Young clinicians often ask me, "how were you able to start your own cash based practice within 3 years of graduating?" While hard work and passion are at the center of this answer, properly positioning myself around the best mentors and educators early in my career was equally important. These mentors largely came from my Orthopedic residency program, the Harris Health System. My residency program taught me pain science education, manual therapy treatments, improved clinical reasoning, differential diagnosis, and improved patient education/ communication. If you combine all of these components into a patient interaction, you hopefully get an efficient and effective Orthopedic clinician.
From opening a cash practice to finding fulfillment, in this post I discuss the need to pursue specialization!
Specializing is Worth It: Your Outcomes Will Improve
Since the majority of physical therapists are caring and compassionate individuals, it is safe to assume that most people who become Doctors of Physical Therapy have a primarily goal of helping others. Furthering this assumption, I would guess that getting patients healthier as fast as possible is even better! For me personally, I know that this is my primarily goal. Going through a residency program and preparing for the Orthopedic Clinical Specialty examination taught me how to quickly improve my patient's pain and function. Additionally, I learned how to become a direct access practitioner. As the entry-point diagnostician, it has always been important for me to know when to treat, but more important to know when NOT to treat. As I studied the clinical practice guidelines and APTA monographs, I learned how to incorporate this evidence into my patient interactions. Instead of passively guessing a patient's prognosis, I learned to actively create a plan of care with a predictable prognosis. As my knowledge improved, my outcomes continued to get better!
Specializing is Worth It: You Will Be More Fulfilled
While I am always developing my practice, my training as an Orthopedic Specialist allows me to view each patient from a different viewpoint. I credit my OCS preparation and residency training for providing me with a deeper understanding of pain science, tissue pathology, and biomechanics. This deeper understanding allows me to provide specific education to each patient based on their individual needs.
As more residencies are being credentialed each year, the awareness and availability of residencies have also increased. With this development, more PT students show interest in pursuing residency, but the question remains, "when is the right time to pursue residency?" There is no correct answer, as each person and situation is different.
Now a residency is not right for everyone. Even with the twelve residency specialties available, the educational pursuit may not be possible or desired. There are some that like to be "generalists" and treat a wide variety of conditions in different settings. While it is not currently a specialty, it may eventually become one. For others, residency may not be financially possible. It can cost income/tuition temporarily and may not lead to an increase in pay upon graduation. There are over 250 credentialed residencies currently and all have different pay and tuition requirements. Some offer very reasonable salary/tuition options compared to "standard local wages," while others are relatively expensive and make it difficult to live off in high cost-of-living regions. With residency pay cuts, it may be easier to manage immediately after graduating PT school (one typically has less expenses immediately after school i.e. may not have a mortgage or kids) or if one has a spouse or family member to help support housing or other living expenses.
As for education and clinical development, timing is different for each individual. Some people, myself included, find that when graduating from PT school, it's easiest to roll right into residency since the mind is still in a "learning state." I knew that I wanted to learn more and specialize in orthopaedics immediately. I felt like I didn't know enough about my area of practice upon graduation. That is not the case for all. Many people do not know right away in what they want to specialize. For those, it may be best to practice (or perform clinicals in various areas) for a few years to solidify interest in a specialty. There isn't necessarily a rush to specialize or complete a residency, so if uncertainty exists, take your time.
All that being said, I still highly recommend residency pursuit. While one learns plenty of clinical knowledge and hands on skills, the two best things that come from residency are clinical reasoning development and how to critically appraise research (and apply it). Clinical knowledge changes with time, as does research. The ability to stay up to date on research an identify study limitations/applications is essential for "evidence based practice." Clinical reasoning skills helps with problem solving, self-reflection, and clinical development. A residency teaches all these things and holds one accountable to certain standards.
-Dr. Chris Fox, PT, DPT, OCS
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