Have you come here looking for awesome clinical and career-related content? Well, you’re almost in the right place! NewGradPhysicalTherapy can now be found on CovalentCareers.com/resources.
In March 2019, we will be sunsetting the NewGradPhysicalTherapy, NewGradOccupationalTherapy, and NewGradSpeechTherapy blogs and migrating all of their content and resources to our parent company website, CovalentCareers.com. For now, the social media pages for each new grad brand will remain live and active.
The biggest reasons for this change? To provide our readers with higher quality content and new web-based career development tools—both of which are only possible if we migrate to the CovalentCareers ecosystem.
We understand this may come as a shock, but keep reading.
Going forward, our efforts in the physical therapy space will be supported by a fast growing team of fifteen San Diego based employees rather than solely conducted by the small team that operated NGPT prior. The result will be a significantly more valuable experience for you, our reader.
Just like you, we’re sad to see newgradphysicaltherapy.com go away but this domain name and logo are the only elements going away. We will never remove our primary focus from the student and new grad. To be transparent with you, we were getting spread way too thin managing 5 different brands and we weren’t delivering the value we aspired to.
Think of it as a name change, nothing more.
Our new grad content, new grad PT team, new grad focus, new grad investment, and new grad philanthropy will not only remain but will grow stronger, and yes, it will always be free. Just look at our core values: you’ll see we’re still here to “be the champion for the new graduate.” Our company purpose statement will remain “to empower new healthcare professionals to create happy and successful careers.”
The NewGradMedia brand started 5 years ago and it grew to what it is today thanks to you, our loyal reader. Welcome to the next phase of our evolution—I know you’re going to absolutely love what we have planned!
Mentorship: the “hot” word on the street for new graduates looking to enter the job market. Yes, you can choose to apply for a residency and you will get plenty of one-on-one mentorship hours, but often times students are burnt out by the time the word “residency” rolls around and just want to start practicing what they have learned for the past 7 years. Many employers offer PT “mentorship,” only for you to find out the mentor either doesn’t provide hands-on learning opportunities or your schedule is too busy to squeeze in quality learning time.
So how do we find it? How do we know the clinic we are applying to really offers that mentorship that we as new graduates so desperately need? The great thing about the world of the internet is that there are so many great and accessible therapists, and even if your new employer doesn’t offer formal mentorship, you can and should get it from someone else. We even had a great YouTube Live all about mentorship for new grads!
As you begin to look for your first job or even for those a few years out who are still looking for that missing piece, here are a few ways how to find legit mentorship and the questions you should ask.
So to start, where can you find mentorship?
As a new graduate, I was really seeking “informal” mentorship at the place I decided to work. I wanted to be surrounded by physical therapists who are experts at what they do and be in an environment where therapists are willing to teach what they know. I was so fortunate to find this at the clinic where I currently work, and it’s important before starting a job to ask the clinic manager what the experience and knowledge level is of the therapists.
Also, keep in mind just because the therapist may only be a few years out does not mean that they are not skilled or experienced. In fact, some of the smartest therapists I know have graduated within the last 5-10 years.
The staff wants you to succeed, and most clinic managers want to invest in you as a therapist. It is important to be upfront before accepting a job and express to the clinic manager your goals, aspirations and expectation levels in regards to mentorship. Let them know that finding a great physical therapy mentor is important to you! As I said, it doesn’t have to be structured to be effective, but I do believe it is important for a new graduate to be eased in and to be able to talk to any of the therapists they work with about complex patient cases. I have seen many of my classmates be promised mentorship, only to be in a clinic by themselves at the end of the day.
Do not let this happen to you if you are not comfortable!
It is important to complete your due diligence. How long is the “mentorship” that’s promised offered? Are you assigned a therapist? Are your schedules blocked off for any time to discuss patient cases? These are all important questions to ask your employer when mentorship is brought up in conversation.
Your alma mater
I want to give a large shout out to my musculoskeletal professors. They did an incredible job of preparing me for my clinicals and beyond that, as I began to navigate my life after PT school. I would also encourage you DPT students to not just talk to your professors about assignments but talk to them about the real world life as a physical therapist.
They are not only your professors; they are also your future colleagues.
I can’t even count the number of times I talked to my professors about whether I should do a residency, what job I should take, or how to develop my skills further after graduating. I would not be the clinician I am today without their support and guidance, and I believe have ultimately led me to the job I am in right now.
They are not only your professors; they are also your future colleagues. They want you to succeed and represent the school in the best possible way. They also have many professional connections, and I have seen this firsthand. It is astonishing to me how small the PT world is, especially the “brotherhood” made up of sports physical therapists.
I have made a large number of connections through my professors, and networking is so imporant for PTs. Plus, if one area of physical therapy sparks your interest, talk to your professor who specializes in it!
Throughout my academic career, I was blessed to have a few mentors, most being my clinical instructors. They helped me gain opportunities such as working with the University of Florida athletic teams, working as a research assistant for a concussion study, and eventually working with the Pittsburgh Pirates during spring training! Working in sports can be super rewarding, and if you love sports as much as I do, check out these reasons for working in an elite sports clinic.
It’s also important to consider not just the therapy side of our profession, but the work-life balance portion of having a full-time job. I was fortunate to grow up with a mom whose job was flexible, and she was able to pick me up at school at 3:00 P.M. every day. However, if you work in an 8-5 job (or for a sports team which is my ultimate goal) this probably will not happen. I talked with my first clinical instructor about raising a family as a full-time worker, managing finances, juggling life experiences in general, and even dating another PT (this can be a whole other article in itself). I quickly realized, after my first paycheck, that life is not always greener on the other side of graduating (literally). It is important to be prepared not just as a physical therapist, but for life itself.
In addition, you can find mentors in other folks, not just your clinical instructor. If you know a physical therapist who has progressed in a career path that you would want to follow, approach them and ask them how they got to where they are. I speak from personal experience!
I was pretty miserable in my acute rotation (shout out to those hospital PTs; it’s harder than it looks), and I reached out to the Pittsburgh Pirates Minor League Rehab PT since their spring training facility is in my hometown. He met with me and told me what experience I would need to get into his position and what to do to set myself apart from other new graduates. This one hour conversation ultimately led to an eight week long, unofficial internship with the Pirates during spring training.
I could not have learned all I know now about rehab injuries in baseball and the daily grind these players engage in without it, and I am so grateful for the experience because I now have made connections that may lead to my ultimate career goal.
The little conversations you have may lead to opportunities down the line. So take each experience and learn from each and every one of them.
Residency or Fellowship
PT school will give you a foundational knowledge of physical therapy, but I do believe that new graduates lack advanced clinical thinking skills and hands-on experience. This is not to say we are not smart or are mediocre at what we do, but there is no denying that a residency or fellowship will accelerate your learning process by three to five years. While this is not a necessary route to take, I have chosen to partake in a sports and orthopedic manual therapy certification and here is why: there is a huge learning curve after you graduate, and you may think you know a lot, but in reality, new graduates have so much more to learn. I wanted a fast track to get to where I want to go, and I believe a fellowship will help me develop the hands-on skills and clinical reasoning ability that I need and want in order to work for a collegiate or professional sports team.
In addition, you are guaranteed that mentorship time that so many new graduates truly want. I don’t think residency or fellowship is ideal for everyone, but I would strongly encourage you to think about what you want and your career goals. I think the most important thing is to find the residency or fellowship that is right for you.
However, do not just do a residency or fellowship to get those three or four letters behind your name: do it because you want to grow and develop your clinical and professional skills as a physical therapist. Do it for the sake of your patients, whether they be that top prospect pitcher or the 65-year-old patient with knee osteoarthritis.
Having a good mentor is critical as a new graduate to help develop your clinical skills and accelerate your personal and professional growth. I encourage you all to seek out one, whether you are a new graduate, a therapist a few years out, or even an experienced therapist who wants to continue to learn more. And for those who are experts now, I hope you can return the favor to us new graduates looking to find someone to take us under their wing.
This article was made possible by thorough feedback and assistance from Austin Win, DPT,
Disclaimer: Please consult your doctor or Registered Dietitian before starting any type of supplementation. This is not intended to be a substitute for medical advice. As the name implies, supplements are meant to supplement an already-established healthy diet. These supplements may have side effects that vary on an individual basis.
The American Physical Therapy Association states that nutrition is a part of the professional scope of practice of physical therapists. As physical therapists, we are obligated to at least address the basics of proper nutrition with patients. I recommend referring your patient to a Registered Dietitian for any dietary interventions beyond the basics of nutrition, especially if they have a certain medical condition. Dietary changes may help your patient’s prognosis in physical therapy and overall health.
Before we talk about supplements, one of the most important improvements a patient can make to their diet and nutritional habits is to stay hydrated. I cannot tell you how frequently patients will be sweating and breathing heavily during physical therapy sessions but decline a cup of water. Also, a majority of the time, if a patient complains of muscle cramping at home, I ask if they drink adequate water at home, especially if you’re working with them using HEP software. More often than not, the answer is no. In an ideal world, patients would drink at least 20 oz. water an hour prior to starting physical therapy. Hydration can also help a patient’s prognosis in physical therapy as physical performance can decline after losing 2% of your body weight in water.
As you may know, there are hundreds of different supplements on the market, and it may be extremely difficult to know which ones to recommend. The goal of this article is to go over the top seven safe and effective supplements a patient may benefit from during physical therapy and while staying active on their own. Although these supplements have shown to be beneficial, you must take into consideration a patient’s medical condition or history before making any recommendations to avoid any contraindications. This includes being aware of any allergies or medications a patient is taking that can negatively interact with certain nutrients or supplements.
Micronutrients play a vital role in many of the body’s daily functions. Many physicians recommend taking a multivitamin as “health insurance” for your body. You may be missing out on key nutrients in your diet; a multivitamin can help fill the gaps.1 Moreover, various cooking methods can destroy the vitamins contained within food.2 Those who are unable to eat a variety of foods or are at risk for nutrient deficiencies can benefit from taking a multivitamin.
People with certain diseases such as Crohn’s disease or those on restrictive diets can find it more difficult to meet their nutritional requirements. Additionally, a person planning on conceiving a child can benefit from the folic acid in the multivitamin 1-3 months before conception. Folic acid helps protect against a child being born with spina bifida. 400mcg of folic acid each day could help reduce the risk of a child developing spina bifida by 70%.3
Be sure to consult with a physician or Registered Dietitian before taking a multivitamin.4 Some multivitamins contain iron, and iron supplementation is not recommended for certain individuals, especially those who consume high quantities of red meat and other high-iron foods.5
Caution: Do not overdose on multivitamins. Ingesting too much of a particular vitamin may be worse than not receiving the vitamin at all.
It is recommended that men take 8mg/day of iron. However, pregnant women should aim for at least 18mg/day to help support the growing baby and prepare the mother’s body for any possible blood loss during pregnancy.5 But as stated earlier, recommended iron intake can vary greatly depending on diet, existing health conditions, etc. Vitamins and minerals typically have a tolerable upper intake limit (UL), which is the maximum amount of a vitamin or mineral one can take without the risk of an overdose. Make sure to be aware of a vitamin and/or mineral’s UL.5
Fish Oil (Omega-3s)
Fish oil has been shown to have many health benefits, including prevention of heart disease as fish oil acts as an anti-inflammatory. Furthermore, regular use of fish oil may promote joint health through a combination of the aforementioned anti-inflammatory effects and the increased blood flow promoted from the omega-3 fatty acids.6
Some people may opt to take flaxseed oil rather than fish oil to add omega-3 fatty acids to their diet. However, studies have shown that fish oil can be more effective than flaxseed oil.6 Fish oil contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are fatty acids that have been shown to be beneficial in the prevention of several diseases.6 On the other hand, flaxseed oil contains ALA (alpha-linolenic acid) which is another omega-3 fatty acid. Both are great, but fish oil (with EPA and DHA) has more evidence-based research backing its effectiveness.6
Aside from possible “fish burps” one may incur while taking fish oil, this supplement has shown to be relatively safe when taking in recommended amounts – generally 1000mg to 3000mg per day.
Creatine use is usually associated with bodybuilders and the weightlifting crowd. However, creatine can be useful for a wide variety of people including those with neurodegenerative diseases. There are various types of creatine on the market (e.g. Creatine Monohydrate, Creatine HCL, Kre-Alkalyn, etc.), but the most commonly used and widely-researched form is Creatine Monohydrate. Benefits of creatine use include:
Increased muscle mass and strength
Increased bone mineral density
Reduced oxidative stress
Increased short-term memory
Increased aerobic performance
Faster recovery / decreased soreness after exercise
Improved glucose metabolism7
Greater protection / less damage after a traumatic brain injury
Research published in Medicine and Science in Sports and Exercise found a significant improvement in glycemic control when participants with type 2 diabetes combined creatine supplementation with an exercise program.8
Creatine can have some negative side effects – mostly GI-related – especially for those trying the supplement for the first time or trying to take too large of a dose at one time.9 It is recommended a patient take creatine as a part of a cycle (usually 4 weeks in duration) and then temporarily cease use of the supplement. As with any supplement, be sure to consult with your doctor and start with small doses to assess tolerance and any potential side effects.
Ultimately, Creatine has many benefits—more benefits than the bodybuilding stereotype associated with this supplement—and it can aid your patient when recovering from an injury. While you work with your patients on their recovery, work on minimizing these four words in your PT vocabulary to keep them on a positive track.
Caution: Creatine may increase the risk for renal dysfunction in people with a history of renal disease.
Vitamin C, or ascorbic acid, contains several health benefits including the prevention of free-radical damage that contributes to aging-related diseases. Vitamin C acts as a powerful antioxidant that has the ability to boost your body’s immune system. It also has an important role in the growth and repair of tissues in all parts of the body. As a result, it can greatly improve your body’s ability to handle physical and mental stress.
Supplementing with Vitamin C can help your patient accelerate their recovery from an injury or surgery. It can aid in the recovery of wounds and may help with the repair of any fractured bones or connective tissue dysfunctions.
Caution: Be sure to talk to a doctor or Registered Dietitian before taking Vitamin C if you have an existing medical condition to avoid any side effects. Vitamin C increases the iron absorption in your body and may have interactions with certain medications.
CoQ10 is an increasingly popular supplement and is often associated with heart health. Cells use CoQ10 as an energy source; it is stored in the mitochondria of your body’s cells. Levels of CoQ10 in the body naturally decline with age.10 Therefore, supplementation may be warranted in those with decreased levels. Additionally, the use of statin medication (used to treat hypercholesterolemia) may also decrease levels of CoQ10 in the body.11
CoQ10 is generally found over-the-counter in two forms: ubiquinol and ubiquinone. Ubiquinol is the form naturally produced by the human body, but ubiquinone is usually less expensive. However, both forms have been shown to be beneficial. Studies suggest that although ubiquinol is more natural, it may not be worth paying the premium on it while more affordable ubiquinone supplements are available.12
Per the National Institutes of Health, “For patients with heart failure, taking CoQ10 was associated with improved heart function and also feeling better, according to research reviews published in 2007 and 2009. A 2013 meta-analysis also found an association between taking CoQ10 and improved heart function.”12 CoQ10 may also help patients recover more quickly from various cardiac surgeries. However, correlations linking CoQ10 to lower blood pressure remain weak.12
Caution: Be sure to talk to a doctor before taking CoQ10, as this supplement can interact with certain medications. For example, CoQ10 can reduce the efficiency of Warfarin.
More research indicates that gut health may have a direct impact on overall health. 80% of the immune system’s cells are in the gut. Therefore, probiotics are a supplement that may be worth adding to your daily routine.
Probiotics may help reduce gastrointestinal bloating, constipation, diarrhea, and gas.13 Additionally, probiotics may help your body produce vitamins, extract nutrients, absorb minerals, and facilitate the creation of neurotransmitters.
Probiotics may even help with those suffering from anxiety and depression. In a 2016 eight-week study, those who took a probiotic compared to patients who were prescribed a placebo had significantly decreased Beck Depression Inventory scores and serum insulin levels.14
Dermatologist Dendy Engelman, MD, argues that if we have an unhealthy, unbalanced gut environment, toxins can be released into the bloodstream and cause inflammation throughout the body.13 Amy Shapiro, MS, RD, CDN (founder and director of Real Nutrition in New York City), states that probiotics protect the body from infections and allow the body to maintain homeostasis.13
Besides traditional capsule forms, there are other, food-based sources of probiotics:
Note: probiotics are not to be confused with prebiotics, which are the “fuel” probiotics use to thrive.
Sufficient protein intake is needed to both maintain and build muscle mass. By encouraging our patients to increase the amount of protein in their diet we can also help stimulate muscle protein synthesis. As physical therapists, we are exercising our patients to improve their strength, and this can be accelerated by having them properly fuel their body with the right nutrients. The amount of protein an individual should intake depends on factors such as their age, gender, weight, stress factor, activity level, and individual goals.
The protein required by an elderly woman with sarcopenia will drastically differ from the requirements of a young male athlete. Although it is possible for individuals to obtain their protein requirement from eating whole foods, supplementation ensures that they will receive adequate protein needed to promote recovery. Again the protein requirements will differ depending on your patient population, but encouraging your patients to consume adequate protein can mitigate any muscle damage. Along with the increased protein intake, try these 11 strength and conditioning practices to aid in the development of new muscle!
Caution: Be sure to talk to a doctor or Registered Dietitian before supplementing with protein. In some cases, excess protein can cause interactions in individuals with Parkinson’s disease due to certain medications such as Levodopa.
Using these supplements may help your patients (and you) with individual health-related goals. As always, be sure to consult with a physician or Registered Dietitian before starting any new supplementation programs.
It is important to mention that recommending certain supplements without complete knowledge of a patient’s medical history and medications is both ignorant and unethical.
To put it into perspective: it is no different than recommending certain exercises without knowing the diagnosis of a musculoskeletal disorder. You can do more harm than good if the patient’s medical condition is not taken into consideration, whether you’re recommending a supplement or an exercise.
Are there any supplements that you recommend personally? Please let us know in the comments below. Thanks for reading!
Disclaimer (repeated from above): Please consult your doctor or Registered Dietitian before starting any type of supplementation. This is not intended to be a substitute for medical advice. As the name implies, supplements are meant to supplement an already-established healthy diet. These supplements may have side effects that vary on an individual basis.
Woodward L. Why are multivitamins important? Livestrong. https://www.livestrong.com/article/240179-why-are-multivitamins-important/. October 3, 2017. Accessed May 17, 2018.
Cote, R. The importance of taking a multivitamin supplement. HealthGuidance. http://www.healthguidance.org/entry/1032/1/the-importance-of-taking-a-multivitamin-supplement.html. January 2, 2018. Accessed May 24, 2018.
Spina Bifida. American Pregnancy Association. http://americanpregnancy.org/birth-defects/spina-bifida/ July 2015. Accessed June 1, 2018.
Melnick M. Should you take a multivitamin? Huffington Post. https://www.huffingtonpost.com/2012/08/01/should-you-take-a-multivitamin_n_1725380.html August 2, 2012. Accessed June 4, 2018.
Vitamins and minerals: how much should you take? WebMD. https://www.webmd.com/vitamins-and-supplements/vitamins-minerals-how-much-should-you-take#1 Accessed June 2, 2018.
Bowden J. Fish oil versus flaxseed oil. Better Nutrition. https://www.betternutrition.com/natural-rx/fish-versus-flax-oil. June 2, 2010. Accessed June 9, 2018.
Kendall K. 6 reasons everyone should take creatine. BodyBuilding.com https://www.bodybuilding.com/fun/6-reasons-everyone-should-take-creatine.html. August 2, 2018. Accessed August 9, 2018.
Gualano, B., de Salles Painneli, V., Roschel, H., Artioli, G. G., Junior, M. N., Lucia de Sa Pinto, A., … & Lancha, A. H. J. (2011). Creatine in type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Medicine and Science in Sports and Exercise, 43(5), 770-778.
Creatine monohydrate: beneficial or just dangerous? Dr. Axe. https://draxe.com/creatine-monohydrate/. Accessed June 17, 2018.
Semeco A. 9 benefits of coenzyme q10. HealthLine. https://www.healthline.com/nutrition/coenzyme-q10#section1. October 12, 2017. Accessed June 12, 2018.
Coenzyme Q10. National Center for Contemporary and Integrative Health. https://nccih.nih.gov/health/supplements/coq10. July 18, 2018. Accessed August 1, 2018.
Sinatra S. Which form of CoQ10 is best, ubiquinol or ubiquinone? Dr. Sinatra. https://www.drsinatra.com/is-ubuquinol-coq10-better-than-ubiquinone-surprising-results-from-my-own-research. Accessed August 7, 2018.
Allen M. Experts break down all the benefits of probiotics. TheThirty. https://thethirty.byrdie.com/benefits-of-probiotics–5a7cbfb386960. February 9, 2018. Accessed August 11, 2018.
Akkasheh G, Kaskani-Poor Z, Tajabadi-Ebrahimi M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition. 2016;32(3):315-320.
San Diego, California – January 14, 2019 –CovalentCareers, Inc. sponsored the 2018 Global PT Day of Service. On October 13, 2018, the CovalentCareers team joined thousands of participants worldwide volunteering to serve their communities in the name of physical therapy.
The Global PT Day of Service began in 2015 as an initiative to raise the profile of physical therapy worldwide while also getting physical therapists involved in their communities. Participants can sign up to volunteer or organize events in their area. Since 2015, the event has expanded to include PTs in 55 countries. Events include everything from beach cleanup to pro bono care.
CovalentCareers has sponsored service initiatives in optometry and allied therapy for the last 5 years in an effort to fulfill their mission of empowering new healthcare professionals to create happy and successful careers. “PT Day of Service is the perfect complement to CovalentCareers. The initiative started as something small and has turned into something worldwide,” said Dr. Brett Kestenbaum, DPT and COO of CovalentCareers.
As a PT Day of Service Ambassador, Dr. Kestenbaum organized a beach cleanup at Mission Beach in San Diego. “There was actually a local surf competition going on,” Dr. Kestenbaum said. “They noticed that we were cleaning the beaches, and they gave a huge shout-out to us, and thanked us all for the work that we were doing, just cleaning the beaches right in front of them.”
“As physical therapists, we’re all very blessed,” said Dr. Kestenbaum. “We have a career where we get to help people. When we’re doing our daily routines and our daily jobs, we’re helping patients, and that’s great. But there’s more to it than that: there’s serving our communities.”
CovalentCareers is a career development company for new healthcare professionals and the largest provider of new graduate healthcare professional career resources. In addition, CovalentCareers provides job listing and recruitment-marketing services to healthcare facilities in the healthcare verticals of eyecare and allied therapy.
If you’ve read either of my previous articles, you know that I’m passionate about home health. In my first, I discussed reasons why a new grad would benefit from a home health experience. In the second, I provided an overview of methods of gaining experience in home health. I think it’s an amazing field that would benefit so much from the spirit and skill sets of new grads, but because of its uniqueness compared to other areas of PT, I also think it’s paramount that new grads are cautious to select organizations that are equipped to provide them the most rewarding experience.
Why do I think it’s so important to take extra caution when selecting an employer in home health? There are many reasons, but the two that immediately come to my mind are:
You’re going into someone’s home. You have no idea what you’ll be walking into.
You’re alone. Although your team is a call or click away and at times you can justify co-treating, you’re primarily alone in someone’s home. Granted, critical thinking is necessary in every area of PT, but it’s an entirely different ball game when you’re in home health.
You may wonder why I’d start off an article focused on drawing new grads to home health by describing some of the most intimidating things about this profession. The answer: they were also my two favorite things!
Going into a vastly unique environment with every new patient was part of the adventure and challenge of it all. And autonomy and the ability to actually have undivided one-on-one time with a patient is awesome! But the main component that turns the intimidating facets of home health into adventures and making it, what I consider to be one of the most rewarding areas of practice around, is having adequate training and mentorship.
Qualities to look for in potential home health employers
As a new graduate, one of the first things I would look for in a home health agency is their experience with non-seasoned clinicians.
Do they have a solid student program? This may provide insight on if they have clinical instructors/educators that are familiar with working with less experienced clinicians. Some examples of things to look for in an agency’s student program can be found on the Home Health Section’s (HHS) website.
Do they have a formal mentorship program in place? There can be many levels of a mentorship or buddy program, but from my experience, the more formalized, the better. You want to ensure there is a clinical team member that is a good communicator, a skilled educator, a star performer, and a company champion that will be allowed ample time to give you the support you need to ensure you have the best experience possible. A sample of what to look for in a mentorship program can be found on the HHS website as well.
Next, I would want to know about the organization’s dedication to hiring clinicians skilled in and/or pursuing higher level training in the nuances of home health.
Do they have any clinicians that have received, are pursuing, or have taken courses from the Certificate of Advanced Competence in Home Health? Keep in mind with this question that this is a newer program, so not all agencies may be aware that it is out there, but it would be interesting to find out which organizations are in touch with the latest and greatest programs developed by their section. There are many nuances to home health that, despite having years under your belt in another area of PT, can only be learned through time spent actually working in or seeking out coursework specifically dedicated to this field.
Does their Staff Development/Preceptor/Field Trainer, etc team have clinicians who are OASIS (Outcome and Assessment Information Set) certified? The OASIS is home health tool to assess patient outcomes. Some clinicians view it as a lot of paperwork, but I thought of it as a window into my patient’s whole self. There are questions I never would have thought to ask or fully comprehended the relevance of in developing my PT treatment plan if it wasn’t for having to complete the OASIS. I saw it as a tool for assisting me with identifying what other home health resources my patient may benefit from.
While asking about feeding, I may find out someone has trouble swallowing, so they don’t take their large pills consistently.
While inquiring about how often they feel down or lack pleasure in doing things, I may realize that someone that has been deemed ‘non-compliant’ may be struggling with feelings of depression.
Sure, it’s a data set to measure home health outcomes, and I won’t lie and tell you that it’s not time intensive, but as a ‘green’ home health PT, I always appreciated it as a tool to help me see aspects of my patient that I otherwise may not have. And that appreciation only came from a mentor that was well-trained in it and understood the deeper benefits of it.
Does the organization have clinical/specialty ladders in place? This could be in wheelchair assessment, lymphedema management, wound care, mental health, etc. This question shows not only if the company is dedicated to their clinicians’ growth and development, but also helps you identify what types of specialty resources will be available to you.
Questions to ask potential home health employers
Once you research home health agencies, land on a few places you’re interested in, and receive offers for interviews, you’ll want to prepare questions for the interviewer to help determine if the organization is a good fit for you. This certainly isn’t an exhaustive list, but there are definitely questions that over the years I’ve added to my bag of tricks and/or wish I had added to my bag of tricks.
Have they hired new grads in the past? Do they have experience handling the extra time/resources that may be necessary during new grad onboarding.
Does/how does orientation or onboarding differ for a new grad versus a more experienced clinician? I’d be concerned if as a new grad, especially one without any home health experience, I went through an identical orientation as someone with 12yrs of experience as a home health PT
What is the ratio of mentors/preceptors to new hires? Will you have the same preceptor throughout your orientation or will you work with multiple preceptors? Will your preceptor also have other new hires to orient at the same time?
What are the productivity standards fore new hires?And what is the ramp up time allotted to achieve full productivity? There’s no gold standard here. If I was a student with an organization and am now looking to get hired by them, I may be ready to ramp up faster than someone with no experience at that organization. Or if you’re already familiar with the documentation system from a previous experience, your ramp up time may not be as time intensive as if you’re learning a brand new system. You just want to make sure that you’re comfortable with what’s presented to you and that you know and understand your expectations up front.
After orientation/onboarding is complete, does the organization offer any sort of mentor/buddy program for future support? Although you’ll most likely meet a lot of new team members during orientation, it is nice to know if there will be a specific point person to reach out to if you’re in a pinch.
Does onboarding/orientation include shadowing other members of the interdisciplinary team? I can’t stress the importance of gaining full understanding of what your teammates do and when it’s appropriate and necessary to request referrals for their services.
In Closing . . .
I’ve heard stories of passionate, bright-eyed clinicians that had their dreams squashed by negative orientation experiences. And I’ve seen lukewarm clinicians be completely inspired and transformed into awesome home health champions because of their onboarding experiences. I was the ‘green’ orientee, then a field preceptor, and eventually a staff development specialist. I grew to love home health, not despite the challenges of it, but because of them. But it didn’t happen overnight and I didn’t develop that passion alone. I’m sure this is true of many areas of practice, but definitely fitting for home health is the saying that ‘It takes a village’.
If you’re inspired to seek out a job in home health, I can’t stress enough the importance of not only preparing for how you’ll answer questions during an interview, but also preparing questions you’ll use to interview potential employers. It’s so important to select the right organization that fits with your level of experience and comfort in this setting. Since it truly does take a village, you need to make sure you find the right tribe!
When we first enter the physical therapy profession as new graduates, listening, remaining humble, and taking in as much information as possible is crucial to our success. But even if you’re new to the game, it doesn’t mean you don’t have the power to make an impact. In fact, you may even have more power than a burned-out PT who’s simply going through the motions. Between constantly battling payers for better reimbursement rates and fighting tooth and nail for physician referrals, longtime physical therapists often become pretty jaded about the future of the profession.
According to data cited in the 2018 State of Rehab Therapy report, the longer a therapist is in a role, the less happy they are with the direction rehab therapy is heading—and the more the therapist agrees that they used to enjoy the role much more which is why I believe new grads are the key to a new era of value-based care.
As someone who has been a PT for more than two decades, I understand why many of my contemporaries feel this way. However, I also see ample opportunity for the PT community to grow and progress—and for PTs to further establish ourselves as valuable first-line care providers. That, of course, will require a shift in thinking—particularly with respect to our relationships with other healthcare stakeholders. And I think fresh PTs will be integral to spurring that movement.
Payers and PTs have a messy history.
As I mentioned, I understand why many physical therapists feel the way they do—especially when it comes to insurance providers. You don’t have to be in the profession for very long—or at all, really—to know that insurance payers are notoriously difficult to work with. (And on top of that, according to the aforementioned State of Rehab Therapy report, payers are one of the biggest barriers to accessing patients and providing effective care.) Historically, there’s been a unique strain affecting the dynamic between payers and physical therapists, and as a result, many PTs feel somewhat defeated—resigning themselves to being overworked, underpaid, and at the mercy of insurance payers’ corporate greed.
It’s an attitude you will undoubtedly encounter once you start working with more tenured providers, and I strongly caution you to not get wrapped up in the negativity. After all, the future our profession hinges on collaborating with other healthcare stakeholders—including payers and physicians. Your attitude will set the tone for the early years of your career, and more importantly, your enthusiasm and energy can fuel the evolution of the profession and help keep it in step with the industry-wide movement toward value-based care.
Data drives payer decisions.
That said, attitude and energy alone won’t be the only impetus for change. PTs are on the precipice of a major shift in our relationship with payers—one that could seriously impact how payers set their rates for our services. But before we get into that, we must first understand how payers set their rates.
In short, it’s all about data. Everything—reimbursement rates, coverage decisions, and policies—hinges on cold, hard facts. That means a payer’s coverage decisions will depend on whatever data is accessible. But, the data points most payers have—which primarily focus on cost and utilization—only paint a half-finished picture. This data doesn’t typically factor in outcomes or patient satisfaction, which means payers ultimately have a very narrow understanding of the true ROI of physical therapy. Without knowing what the results of PT intervention may be—or having a way to measure those results—it’s only natural they wouldn’t invest more than they need to. That’s just smart business.
There’s change on the horizon.
However, there’s been a noticeable shift lately, and it’s one that—if we can keep the momentum going—could have a profound impact on the way payers view PT services. First, as healthcare spending continues to rise, payers are putting more emphasis on developing sustainable cost-cutting strategies. That means prioritizing the delivery of less expensive—and often, less invasive—treatments. At the same time, the ongoing opioid epidemic has put major pressure on payers to promote prescription drug alternatives, which brings me to my next point.
And if we want to create a new culture around pain management—one that promotes movement, rather than medication, as the first course of action—then we can’t afford to maintain the status quo.
This past September, my company hosted its fifth annual Ascend conference, where about 500 industry professionals gathered for two days to learn about and discuss the changes and challenges facing our profession. Keynote speakers included major industry players such as the APTA’s Sharon Dunn and ESPN’s Stephania Bell. On the data front, though, one keynote address stood out in particular: David Elton of OptumHealth took to the stage to discuss Optum’s recent study on the efficacy of physical therapy (and other conservative therapies) in combating the opioid epidemic.
A PT-first approach could be key to fighting the opioid crisis.
During the yet-to-be-published study conducted by Boston University—which was co-sponsored by Optum and the APTA—researchers found that only a third of eligible patients received conservative treatments (i.e., physical therapy or chiropractic care) as a first option instead of surgery or prescription meds. However, low back pain patients who were sent to conservative therapies first were “75% to 90% less likely to have short or long-term exposure to opioids.”
Those are powerful numbers—which begs the question: why aren’t more patients turning to conservative treatments as opposed to prescription painkillers? Well, the study addressed that, too, finding that patients are “10% to 25% less likely to see a PT, rather than a primary care provider, if their copay is more than $20 or deductible is more than $300.” In other words, patient-consumers—just like consumers in any other market—are drawn to the most cost-effective care options. And as you may know, PT copays and deductibles are often much higher compared to those associated with other care disciplines, due in part to our specialist designation.
Payers are starting to take notice.
So, now what? Fortunately, Optum/UHC has already enacted some meaningful changes based on this data. Per Elton, “starting in 2019, UHC will adjust its benefits packages to waive the copay and/or deductibles for each beneficiary’s first three physical therapy visits.” He went on to explain that reimbursement rates could also potentially increase based on patient outcomes. And sure, UHC is only one payer, but it happens to be one of the largest payers in the country. So, it stands to reason that if UHC makes these changes, other payers could follow suit.
We must remain vocal for the sake of value-based care.
Unfortunately, despite the data being present—and despite one of the largest payers in the country taking steps to make PT more accessible to its beneficiaries—this information has still been met with skepticism from PTs who point to UHC’s long history of low reimbursement rates. (Even during Elton’s address, several attendees expressed this sentiment directly to him). And while I agree that we should be cautiously optimistic, I believe UHC’s changes represent a huge move in the right direction. And if we want to create a new culture around pain management—one that promotes movement, rather than medication, as the first course of action—then we can’t afford to maintain the status quo.
This is truly a pivotal moment for PTs, and there’s never been a better time to enter the profession. Physical therapy is a safe, effective, and financially-friendly alternative to painkillers when it comes to treating chronic pain—and we have the data to back it up. If we want our profession to thrive as we move into the future, we must be vocal about our role in ending the opioid crisis and supporting a value-driven healthcare system—and we must diligently educate our peers, patients, payers, and other healthcare stakeholders.
New grads especially have a lot to learn (you can check out our list of 10 things new grad PTs should do to continue learning), and on that front, make sure you stay in the know on the latest pro-PT research—or do your own data collection and research—and share it with your fellow PTs, physicians, and payers. And don’t stop there; it’s on all of us to market the value of PT directly to the patients who need us—and to do everything we can to spread the word about the benefits of a PT-first, value-based care approach. After all, the more exposure we create, the more opportunity we’ll have to help create clinical pathways—and insurance plans—that support that approach.
Physical therapy is an incredible profession, and I believe your decision to join the PT community is a great one. But, I won’t lie to you: the modern healthcare environment presents us with a lot of challenges. To meet the challenges of the future, though, we first must let go of the past—and I’m counting on the next generation of therapists to help us do just that.
How many of us have experience these frustrating statements when treating? These sentiments are born of an era when physicians solely dictated the orders of therapy to physical therapists. PTs in general are relatively new to the scene as autonomous doctoral-level practitioners in comparison to established medical disciplines. As a result, all too often we find ourselves stuck in scenarios where a patient does not or is delayed in receiving the physical therapy services he or she needs due to taking multiple steps in the healthcare system.
Traditionally, when people sustain a musculoskeletal injury, what do they do? They see a physician, which may not happen right away. They may be referred for imaging, which may not be covered or may not be necessary. Then after all is said and done, if there are no red flags to consider, many are referred to physical therapy.
Direct access is defined by The American Physical Therapy Association as “the removal of the physician referral mandated by state law to access physical therapists’ services for evaluation and treatment.” The APTA has long advocated for direct access to physical therapy to make acute injury management more efficient. In a nutshell, patients would be able to see their physical therapist directly, without the need for a physician diagnosis or referral.
When it comes to direct access physical therapy, states are not on the same page just yet.
Currently, the legislation on direct access varies state to state. A comprehensive list of direct access law by state can be found on the APTA website. The states break down into three basic categories:
Unrestricted Patient Access: no restrictions or limitations whatsoever for treatment absent a referral
Patient Access With Provisions: access to evaluation and treatment with some provisions such as a time or visit limit, or referral requirement for a specific treatment intervention such as needle EMG or spinal manipulation
Limited Patient Access: Access to evaluation, fitness and wellness, and limited treatment only to certain patient populations or under certain circumstances (i.e. treatment restricted to patients with a previous medical diagnosis or subject of a previous physician referral).
The evidence in support of direct access is growing in our favor.
Despite legislative barriers to accomplishing direct access in the industry, an area that has seen the most progress is in the military. Physical therapists that are credentialed by the Department of Defense have the ability to not only treat without referral, but also can order diagnostic imaging and prescribe certain medications.
A study published in the journal Military Medicine in 2013 investigated the effectiveness of utilizing a physical therapist as the primary caregiver for musculoskeletal conditions. The following findings were produced for data following patients on a military base in Afghanistan:
The physical therapist ordered imaging for 11% of patients. The family physician ordered imaging for 82% of patients.
The physical therapist prescribed medications for 24% of patients. The family physician prescribed medication for 90% of patients.
The patients treated by the physical therapist first had a 50% greater likelihood of return to duty.
Of course, there are limitations to these findings. We are looking at a small, homogeneous sample size, and the study evaluated only one physical therapist and two family physicians. However, this study demonstrates a model in which a physical therapist as a musculoskeletal gatekeeper yielded both decreased health care cost and improved outcomes.
Physical therapists can diagnose. We are educated at a doctoral level. The APTA’s Physical Therapist Guide to Practice which is widely used in DPT programs outlines examination, evaluation, diagnosis, prognosis, and intervention of patients. We can use these guidelines to identify conditions that are within the scope of practice of a physical therapist.
Additionally, we are trained to identify those who are not a candidate for physical therapy. A physical therapy evaluation is designed to encompass systems review and red flag screening. Anyone who presents red flags or signs and symptoms that warrant further investigation are to be referred appropriately.
A common misconception is that underlying medical conditions can be missed by seeing a physical therapist first. Although there is always going to be an inherent risk of a medical error, the Health Providers Service Organization found that direct access is not a risk factor for increased chance of a claim. The HPSO is at the forefront of liability insurance for physical therapists, and has found no significant increase in the number of claims in states that have direct access.
The process of gaining direct access has been positive, but far from over.
Now, let’s get back to our patient quotes from earlier. What are some strategies and resources to deal with the all too frequent push back on the direct access philosophy? Here are some pointers I find useful:
Go straight to the people: Physician referrals will always make up a piece of our practice, but there is no reason to wait for them to trickle in. Millions of people walk around in pain everyday looking for answers. Start community outreach through workshops, free consults, educational content on social media, or maintaining a presence at community health centers and events. There’s always going to be people to talk to about pain, whether it’s in your clinic or not.
Build a brand as an autonomous practitioner: Once you’ve put yourself out there in the community, utilize the evidence regarding the pros of seeing a PT first. Stand out as the local go-to for musculoskeletal conditions. Patient relationships and word of mouth can go a long way in advancing patients seeking care and referring even more patients once they’ve achieved positive results.
Be an advocate for the implementation and advancement of direct access: The APTA has dedicated a page to resources regarding direct access. There is a comprehensive collection of resources for both education of direct access, how to implement it in practice, and how to get involved in advocacy.
Network with local physicians: MDs are not the villains in this story. Physicians absolutely are the cornerstone of the healthcare system, and referrals are a two way street. Direct access can benefit physicians just as much as it can physical therapists. You have the ability to open up new opportunities for physicians to see patients that otherwise wouldn’t have known where to go. Additionally, the patients we sent to MDs are already screened and are being sent to the specialty that is mostly likely to help them. Creating referral networks and communicating with physicians about your services will help foster collaboration among disciplines.
So, we utilize less health care dollars, with comparable and efficient outcomes, without any significant increase in liability risk? I call that a win-win-win.
Think about the implications of patients seeking PT first in the current climate of an opioid epidemic, an obesity crisis, and rising out of pocket insurance costs placed on consumers. There will always be patients who come in with preconceived notions about the role of physical therapy. It’s a daily educational push one patient at a time, but not any less worth doing. We have to offer as physical therapists, and deserve a seat at the health care table just as much as anyone else.
800 is a magical number when it comes to the NPTE. It’s the highest score reported: maybe not a “perfect” score, but the highest possible based on the NPTE’s scoring system.
The NPTE is scored in a way that takes your raw score, which is the number of questions answered correctly, and converts it to a scaled score. The FSBPT does this to ensure fairness in scoring as each exam is slightly varied in difficulty. An 800 score is not necessarily perfect in the sense that you didn’t miss a single question, but it does mean that when your raw score was converted it was scaled to 100%. When you receive your individual score report there will be a number score out of 800, as well as a converted score in a percentage.
There were 3 factors that directly contributed to my ability to score 800 on the NPTE — so let’s get to it.
1. Take as many practice exams as possible
I started with the PEAT practice form about eight weeks before the exam without reviewing a single concept because I needed to gauge my baseline. Everyone needs a baseline and the PEAT practice form is the perfect way to establish it. Two weeks later, after only studying the bulk of NPTE content (musculoskeletal), I took the PEAT retired form.
I will tell you I didn’t score particularly well on either of these: in fact, I only passed by about 6 and 14 questions respectively. You may not score well on the PEAT either and it may scare you! You will hear that it’s the best indicator of your ability to pass and while it’s important to treat it as the real thing, do not become discouraged if your score isn’t where you want it to be.
Over the next 6 weeks I pored through my review books and notes. I took 1 exam per week: 3 from Scorebuilders and 3 from Therapy Ed. You will feel exhausted during every single one of those tests and you may not fully focus throughout. You may not be receiving the score you want (I didn’t pass a single one) but KEEP taking them. The exposure to that many test questions/content and the mental fatigue you learn to endure will lead you to success on the real deal.
2. Know your vocabulary
This is huge and not something many people consider. You will come across topics and words you’ve never seen before on the NPTE — it’s inevitable. This is when you need to remember prefixes and common roots of medical terms. Maybe Latin isn’t so useless of a language to learn after all?
When you come across a word you don’t recognize, DON’T PANIC. You know everything you need to be able to figure any question out — don’t downplay your guesses. Those are some extremely well educated guesses, and you know the answer!
This is key. Spend the entire 24 hours before the exam doing anything but studying. Go to the gym, play video games, download new music, watch a movie, read fiction. DO NOT study. Give your brain a break from the months of studying that have just occurred: whatever you look at in the 24 hours before the test certainly isn’t going to make or break you.
There you have it! No big, juicy secrets and no bizarre tactics to scoring an 800 on the NPTE. Trust your instincts and your education. Hopefully, the combination of those things and these tips will help you achieve your very best score! Good luck and happy studying.
We have all seen the pictures. Athletes looking to get an edge have turned to cupping, an ancient healing modality, and have shown up to many sporting events covered in the characteristic circular bruises of a cupping treatment. In physical therapy circles, cupping has had a bit of a revival, and is often incorporated as part of a treatment to help relieve pain and get patients better. It is not hard to find reports of the beneficial effects of cupping; just look for the Twitter and Instagram posts, the Facebook discussions, and the course advertisements targeted towards you.
Despite the enthusiasm, cupping is not without its critics. Many suggest cupping should not be a part of physical therapy practice, or medical practice in general, and should remain in antiquity along with bloodletting, acupuncture, and reflexology. In this article, we will take a critical look at the scientific research on cupping and I will help you decide whether or not it should become a part of your practice.
What Is Cupping Therapy?
Cupping refers to using cups made of glass, bamboo, or plastic to create suction on the skin for therapeutic purposes. There is evidence that cupping has been performed since 3300 BC, and is practiced widely in the eastern world (4). There are many types of cupping, each with their own protocols and techniques, and it can be paired with other treatments like acupuncture. Two broad categories of cupping can be distinguished; wet cupping involves scarification or cutting of the skin prior to the application of the cups, which will allow blood to be drawn into the cup, and dry cupping, which involves the application of the cups to the affected area only.
Cupping is purported to have various health benefits, but trying to list them all is an exercise in futility. As practiced in the eastern world, the claims tend to be broad and non-specific. In the physical therapy world however, it is used more narrowly and is focused on pain management, among a few other uses. As physical therapists interested in helping our patients with pain, cupping may be of interest to us.
The State Of The Research
If we want to establish ourselves as allied health team members and evidence-based professionals it is essential that we critically evaluate the scientific evidence on a given treatment and adjust our beliefs and practice accordingly.
Reading through the available literature revealed two broad trends. First, cupping simply hasn’t been studied that much. While it is hard to precisely quantify how many studies have been performed on any given treatment, a student can read through a representative majority of cupping trials and reviews in an afternoon. Second, the overwhelming majority of trials were of relatively low quality and had a high risk of bias. This was characterized by low numbers of participants, failures to control for researcher bias, lack of blinding of any kind, comparisons to an inactive control group, only short-term follow ups, and lack of placebo-controlled study designs.
While having insufficient high-quality research is not a problem unique to cupping, it is still something we need to consider when we adopt new treatments. Given the caveats listed above, what does the research actually say?
A paper from 2016 was the only available trial that attempted to control for non-specific effects cupping might have. The researchers recruited 141 patients with fibromyalgia and randomized them into one of three groups. One group received a true cupping treatment to various body parts. A second group received an identical treatment but the researchers utilized sham cups, which had tiny holes in them that prevented any negative pressure from developing. Lastly, a control group was advised to just continue normal activities and refrain from trying any new treatments. The cupping groups underwent five treatments over the course of two weeks. They found that while both cupping groups reported better outcomes on a visual analog scale and a functional measure compared to usual care, there was no differences between true cupping and sham cupping (15).
A similar study was performed in 2018 on 110 patients with chronic low back pain. They were divided into a normal cupping group, a “minimal” cupping group that utilized a lower negative pressure, and a control group that did nothing. All three groups were allowed to take pain medication as needed. After eight cupping sessions over four weeks, both cupping groups had similar decreases in pain (20).
Many other smaller preliminary trials have been performed comparing cupping to a waitlist control or usual care for different populations and have shown that dry or wet cupping can reduce pain by varying amounts. These populations include people with headaches (1), low back pain (2, 9, 12), neck pain (7, 8, 14 16, 19) and knee osteoarthritis (21). Throughout each of these trials, the amount of sessions, techniques, and outcome measures varied, but all reported beneficial effects. Cupping also edged out hot packs for neck pain (13) and carpal tunnel syndrome (18), and beat e-stim for plantar fasciitis (10). We need to be careful interpreting this group of studies however, because we expect an active group receiving an intervention to do better than an inactive control, especially when it comes to subjective outcomes like pain.
Systematic Reviews And Meta-Analyses
The systematic reviews and meta-analyses thus far reinforce the broader trend seen in the trials we examined above.
One review from 2017 focused on the effects of cupping on athletes and found 13 papers on 11 different trials. On the majority of the outcomes each study looked at, cupping provided beneficial effects. However, most of the time, cupping was compared to an inactive control or no intervention at all, there were no placebo controls, there was significant variability in technique, it was unclear if the studies found were adequately peer-reviewed, there was no blinding, and there was no information about safety or side-effects (4). The authors go on to say they cannot make any recommendations for or against cupping in clinical practice.
Three other reviews for low back pain, knee osteoarthritis and in pain in general came to similar conclusions. Cupping may be helpful for reducing pain, but the quality of the research, statistical heterogeneity, and high risk of bias present in the research limits the strength of the evidence (11, 17, 22). Three other more broad reviews that did not limit their literature search to a specific condition or type of cupping found that results were mixed overall, and we need better quality research to make any definitive conclusions (2, 5, 6).
The Clearest Picture
Taking a look at the totality of the evidence, what can we say with certainty in regards to cupping? Is something of clinical value actually happening during a cupping treatment? Anecdotal evidence and very weak scientific evidence suggests that in isolation, cupping may help reduce pain by small amounts for various conditions, but the literature is not strong enough to give us a definitive answer. We have no studies looking at how cupping would fair in addition to a traditional physical therapy treatment program. The one study we have that was designed to differentiate between specific and non-specific effects failed to show cupping has any additional benefits over a credible sham procedure. In regards to the potential placebo effects, one author writes:
“Cupping therapy may simply have a powerful placebo effect. In fact, all invasive or non-pharmacological treatments may have relevant placebo effects. In a recent randomized trial, a sham device was more effective in relieving pain than a placebo pill. Therefore, the nonspecific and placebo effects of cupping therapy may result from the fact that it is an uncommon procedure” (18).
As of today, there are no strong studies we can be confident in that suggest cupping adds anything of value beyond nonspecific pain relief, which almost all of our other treatments can provide. This may change, but cupping has only faced one hard test of effectiveness and it failed.
The Role Of Cupping In Physical Therapy Practice
So where does that leave us? How should we view treatments that have anecdotal support, yet weak or absent scientific evidence? Many online discussions and public debates break down at this point but reasonable people can disagree. The arguments in favor of cupping typically point out that patients report benefits after cupping sessions, the research isn’t absolutely negative (even though it is weak), and in the therapist’s experience, they have seen benefits. These seem to fit Sackett’s classic definition of evidence-based practice we all learned in school, and is therefore okay to include as part of a multi-modal treatment.
My opinion diverges here because of a fundamentally different philosophy on what physical therapists do and why they should do it. It is not enough to merely show a treatment can reduce pain by a few points in a handful of poorly-designed trials and to have anecdotal success stories from patients and other therapists. Any treatment can be justified with this type of reasoning, including homeopathy, craniosacral therapy, acupuncture, reiki, or magnet therapy. If we are going to be a respected part of the medical community, we need to embrace science-based medicine, and seek strong scientific ground and biological plausibility for the things we do. Cupping has not met that threshold.
We already provide many of these types of treatments, and we don’t have robust evidence to suggest that cupping offers something significantly different or better. Why would we need more of the same? If you chose to incorporate cupping into your treatments, it is important to emphasize that cupping is largely unstudied and has only been shown to reduce pain by small amounts. It should be a minor part of treatment, if at all. As far as the science is concerned, cupping has not yet passed any fair tests, and as such, we should all be very skeptical of the inclusion of it in physical therapy practice.
Ahmadi, Alireza, et al. “The Efficacy of Wet-Cupping in the Treatment of Tension and Migraine Headache.” The American Journal of Chinese Medicine, vol. 36, no. 01, 2008, pp. 37–44., doi:10.1142/s0192415x08005564.
Albedah, Abdullah, et al. “The Use of Wet Cupping for Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial.” The Journal of Alternative and Complementary Medicine, vol. 21, no. 8, 2015, pp. 504–508., doi:10.1089/acm.2015.0065.
Bedah, Abdullah M.n. Al, et al. “Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials.” The Journal of Alternative and Complementary Medicine, vol. 22, no. 10, 2016, pp. 768–777., doi:10.1089/acm.2016.0193.
Bridgett, Rhianna, et al. “Effects of Cupping Therapy in Amateur and Professional Athletes: Systematic Review of Randomized Controlled Trials.” The Journal of Alternative and Complementary Medicine, vol. 24, no. 3, 2018, pp. 208–219., doi:10.1089/acm.2017.0191.
Cao, Huijuan, et al. “Clinical Research Evidence of Cupping Therapy in China: a Systematic Literature Review.” BMC Complementary and Alternative Medicine, vol. 10, no. 1, 2010, doi:10.1186/1472-6882-10-70.
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When I graduated from physical therapy school I was feeling like a hot shot. Come on, I was a DOCTOR of physical therapy and I was looking for a job that would pay me well and treat me like one. How do you know how to choose the right job fresh out of PT school? I was unsure, overwhelmed, and ended up choosing the wrong one and stayed for 2 years.
Following graduation, you start to apply with your fresh new resume which now says DR. at the top, but how do you truly know that THIS is the right job? How do you know you are going to be happy HERE? How do you know your goals will be met?
I was there, felt that feeling, and I was frightened, but excited to actually make REAL money and to change the lives of my patients! I did not ask the right questions before taking my first job. I did not observe for a day at the clinic. I did not get to know the staff.
I had a connection from a professor. If the place was recommended by a professor then it surely was the best fit for anyone, right?! Well.. I was offered the job on the first interview and I took it without observing for a full day.
I took the job in another clinic before even meeting the staff. I took it without asking questions. It seemed…all right. I was just so excited to change lives and such that I was just going for it.
Let me tell you why I wish I observed for a day. If I had observed for a day, I would have seen sooner that my personality was not the right fit for this position and for this exact location. I would have noted that this position was not in line with my goals and would not get me to business ownership status as I was wanting.
I would have noted that in 6 months from the start date I would be experiencing the signs and symptoms of “burnout.” I would have been more accepting of who I am and allowed myself to search more for a position that was right for me. I would have known. But I did not do that.
Let’s make something clear: I learned A LOT during my near 2 years. More than I would initially would have admitted. I learned more about myself and my career goals than I would have without this first placement.
I figured out what exactly my goals were and what I wanted out of my career and my life. I learned that I wanted to learn more. I learned that I was excited about my field and I had a lot of interests.
I learned that I was a great clinician and had very strong communication skills. I learned how much control I was able to tolerate from overhead. I realized I had an entrepreneur mindset and I wanted to market and be a business owner. I learned that I was just not made for where I was. Most importantly, I learned that is okay.
I did not set myself up for success or make sure everyone was on the same page. I did not ask questions. I did not reflect.
These are the questions I WISH I would have asked BEFORE saying yes to the job:
Mentorship. What kind do you offer, why, and what will I get out of it?
Value: How will I be valued? What will you do to assist me in growing and improving myself for our profession?
Environment: What do you do to allow a positive working environment that is comfortable and a good fit for all of your employees?
Learning: Will i learn, what will i learn, do you pay for CEU’s, etc
Systems: What systems do you have in place? How many patients per hour, week, month am I expected to see? Do you offer anything after traditional physical therapy? What does the clinic offer the patient to completely fulfill their goal?
Money: What is the bonus structure? Why? How can I be placed in a position for a raise? Do you base them on quality and satisfaction or solely the numbers?
I did not spend time on figuring out what my goals were. I came out of school and just wanted to work. I assumed, at that time, there was no option other than working for someone else.
I did not know at that time anything I wanted was possible, I just had to do it. I wish I spent more time on mentorship and focused on where I TRULY wanted to be. However, without getting the answers to those questions and without doing the reflections, I learned what I learned. I finally know what my goals are and what I want from my career!
Since I failed to ask the questions, I began to get feelings similar to what is described as, “burnout.” I understood at that point that I chose the wrong job right out of PT school. I came to the conclusion that I was not happy.
I was burning out. I was only almost 2 years into my career and here I was…where no DPT wants to be. Insomnia, sick all the time, difficulty getting out of bed, watching the clock and counting the hours until the end of the day.
I’ve now spent countless amounts of hours on studying and learning what NOT to do when taking that first job so I can help new grads make better choices and pay closer attention to their goals. Because honestly, I did not pay attention to any of the tips I am about to share with you. The unfortunate part is, if I would have stayed it would have broken me. Your first job matters, the choice matters.
So, without further ado, here are the tips I would like to share with you. Take them with a grain of salt because every situation is different and every person is different. I recommend sitting down to read this with a pen and paper. Reflect as you go. It is simply a starting point to get you going on the right track and on to your dreams.
Make sure it is a right fit for BOTH of you. Yes, both. That’s your employer too.
You have to form a relationship with your employer. You need to have several email conversations, phone calls, meetups, whatever it is to really see what kind of person they are. You want to make sure they will fit well with your personality.
Make sure you do not butt heads this early in the game. Make sure you will not find yourself wanting to scream at them for telling you what to do. Find out what their morals/values are when it comes to the practice BEFORE taking the job.
With this being said, BE YOURSELF. There is nothing worse than faking it and then trying to be someone else in a situation that does not suit you in the first place.
Be sure the questions I’ve written out above are answered. Be sure you are going to receive exactly what you need. Make sure you will be able to bring value to this setting and be appreciated for it.
Know YOUR goals.
What are your goals? Have you spent any time writing out what you want your career to be in 6 months? 1 year? 5 years? 10 years?
If not, you are doing yourself a disservice. Grab a pen and paper and do it. Write it out. Be honest. Do you want to pay off debt? Do you want your own business?
It’s all possible. Your goals should be what makes you happy. What you can do everyday for the rest of your life, no problem.
I recommend answering these questions during goal writing:
Do I want to work for someone?
Do I want to follow demands of another company?
What patient population gets me up in the morning? Who do I LOVE to work with?
Make sure you are spending time on your mindset when working out the decision.
What does your employer want from you? What do they expect? Are they open and honest? Does it feel like a positive experience?
You hear it all the time, go with your gut. It’s true. You really need to see if you feel positive or negative when experiencing, thinking of, or being in the future workplace.
Find out if this “employer” is making you feel uncomfortable or like you need to be someone you aren’t. How do they run the clinic, money or patient first? This is SO important.
Know what their environment is like.
This is huge. You are going to be spending 40 hours or so at this place and should make sure you get along with how it is ran, how it runs, and even how you get along with others in the clinic/area. If you notice drama or things happening you are not fond of, move on it will only get worse.
That’s why it is so important to spend at least a day before taking the job. How does the staff treat each other? Do they talk about the patients negatively? Or is it comfortable, free, and positive? Do you want music while in the clinic? Do they play music? What systems or processes do they use? Do you agree with them? Is it fun? Is it boring? Is it slow? How many patients at a time?
Make sure all of your questions are answered.
Make sure you ask all of your questions before getting hired. It says a lot when a future employer sits with you and answers your questions. Make sure you ask about the money, progression, improvement, value, etc.
Make sure there is nothing keeping you up at night. It should be available for you to ask all of your questions with good answers. So, don’t leave them unanswered.
You don’t tell yourself, “I can always leave if I need or want to. “
Chances are, if you are saying that walking out of the place it is not right for you. You must be cautious of this because we so often just think we can get out of things. You can, but if you already feel that way, stop wasting your time. Life is short, be sure you make good decisions in order to make your life worth it!
Hopefully this takes out some of the stress and fear of finding that right job. Truth is, you probably won’t the first time around. If you do, you are lucky.
Most of us take what we initially think is “the one”, learn from it and move on. Also, don’t be afraid of making the mistake. Most of the time our mistakes put us on the path of our destiny, which is where I am now.
Your choice does matter and can affect your mindset, progression into your future, and your goals. Utilize these tips and be on top of things when you apply. Be sure you REALLY and TRULY want it. The unfortunate thing is if you allow it, your first job can break you. Find one that makes you into the clinician you want to be!
Let’s learn to be adequate decision makers, ask questions like a doctor should, and be confident that we are making the right job choice by using the resources available to us!