Recently, my family and I moved to Boise, ID and I started practicing at a new private practice clinic that is one-on-one for 45 minutes with each patient. For those of you unfamiliar with my work history, I had previously worked in both a hospital-based outpatient ortho clinic (for 1 year) and a high-volume private practice ortho clinic (for 3 years). There are many differences between each setting and different pros and cons to each one as well.
Let's start with obvious cons of high-volume clinics: less time with each patient, difficulty with case management and therapeutic alliance, and possibly tech oversight. The worst part of it is that it can be more difficult to develop your clinical skills and clinical reasoning as you are more worried about getting to your next patient or managing your schedule, instead of focusing on the patient in front of you. The pros of a high-volume clinic are that you often are paid better (not always), you may see a more active population, and you get A LOT of exposure to different types of body parts, injuries or surgeries. Having worked in an hospital-based outpatient ortho setting, I would say that 70% of my patient population was chronic low back pain, deconditioning or balance issues. I probably saw 1 case of TMD and 1 or 2 wrist/hand injuries the entire year. Comparatively, I probably had 1 each of TMD or wrist/hand dysfunction throughout most of my time in the high-volume setting. Seeing more patients not only exposes you to more injuries, but also allows you to practice your techniques and skills on more people! You can become a lot more comfortable or proficient treating less common things just via exposure.
I am hoping that my new setting will bring the best of both worlds: one-on-one care, diverse population, good pay, and more. The most important aspect in my opinion is one-on-one care. I cannot wait to get into proper exercise prescription, loading techniques, and, above all else, patient education. Empowering and educating our patients helps to build their independence and restore their function. While I look forward to my new position, I am extremely grateful for my time I spent in a high volume clinic. I feel much more comfortable treating a variety of injuries, managing cases, and using certain manual techniques. The busy clinic can still be a useful part of clinical development, although, I don't recommend it long-term.
-Dr. Chris Fox, PT, DPT, OCS
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