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Raising the Bar in Rehab

PT Practice: Outpatient is Better

Published February 20, 2014 3:56 PM by Lisa Mueller

(Editor's Note: Throughout the month of February, ADVANCE bloggers Lisa Mueller and Michael Kelley will post "Dueling Blogs," in which they argue opposing sides of the same issue. Topic #3 -- "Does the Inpatient or Outpatient Setting Allow Greater PT Practice?")

Since I graduated from physical therapy school almost five years ago, I've been lucky enough to have the opportunity to practice in both inpatient and outpatient settings. While they both provide unique advantages, I'm writing today to debate that the outpatient setting is better aligned with the fundamentals of physical therapy practice.

I remember making the transition from inpatient to outpatient practice and was stunned by the realization that patients of outpatient physical therapy seek out our services.

Patients drive to our building, sit and wait for us to work with them. This was the opposite of my experience with inpatient, where I frequently had to encourage my patients to participate in the most basic therapy sessions. It was such a compliment to know that my outpatient folks were going out of their way, making time in their day to see me. I know there are exceptions in every situation, but I think the outpatient setting highlights how well physical therapy services are understood, implemented and appreciated.

Inpatient facilities are commonly organized by pathologies -- hospitals will have a floor for patients with neurologic pathologies, a floor for patients with cardiac problems etc. For the sake of argument, I'm going to simplify that therapists follow those patterns and end up practicing basic physical therapy interventions (gait, balance) to very similar populations. There isn't a ton of diversity. Outpatient is quite the opposite. I can start my day with a cervical disc and end with prosthetic training. You have to be ready for anything that walks through the door.

Speaking of walking through the door, that's another advantage of outpatient practice -- fewer interruptions. While I appreciate the collaboration in an inpatient setting with other healthcare providers, physical therapy sessions were often put on pause for lab draws, X-rays, or visitors. These things are important, but I'm very happy in outpatient when the whole appointment time is spent on treatment, and not waiting patiently!

I think the biggest advantage outpatient physical therapy has over inpatient is the patient relationship. I enjoyed building relationships with patients in the inpatient setting, but generally the length of stay was very short. Outpatient is a little different in that regard; I typically see patients over several weeks. I feel like I get to know my patients better in the outpatient setting, and making those connections is the biggest reason I went into the PT profession.

What do you think? Is inpatient or outpatient a better location to practice physical therapy?

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I see this discussion as too limiting, a feature I feel is reflected in the way the APTA views the profession as well. Inpatient, the way you describe it sounds very much like acute care, but it leaves out inpatient rehab and subacute care which have their own identities, if you will. Completely out of this discussion is community or home care, which is a huge aspect of the profession.

Acute inpatient has changed dramatically since I worked in the hospital setting (back when total knees stayed for 10 days!) I'm afraid I must agree with your observation, based upon colleagues stories, that working in that setting now amounts to ambulation training, if you're lucky enough to even see a patient prior to discharge.

By the same token, outpatient "shake and bake" mills have diminished the perception some people have of our profession.

It is refreshing and encouraging to read your's and Mike's enthusiasm for both settings. Just don't let it stop there.

Dean Metz February 20, 2014 6:21 PM

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