Inpatient Acute Care

Basically, acute care refers to treatment directly after an injury or an illness. This most often occurs in an inpatient hospital setting. A PT’s work in the hospital is very versatile. Certain settings, such as outpatient orthopedic clinics, provide rehab for common musculoskeletal injuries and post surgical patients. For some, this type of setting can become repetitive depending on the type of patients referred.

A hospital setting provides an opportunity for a variety of conditions directly after surgery, accident, or even acute pathological admission. In the hospital, a PT can begin the day treating a post hip replacement, midday treat a patient who recently had a stroke, and then end the day ambulating someone with a pneumothorax from a motorcycle accident.

This fast paced environment will keep a PT on their toes exposing them to a diverse variety of diseases, disorders, and conditions that changes on a daily basis. For a new graduate or a SPT on a clinical rotation, the experience gained in this setting is extremely valuable.

The major areas of any PT program, orthopedics, neuro, cardiopulm, pediatrics, and geriatrics, can all be found in the acute care setting. Consider this environment an excellent place to begin a career and a must have when selecting clinical rotations.

Orthopedics

Orthopedic physical therapy concentrates on the diagnosis and treatment of musculoskeletal conditions, disorders, and injuries. Orthopedics is typically found in an outpatient setting with physicians referring patients for post-op rehabilitation and for treatment of a variety of musculoskeletal pathologies. In most states, direct access now allows patients to come directly to PT for treatment of their musculoskeletal problems. In this setting, a PT can expect to see patients for acute injuries like a sprained ankle or chronic conditions, such as, low back pain. Post surgical patients are also commonly referred to outpatient ortho clinics for continuation of rehab began during inpatient acute care.

A PT in this area of rehabilitation should have a firm basis in anatomy, biomechanics and ther ex. Therapists will live or die by these tools established during PT school and in continuing education classes taken after graduation. This area seems to attract the mechanically minded individuals who love to fix problems.

Through observation, palpation, and testing, musculoskeletal problems can be identified, analyzed, and solved based on the PT’s knowledge of the human body and biomechanics. Outpatient ortho is a must have when picking clinical rotations and a fast and easy way to find a job after graduation. This area of PT seems to always be hiring with very competitive pay.

Now this area is not without its draw backs. The average outpatient ortho clinic books patients every 15 to 30 minutes. Some clinics give new grads an opportunity to ease into this new situation, while others expect them to handle a full caseload from the get go.

Home Health Services

This area focuses on home based PT programs. Home health is designed for patients who need rehab but are homebound so the patient’s home becomes the clinic. Home health offers PT time away from the traditional office setting. The PT can bring some equipment with them, but many times a therapist will have to improvise with items in the patient’s house. PTs in this area set their daily schedules around their patients’ schedules. This gives home health PTs the flexibility to set their schedule own schedules unlike PTs in more traditional clinical settings. Home health offers PTs the opportunity to work one on one with their patients. Each patient is typically booked for an hour, but exact session length depends on the company’s policy.

Most of the documentation in this setting is done in the PTs car on a computer and it can be also done at home if needed. If you’ve looked on the Jobs section of rehabstudents.com, you may have noticed this tends to be the highest paid area.

There are drawbacks to this area of PT however. A PT in this setting must know what they are doing! The patient diagnoses in this area vary just as much as inpatient care and can be just as critical. The PTs in this area of practice are typically on their own during treatment so they have no one immediately available to help should unexpected problems or complications occur.

A new graduate may want to gain experience in the acute care setting before attempting home health. This is an excellent area for choosing a clinical rotation. PTs need to have a solid knowledge of pathology, cardiopulm, neuro, patient care principles, and ther ex.

Pediatrics

This area of physical therapy focuses on treating illness and injury in children. This is a challenging, but very rewarding and enjoyable specialty. Many of the patients treated in this setting are dealing with congenital conditions, developmental delays, pathological illness, and injuries caused by accidents. PTs that excel in this area work well with children in addition to having a well rounded PT resume.

Most diseases, disorders, and conditions seen in adults can occur in this population. A challenge faced by PTs in peds is working with these conditions in bodies that are continuing to grow, develop, and mature.

Many hospitals have a special wing devoted to peds and PTs are part of the multidisciplinary healthcare team working with these patients. Pediatric PTs are also be found in school systems and privately owned clinics devoted solely to pediatrics. Some outpatient orthopedic clinics will have physical therapists specializing in Manual Therapy, Women’s Health or Pediatrics to increase the services the faculty is able to offer.

Skilled Nursing Facilities

These are often referred to as “nursing homes” by the general public or SNF’s (pronounced “sniffs”) by healthcare professionals. These facilities tend to have a predominately geriatric population. Many patients in these facilities are still recovering from an illness or surgical procedure and are either not ready or are unable to be discharged home. These facilities can either be short or long- term depending on the needs of the patient. A SNF is a great area to get experience in comorbidities and learn firsthand they how can affect PT interventions.

Most people have the misconception that patients in these facilities are not in their right mind and are so fragile they can’t even be touched. This is far from the truth! Individuals in SNFs have lived interesting, colorful lives and are quite capable of continuing to function well into their later years of life.

This type of facility requires a PT that is respectful, enjoys working with the geriatric population, and knows how to accurately pace interventions based on each patient’s status. Again, this setting is a wonderful learning experience and as an added bonus, SNFs tend to pay well and have good hours!

Sports Teams

Just like the name implies, many PTs are being hired by sports teams to treat players dealing with various injuries or to help athletes improve their performance. PTs can be hired to work for teams at the high school level all the way up to professional levels.

This area overlaps that of athletic trainers leading to some friction and a bit of a turf war with some ATCs. Each team decides which to hire and some teams may hire both as part of the rehab team.

PT’s in this field should have a solid background in anatomy, biomechancis, orthopedics, sports, and the treatment of sports related injuries. A PT needs to be aggressive enough to push the athlete to return to their sport as quickly as possible, but also know when to take things down a notch to prevent further injury.

Pay in this area varies depending on what type of team is doing the hiring. Job security is limited due to the competition with ATCs and the needs of team. Although this is not a typical road for most PT’s to go down, it is an area with growing possibilities.

Neurological Inpatient Hospitals

This can be a hospital specifically designated to neurological problems or a wing of a hospital with a neurological focus. PTs practicing here should have a robust background in all areas of neurological pathology, conditions,and treatment.

There are not many privately owned outpatient clinics due to the billing process associated with neurological injuries. Treatment for these conditions can be extensive and lengthy with many 3rd party payers only funding to a certain point.

This can be an extremely challenging, very rewarding, and sometimes frustrating field. Neurological tissue takes the longest to recover so PT interventions may take many slow small steps before the patient’s function visibly improves.

This setting will really challenge a PT’s creativity and knowledge. A neuro PT mentor can help a new grad or just someone new to this area develop the skills that are needed to be successful in this area.The pay can be very competitive since most PT’s do not go into neurological rehab and you’re entering an Acute Care setting.

Private Practice

This can be a great way to invest in retirement. Many therapists will use their specialty niche, relationship with orthopedic surgeons, patients, and fellow therapists to open their own private practice.

It will take time, patience, and probably a large amount of Advil to open and successfully run a clinic; but once the clinic establishes a reputation in the community, the sky is the limit. Opening a clinic may lead to early retirement, but it will take hard work and dedication to establish a thriving practice.

University

Some PTs grow tired of dealing with the hassles associated with clinical practice, but still have a passion for the profession and knowledge to share, so they become professors in PT programs teaching the next generation of PTs. This can also be a great way for some clinicians to share their knowledge with students, while continuing to work clinically part time.

If this route appeals to you, remember most universities require you to obtain a PhD in education. This can be done online now days, but it is still school so it will require time and study. When considering this route, remember most universities require professors to obtain a PhD in some area, typically education. Also when considering working in academia, it is also important to remember many universities require professors to participate in and publish a certain amount of research.