitals and rehab facilities" is exactly what got us complacent in the first place.  We enabled rather than create an understanding and independence.  Situations where patients "stayed" at facilities sounds like the therapist needed  the patient more than the patient needed the therapist or the rehab.  If you're  a patient in therapy and don't want to go home, well... that another issue.  Back when we had time to "work with patients," were we spending valuable time, or just burning calories with the patients?   Were we really using "skills" or just counting reps with tubing and ankle weights? And treating "whatever came to you"???   Frustrating thinking we were sitting and waiting for things to come.  Again, sounds like settling rather than creating a  need.  Were we "important to the recovery process"? Or did we feel important in the recovery process as we were few?  I think we lost relevance in what we do as we sat on the fact we could produce revenue and others began to see the ability to do 3 sets of 10 reps of long arc quads only made the client one set better than 2 sets of long arc quads.  If you care to see a good article regarding the future of physical therapy and how we work with other disciplines, please see February's issue of PTinMotion, "The Future of Physical Therapy Education". Toni.  I believe we can "transform society by improving the human movement experience."   Please consider who may be reading your blog.  There are young minds that have potential to become great if we show them where we're going, not where we've been.  Advance.  Please don't settle for blogs without foresight.  There are therapists out there who believe in what we do and what the future holds.   I truly believe the best is yet to come!  Thanks!  Justin

Justin Kiger, Out patient PT - Mountain River Physical Therapy March 5, 2015 10:00 PM
St Clairsville OH

Wow-your comments are exactly what I myself have thought or said on multiple occasions - I, too, graduated with my BS in 1984 - things sure have changed, haven't they? The relearning, the evidence-based emphasis, are definitely good things - but the high-pressure environments, demanding that we provide 2 billable units of meaningful PT, connect with & meet our patient's expectations, and finish a medicare-specific note in 30 min-not so much. But what other choice do these kids have, with $150k in school loans??

Melanie, PT - PRN , rehab/SNF/home health March 5, 2015 7:31 PM
Dayton OH

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