With the increased interest in specialization, more and more new graduates are looking towards starting off their professional careers with a residency. Residencies are an excellent method to develop your clinical reasoning and skills. Couple the many hours of class and lab-based learning with 1-on-1 mentoring and it creates a unique experience that can prove extremely beneficial. One of the issues, however, is that there is a much lower number of residency slots than people interested in residencies, which would potentially slow the progression of the profession to specialization.
One method of filling that void includes various certifications and clinical development tracks. Occasional random continuing-education courses, while beneficial, do little to develop a clinical reasoning mindset, which is essential to begin working towards becoming an expert practitioner. There are many different certification series that you can choose from: manual therapy, McKenzie, pain science, SFMA, and more. Personally, starting out in the orthopaedic setting, I would recommend a COMT (or similar) program. There typically aren't restrictions on the number of applicants, due to the relatively high number of programs. The COMT programs enroll you in a set of courses that develop a clinical reasoning mindset to managing your patient's conditions over a year typically. While just glancing at programs appear expensive, they are significantly less than a typical residency. Residencies pay, at the highest, around $45,000/year. Depending on your setting and location, a COMT program may only cost a few thousand dollars and often is the same initial stepping stone as a residency when trying to enter a fellowship. One of the downsides of COMT programs is the usual lack of mentoring compared to residencies. However, at Optim, we provide online case discussion between courses to try and offer a component of it.
Just because you may not get into a residency, doesn't mean you should abandon your drive to specialize. Look into all the options for different tracks to pursue and ask around if you have questions. Be sure to develop some sort of plan in order to work towards learning and practicing a system of care.