From what I can tell, there are a few main ways to advance your career as a Physical Therapist. 1.) Increased decision making 2.) Increased marketing 3.) Increased research-academia 4.) Increased productivity 5.) Entrepreneurial pursuits. There is something missing off this list that I think needs to be investigated – increased thinking and patient care. Let’s discuss…
I will get in to what I mean in each category in a second, but notice that patient interaction is not a focus of developing your career ladder. This is not unique to physical therapy. We notice that the farther away from the patient: the more money you make. This is true in other aspects of medicine- I have a good friend who is a Psychiatrist and he makes more money in 5 hrs of auditing charts for an insurance company than he ever could in direct patient care. This is also true in other fields as well; consider the pay scale/incentives for the guy who put the bolt on your new car, the guy who actually built it vs. the CEO who is quite physically removed from the process. The farther away from the action you are, the more money.
So, we all have a passion to be the best PT/Physio we can be, and we also want to advance in our careers and make more money and provide for our families and put some chrome rims on the mini-van. Let’s look at the ways one could do that –
Increased decision making: This means anything managerial, something you are doing to make the process of the clinic work smoother. This could be becoming director of a clinic, or manager of therapy/rehab, etc. It is a nice way to go, but often involves a reduction in patient care, perhaps alienation of peers (you are not one of the group, nor are you the owner…), an increase in paperwork, but seems to be the clearest way to advance your career.
Increased marketing: This covers a bunch of directions as well. I’m thinking of this in the way of gaining certifications and other things that entice physicians to refer. You get a specialty, you get more patients. This advancement choice is the reason why you see so many PTs going after technique certifications, it is a way to be involved in patient care while still advancing your skills in a way that is rewarded. One of my clinical mentors shared with me an anecdote of he and a colleague going around marketing themselves and the practice. He is a certMDT and OCS, the other PT was Residency trained, OCS and very EBP focused and savvy. The Physicians were more swayed by the MDT than by the Residency, OCS, EBP positioning. The reward came from the better marketed certification. Perhaps there could be a certEBP…
Increased research-academia: This is just as it sounds. Seek to practice part-time while pursuing an academic career or publishing research on your own. I will assume that this is a nice choice to advance your career, and will perhaps lead to future opportunities (see Entrepreneurial pursuits). This realm is a needed advancement choice. All the PT driven and performed research that is occurring out there is very exciting. If you are pursuing this path: please read this article- The Rational-Scientific Mediating Model which is a great idea, and currently used in Music Therapy research. It basically states that clinical research can only be performed on concepts that have been proven at biological and physiological levels. #BOOM.
Increased productivity: Ah yes, the ‘P’ word. You can advance your paycheck by meeting productivity standards and incentive based goals either daily or weekly, however it is set up. Unless you are the owner, or have a partnership, or some sort of stock option, the ROI on this strategy is quite low. I’m not saying don’t do it, but the extra notes and stress are often not rewarded in conjunction with the increased worth you provide to the clinic. Now, if you saw, say 50% of the reimbursement you earn above your average/minimum productivity, well dang, that would be incentive, but from what I can tell, it’s closer to 5% (small n). Then again, this does go in to the category of being rewarded at the level of patient care, so that is a plus.
Entrepreneurial pursuits: The sky is the limit here. It may or may not fall into the realm of patient care, but you can make it what you want. Find a problem; and solve it. Find a passion and follow it, avoid negativity and blast this one out of the park. Let’s put starting your own clinic in this realm. Now, the hard part here – it requires a lot of energy. It’s in the name: entrepreNEURIAL, it requires brain activity like-WOAH. You get all the burdens, and all the benefits. You have to make all the decisions, you get to make all the decisions. You can use this strategy no matter where you are or what you are doing, things can always be improved upon. I like this one the best so far…
What’s left out? Ok, so I probably left something out, but what I see clearly left out is the pursuit of thinking and simply being better. Now I understand that you need tangible things, objective things. It is hard to say “well, he just needs a raise, he’s awesome.” But how are you rewarding that clinician who is using his/her brain, making an awesome finding of an impairment and treating it is a creative focused way? That advancement in patient care should be rewarded! I’m not talking about outcomes or FOTO scores or whatever. I suppose, since insurance may start to pay off outcomes, we could be incentivized off outcomes, but that is not in place at the moment, that I know of. Along that track, could we be incentivized to refer to another PT who is better in a certain area? I know fellow PTBT member Stephen Henry, SPT, CSCS is a boss when it comes to sports rehab. If patient outcomes are the goal, should I not refer?
Either way, there needs to be a way to quantify that effort, that passion. We try, I know. We have satisfaction surveys and things like this. There is no clear answer, but I want there to be one. As mentioned before, it does not clearly exist in other fields, so it would be novel. Perhaps we’re trying to solve a bigger question here, as in: How do you get people to pay more for more important things? …Isn’t going to happen. We aren’t willing to pay more than $1.50 for an apple (Honey-Crisp, c’mon!) but we are willing to pay $500 for an apple iphone. Only one of them physiologically keeps us alive… So there is an uphill battle here, in a way.
A solution or two: How about a Clinical Reasoning / Critical Thinking CEU course or certification? I suppose this is fitting into the Entrepreneurial pursuits category. CertEBP… reward thinkers who are do-ers? Let’s continue to look at other industries that perform similar to us. Perhaps the comments section of this post will hold some gems, don’t know, but I think it’s a valid search. I’ll defer to those that have advanced their careers… feel free to tell your story, we’d love to hear it.
This much is clear; we want to advance, to further the profession, and by that we want to further ourselves. We have the same goal, and there are many answers to that goal. Let’s find one that increases advancement in patient care.