Where Do Physical Therapists Work?
Physical therapists' working days are most often 50% routine and 50% innovation. Though the need to evaluate and offer a functional diagnosis remains constant, there is no assigned "template" for treatment. The physical therapist uses clinical evidence, past experience, problem-solving skills in the context of the patient's needs and his current condition before designing the best treatment plan.
Any health care facility, acute care hospital, health club, nursing home or outpatient center, depending on its own internal budget and staffing needs will at times require full-time help and at other times only part-time. A physical therapist with young children may decide to work a three-day week and consult to augment earnings. A new physical therapist may decide to work long hours for the first three years and then taper off to part-time clinical work if teaching appeals to him. Physical therapists become highly organized persons by necessity, as they are often juggling patient caseloads, learning and applying new scientific information and pursuing specialty practices, so the variety of options tends not to be too overwhelming for most.
Much of the time, physical therapists evaluate and treat individuals who have suffered from a traumatic injury such as a head injury, spinal cord injury, bone fracture or have an acute or chronic disease such as Parkinson's, Cancer, HIV/AIDS or multiple sclerosis. In addition, physical therapists may also be called upon by sectors of the community, such as government officials, teachers, scientists, other health care professionals for advice and expert knowledge about muscle injury and a broad range of chronic and acute disease. There are so many different places to practice as a physical therapist, most PTs are able to find the patient population they are most interested in treating. From acute care to pediatrics, there is something for everyone.
Acute care hospitals
Acute care hospitals in both urban and rural settings hire physical therapists to work in a rotational mode: PTs may start in an orthopedic unit treating fractures, hip replacements and shoulder injuries, and move to a burn unit or a neurological unit. This way, hospitals are assured all areas are covered, and at the same time, the entry-level physical therapist is exposed to all sorts of patient groups.
The acute care setting is fast-paced and requires the physical therapist to work as a member of an interdisciplinary team which may include a social worker, doctor, nurse, occupational therapist and speech therapist. As a member of the acute care team, the physical therapist sees patients immediately after acute injury and illness, and often evaluates patients before and after surgery. For instance, an 85-year-old woman suffering from a fracture to the hip may require a total hip replacement. The therapist must evaluate this patient's strength, range of motion, balance and coordination after the injury, before surgery and after surgery. Exercise intervention would be cautious and determined by level of pain and flexibility limitations.
Elementary schools throughout the U.S. hire physical therapists on nine-month schedules to provide therapy to disabled students. Schools look to hire PTs who express a deep interest in pediatrics, and will hire both entry-level and experienced PTs. Many PTs enjoy working in schools because of the flexibility of scheduling and relative autonomy (without the hierarchy of a hospital) that the environment lends. A physical therapist working in the school system sees the very young client versus the very old. In the United States, and some other parts of the world, children with disabilities are integrated into schools with the non-disabled. The disabled pediatric population needs the services of physical therapists, occupational therapists and often speech therapists. The physical therapist working in the public schools works a September to June schedule with summers off, and daily working hours often vary. School systems also require that a physical therapist work as a member of a interdisciplinary team (teacher, parent, student, physical therapist, occupational therapist and speech therapist), but the therapist will have more autonomy than the hierarchy of an acute care hospital allows.
Rehabilitation centers across the nation may specialize in head injury, cancer, or spinal cord injury, or may serve more than one patient group; such centers employ physical therapists to lead a patient after injury through what is often a 6-month course of rehabilitation. Nursing homes hire physical therapists to provide therapy to both the well elderly (to maintain physical function) and the sick elderly (to improve physical function).
Rehabilitation centers focus on returning patients to a way of life that most resembles what life was like prior to injury. Physical therapists will often see patients every day, or three times a week, and work over a period of three months or more to enable a spinal cord-injured patient to be able to move from a bed to a chair, or to enable a brain-injured patient to walk 200 feet without falling.
Fitness centers: health clubs and sports clinics
Sports clinics, which are facilities that treat sports injuries, hire physical therapists with 1-2 years of experience and want the PTs to have some manual skills under their belt and an express interest in sports physical therapy.
When a physical therapist works in a fitness center, his focus is on exercise, either as prevention to illness or as a way to maintain a healthy lifestyle. A physical therapist may also evaluate and treat minor sports injuries that occur as a result of excessive or ill-advised exercise. The fitness center therapist may work with persons with or without disabilities who wish to stay healthy through exercise.
Nursing homes will hire both entry level and experienced physical therapists interested in the aging adult. Nursing homes (SNFs) often carry the stigma of an unpleasant place to work but modern SNFs or skilled nursing facilities differ from the nursing home of the 1970s and have a combined patient population of young and old.
A physical therapist working in a nursing home or skilled nursing facility (SNF) needs to be comfortable with and skilled at working with the old, severely disabled, and terminally ill population. The major difference for the physical therapist working in the nursing home or skilled nursing facility is that the patients he or she sees will not be discharged to home. They will stay at the respective facility their whole lives, and this difference can take an emotional toll on the physical therapist as patients often suffer from depression.
Wherever he or she works, a physical therapist is a member of an interdisciplinary team. This generally includes the physician, social worker, occupational therapist, respiratory therapist, speech therapist, nurse, patient's family and the patient. Most of us are familiar with what doctors and nurses do, but what about the other allied health fields? Here's a brief description of what each of these professionals adds to the patient's care. The occupational therapist offers skilled treatment to help individuals achieve independence in all facets of their lives. Services may include a comprehensive home and job site evaluation to determine what adaptive recommendations may be needed (an elevated stool to reach the counter in the kitchen, assistive equipment to open jars and bottles if the patient has weakened grip strength; auditory additions to a computer in the workplace if the person has compromised hearing etc.). Social workers carry out treatment, counseling and oversee other services to help solve immediate financial, housing, and social problems for each patient and to determine whether the problem is an individual one or whether there is a larger system issue. For instance, a social worker would assist a patient having trouble understanding how to use her Medicare card. The social worker would then determine if there was a larger system issue at hand, such as if the directions were not written in Spanish, and the majority of community members spoke Spanish only. The respiratory therapist's day includes all aspects of evaluating and treating breathing capacities in patients of many different diagnoses. The respiratory therapist must be able to clear breathing passageways with the appropriate technology, respond to emergency situations when patients lose breathing capacity due to environmental trauma (fire) or physical trauma (abuse), and be able to educate and train parents and patients dealing with respiratory weakness due to asthma or another problem. The speech therapist evaluates a patient with speech disorders and develops a treatment plan to improve speech patterns and communication skills. Speech is commonly disrupted after stroke and head injury, but persons may also be born with speech deficits in diagnoses such as cerebral palsy. All members of the allied health care team keep one another informed of their evaluative findings and choices of treatment so that patients receive the best care possible.
Interdisciplinary teams are the norm in acute care settings, nursing homes and some comprehensive outpatient care units. In a homecare setting, the physical therapist works independently but will communicate with all other members of the interdisciplinary team on an ongoing basis. The sports physical therapist and the physical therapist in private practice will usually not work with other members of the health care team on-site, but will communicate through verbal or written correspondence. At a hospital, the physical therapist is active in discharge planning for the patient, which is the health care team's strategy for transitioning the patient from a hospital to a long-term care facility or to a nursing home or other home with an informed social support system, adapted to the patient's injury or illness. Patients are always discharged from acute care hospitals (unless they die while in acute care). Discharge planning is central to the PT's role because the PT decides whether a patient is safe to walk, climb stairs, drive a car, go back to work, or lift children.