Careers in Physical Therapy
Your career primer on a growing profession with ancient roots. Find out what it takes to be physical therapy practitioner
by Roseanne R. Bensley
By their very nature, most careers within the field of allied health are considered personally rewarding.
In fact, as part of this work force, your desire to help others is probably at the top of your “what I want to accomplish” list. While many careers in allied health provide a sense of personal satisfaction, the field of physical therapy in particular can offer both career and personal fulfillment.
So what exactly does being a physical therapist entail? Let's say a patient needs treatment for musculoskeletal or neuromuscular problems that affect their ability to move in the way they are accustomed. Who can help this patient get back to doing the things he or she enjoys? Here come physical therapists to the rescue, the experts in movement and function.
The physical therapist, as defined by the American Physical Therapy Association (APTA), provides services aimed at preventing the onset and/or slowing the progression of conditions resulting from injury, disease and other causes. The physical therapist provides these services to people of all ages who have functional conditions resulting from back and neck injuries, sprains/strains and fractures, arthritis, burns, amputations, strokes, multiple sclerosis, birth defects such as cerebral palsy and spina bifida, injuries related to work and sports, and others.
 A career in physical therapy is a great option in the medical field because it provides the opportunity for autonomy in your patients' care, flexibility in choosing a practice setting and a work environment where you are able to interact with people and improve their quality of life. Physical therapists are respected members of the health care team. They work in conjunction with other health providers to meet the individual health needs of their patients. Physical therapists examine patients' medical histories and then test and measure their strength, range of motion, balance and coordination, posture, muscle performance, and respiration and motor function. They determine patients' ability to be independent and reintegrate into the community or workplace after injury or illness. Next, they develop a treatment plan by describing a treatment strategy, its purpose and anticipated the outcome. The publisher of PT Magazine remarked in a past issue, “Today physical therapists provide help for every part of the body and to everyone from infants to the elderly—more than one million people every day.”
An Ancient Tradition Moving Into the Future
The principles of physical therapy have been part of the healing arts since the beginning of recorded time. Treating health problems by applying heat and exercises had its beginning in ancient times. As early as 3000 B.C., the Chinese used rubbing as a therapeutic measure, and Hippocrates advocated this technique in his writings in 460 B.C.
Modern physical therapy in the U.S. was established by the Surgeon General's office in 1917 with the inauguration of the Division of Special Hospitals and Physical Reconstruction. The American Physical Therapy Association was started in 1921, and the professional status of the field was also established that year.
The real worth of physical therapy, however, was not widely recognized until World War II when medical teams in the armed forces rehabilitated seriously injured patients. Their success caused more people in the medical field to appreciate the good that physical therapy could do.
Today, physical therapy is thriving. It's currently a hot profession and that trend is likely to continue—according to the U.S. Bureau of Labor Statistics, 71% more physical therapist jobs will be available by 2006. Over the long run, the demand for physical therapists should continue to rise as a result of:
A rapid growth in the number of middle-aged and elderly individuals that will increases the demand for therapeutic services;
Baby-boomers entering prime age for heart attacks and strokes;
Advanced technologies to save larger proportions of babies with birth defects
And an increased interest in health promotion.
 The growth and demand for the profession also affords opportunities for therapists to specialize in pediatrics, sports medicine, neurology, home health, geriatrics, orthopedics, aquatic therapy, wound care, electrotherapy, occupational health, women's health, acute care, education, administration, research and cardiopulmonary rehabilitation. The work settings are also very diverse and range from hospitals, nursing homes, schools, outpatient clinics, fitness facilities, the home environment, self-employment and at many industrial companies.
“I like this occupation because it offers the opportunity to work and care for people. It really makes me feel better about myself knowing that I am able to help people and assist them in the rehabilitation process.”
 Physical therapists often coordinate treatment plans with doctors, nurses, social workers and occupational therapists for the purpose of evaluating and treating disease, injury or illness. As experts in movement and function, physical therapists are also involved in preventing injury. Physical therapists work as consultants in industrial settings to improve the design of workplaces and reduce the risk of workers overusing certain muscles or developing lower back pain. Physical therapists also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs.
Douglas Auleta, MD, an orthopedic surgeon affiliated with Las Cruces Orthopedic Associates in Las Cruces, N.M., says, “A good PT is an extension of a good surgeon—they make or break the work of the surgeon.” He also explains that as a surgeon, he depends on the PT to carry out treatment plans that allow patients to increase their range of motion, strength and conditioning and to help relieve pain after surgery.
“The quality of a physical therapist is judged by the actual results the patient receives,” Auleta adds. “Does the patient show improvement based on the care received by the PT? Trust and communication between the patient, the PT and the surgeon is crucial.”
Chose Your Own Adventure
 There are three levels of physical therapy practitioners: the physical therapist (PT), the physical therapy assistant (PTA) and the physical therapy aide.
Each position requires a different type and degree of education and skill. The physical therapist's job is to following through with a referral from a physician. Upon an assessment of the patient, a treatment plan is designed to help the patient. Physical therapists must continually document and evaluate the patient's progress and report all information to the referring physician and insurance companies. “Regular communication, either by faxed or mailed reports, is critical,” says Auleta.
The minimum educational requirements for a physical therapist are a post-baccalaureate degree from an accredited education program. A post-baccalaureate degree allows the student to obtain a broad background in the liberal arts and provides time for students to integrate all the scientific technology and literature that would not be possible at the baccalaureate degree level. In addition, the Commission on Accreditation in Physical Therapy Education (CAPTE) no longer accredits baccalaureate professional programs.
 “If I could do it again, I would get my bachelor's degree in something different from the health field, but still have a strong background in science and kinesiology,” says John Popovich, SPT, University of Southern California. He adds, “Volunteering or working in hospitals or clinics to gain experience in the profession is a must.”
Physical therapy assistants are technically educated health providers who assist physical therapists in the provisions of physical therapy and may perform physical therapy interventions selected by supervising physical therapists. Typical duties include giving heat, light and sound treatments; massages; and facilitating exercises that help to heal muscles, nerves, bones and joints. Physical therapy assistants teach patients to re-learn or improve necessary skills such as walking, climbing and general mobility.
Physical therapy assistants must generally possess an associate's degree from one of the 252 accredited physical therapy assistant programs in order to practice legally. The State Board of Medical Examiners, in whichever state they choose to work, must also license them. Forty states require that assistants pass a written examination before granting a license. Additional requirements include certification in first aid and CPR and a specific amount of clinical training. The need for qualified assistants is so great, however, that some states are offering temporary licenses to individuals who have taken the exams but have not yet received the results. A typical PTA program consists of two years of course work including algebra, anatomy, physiology, biology, chemistry and psychology. The PTA program is divided between academics and clinical or “hands on” experience.
Physical therapy aides are skilled health care workers who help physical therapists or physical therapy assistants when a patient is receiving treatment. They prepare patients by helping them dress and undress and by putting on and taking off supports and other devices. They put patients into therapy equipment and supports and turn the patient while keeping them stable during treatments. Physical therapy aides also keep track of the patients' condition during treatment and reports signs of tiredness, distress or other problems.
Physical therapy aides are not licensed. The aide completes on-the-job training in areas they would be expected to perform. Aides must also have strong interpersonal skills and a genuine desire to help and comfort others. Persons desiring admission to a physical therapy program often work as an aid to gain experience in the physical therapy environment.
As of January 15, 2003, there were 204 accredited physical therapy programs at 196 colleges and universities. A growing number of programs offer the doctor of physical therapy (DPT) degree. Of the accredited programs in 2003, 140 offer master's degrees and 64 offer professional DPT programs.
What is the difference between getting a master's degree in physical therapy versus a DPT, and why would you choose one over the other? Leigh Langerwerf, SPT, University of Southern California, says, “I chose to get a DPT because that seems to be the direction that the profession is going in regard to education recommendations, and I believed that the DPT would prepare me the best for the profession.
“After a few years of practicing,” Langerwerf continues, “I realize that in reference to what they've seen in the clinic, there is little difference between DPT and MPT. However, the big benefit with having a DPT is that you have a wider range of knowledge and more clinical experience prior to graduation. That, I feel, is important because it allows you to practice your skills while still under the supervision of a qualified practitioner that can help to mold your skills and thought process further.”
How to Be the Perfect PT
 The general physical therapy curriculum includes courses in biology, chemistry and physics, and there are also specialized courses offered such as biomechanics, neuroanatomy, human growth and development, manifestations of disease, examination techniques and therapeutic procedures. Besides classroom and laboratory instruction, students also receive supervised clinical experience. Upon graduation from the master's program candidates must pass a state administered national exam. Graduation from an accredited program is required for eligibility to sit for the licensure examination for physical therapists and for physical therapist assistants in those states in which licensure is required. Some physical therapists seek advanced certification in a clinical specialty such as orthopedic, neurological, cardiopulmonary, pediatric, geriatric or sports physical therapy. Others are certified in electrophysiological testing and measurement.
When selecting a physical therapy program there are many factors to consider in order to find one that is right for you. Look at the geographic location and size of the school, cost, class size, licensure pass rates, employability, faculty composition and number of years on the staff, design and length of curriculum. Talk to current students and recent graduates of the program. Interview employers who hire graduates from a particular program and ask about the programs strengths and weaknesses.
As an undergraduate considering a career in physical therapy, there are some preparations you can do now to prepare for admission into an accredited program. It's important to have a solid background in anatomy, biology, chemistry, social science, mathematics and physics.
Before granting admission, many professional education programs also require that candidates also have experience as a volunteer in a physical therapy department of a hospital or clinic. Candidates should have GPAs of 3.0 or higher on a 4.0 scale. Admission officers look favorably on an applicant's volunteer experience as a physical therapy aide, letters of recommendation from physical therapists or science teachers, and excellent writing and interpersonal skills. Physical therapists need to be compassionate, patient, tactful and resourceful; have good manual dexterity, be a skilled problem-solver; be knowledgeable of current research; maintain continuing education; have good physical stamina; and be emotionally stable in order to help patients and their families understand the treatments and adjust to any changes in their mobility.
Be aware if you are deciding between becoming a physical therapist or a physical therapy assistant: the physical therapy assistant program is not a stepping-stone to a physical therapy program. The curriculum differs and does not provide the needed prerequisites required for physical therapy education.
Enhancing Cultural Diversity in Physical Therapy
The American Physical Therapy Association conducted a survey of its members, and the results showed that for physical therapists the median salary was $52,000 depending on position, years of experience, degree of education, geographic location and practice setting. The majority of physical therapists are female (67.2%) and Caucasian (90.8%).
Only 4.2% are Asian, 1.9% are Hispanic, 1.5% are African American and 0.5% are American Indian. The type of facility in which members practice shows 32.3% in private out-patient office or group practice, 17.4% in health system or hospital based outpatient facility or clinic, 16.3% with an acute care hospital and 8.0% working in patient's home/home care settings.
““It is very gratifying to help someone and see his or her progress and to know that you are part of that. Also, it is a very versatile field, in that you could go into private practice, hospitals, outpatient and in various specialty areas. It is not about the money—it's decent wages, but not what everyone expects.”
Physical therapist assistants earn a median income of $30,000 and have an unemployment rate of only 3.9%, down from 4.2% in 2001. PTAs are also predominately female (81.2%) and Caucasian (90.7%), according to the APTA survey. Most physical therapy aides earn $16,460 - $23,390. The highest 10% earn more than $28,800.
 As the U. S. population becomes more diverse, it is important for physical therapists to meet the needs of all racial and ethnic groups. Cultural diversity within the profession of physical therapy is highly valued because physical therapists, physical therapy assistants and aides interact with patients and families who are of various ages, races, religions and ethnic backgrounds. When physical therapists and their clients share a common language and a similar background, the effectiveness of treatment is greatly enhanced.
Ruben Abeyta, SPT, University of Southern California says, “Given the diversity of the population, it is important for minorities to enter into the health profession in general. I am Hispanic and am able to communicate Spanish-speaking patients and I understand their culture. It is important for minorities to be represented in the health care system so that patients can have a variety of professionals to choose from.”
The American Physical Therapy Association is committed to enhancing cultural diversity and awareness of cultural differences in the profession of physical therapy. The association's activities include the Minority Scholarship Award for Academic Excellence—a scholarship for candidates enrolled in the final academic year of an accredited physical therapist program. The APTA also provides workshops for physical therapy education faculty on the importance of, and methods to, recruit and graduate a culturally diverse student body and to recruit and retain a culturally diverse faculty. Other APTA initiatives to raise cultural awareness provide mentoring services and campaigns to raise consumer awareness of physical therapy services among minority audiences through a national advertising campaign.
The slogan adopted by the APTA in 2001 states what physical therapy is all about: “The Science of Healing. The Art of Caring.”
Physical Therapy and the Camaraderie of Healing
By CAITLIN KELLY
Published: February 16, 2009
I first had physical therapy at 27, after I slipped on an icy Montreal sidewalk and tore the ligaments in my left ankle. I had it again at 42 and 43, after surgery on my right and left knees, and most recently I’ve had it on both shoulders.
My orthopedist likes to say surgery is half the battle. If so, it’s the easy half.
The slow and repetitive work of physical therapy often starts the next day, and for an injury like a tear in an anterior cruciate ligament, it can take up to six months. Before you’ve done it, it’s hard to imagine anything is going to take so long and hurt so much.
Part of the challenge is the nature of arthroscopic surgery, whose multiple incisions are often so tiny they barely leave a trace. I’ve had torn meniscus (cartilage) removed from both my knees, and I have to look really hard to find my scars. Removal of bone spurs from my shoulder through four incisions left my skin almost smooth. Surely this is a good thing.
But those minuscule entry points make it difficult to comprehend what has been done in there. After only 45 minutes under general anesthetic and with no huge incision or bloody wound, why am I in so much pain? And why do I have to keep doing these silly exercises?
Surgeons have little time, and sometimes less appetite, to discuss the minutiae of a procedure’s aftereffects. Often it’s the physical therapists who patiently explain what the physician did and why we now have to relinquish huge chunks of our time to rehabilitation.
 Physical therapy, or P.T., demands the month-after-month tedium of spending hours in a room filled with strangers stretching colored rubber bands or spinning their arms in circles.
The rituals are oddly and intimately public. Patients of every age, race and income level share a large, sunny room. We do our leg-raises side by side on wide beds. We wait in line for the pulley, the elliptical and the arm bike. We learn a new language and its tools: the strap, the stick, shrugs and pinches.
Everyone ends up in P.T. — lithe teenage athletes, construction workers and police officers with job-related strains, C.E.O.’s with skiing injuries, older people with replaced knees and hips.
I’ve commiserated there with an Episcopal minister, an Ivy League economics professor and a firefighter.
 The rituals become routine, starting with a heating pad and nerve stimulation, ending with the soothing benediction of a black rubber ice pack. We learn to bend our lives around the inexorable, unfashionable truth — healing takes work and it takes time.
Camaraderie grows as patients compare notes on the frustration of needing help for tasks as simple as pulling up your trousers or opening a can of soup. Women commiserate with the new knowledge that a bra strap can pinch a healing shoulder like steel cable. Struggling to complete even the simplest of tasks in a room full of fellow adults is humbling. When I see someone’s jaw clench with effort, I remember that lifting a one-pound weight can be tough.
I never expected to forge a multiyear relationship with my physical therapists, but I have. I like Helen and Matt and Stephanie and Richard. Really. I just hope I never see them again.
I don’t envy them their job, stretching and shaking and manipulating our joints to loosen them and keep them flexible. It has left me gasping in pain, sometimes even tears. I can’t imagine having to intentionally inflict pain, but that, one quickly learns, is an inevitable part of healing.
It must be difficult for our physical therapists to cheer us on for what are, in other circumstances, a toddler’s proud achievements — when we have regained the ability to tie our shoelaces or walk steadily across a room or throw a ball.
There is an upside. Because we see them so frequently for months, we get to know our physical therapists, and they us, in ways we’ll never know our doctors. We learn where they live and go on vacation, who has a new puppy, whose husband changed careers.
It’s not an intimacy we would choose. But, shoved out of our private, busy lives, whether reluctantly or gratefully, we fall into their strong, skilled, waiting hands.
Caitlin Kelly is the author of “Blown Away: American Women and Guns.”
Using Clinical Outcomes to Identify Expert Physical Therapists
Linda Resnik and Dennis L Hart
L Resnik, PT, PhD, OCS, is Postdoctoral Fellow, Center for Gerontology and Health Care Research, Brown University, 2 Stimson Ave, Providence, RI 02912 (USA) (email@example.com).
DL Hart, PT, PhD, is Director of Consulting and Research, Focus On Therapeutic Outcomes Inc, White Stone, Va. He is also an investor in the company
Address all correspondence to Dr Resnik
Background and Purpose. Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes.  The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life
(HRQL) following rehabilitation. Methods. Retrospective data were analyze
d on 24,276 patients (mean age=47.8 years, SD=16, range=14–97) with lumbar spine syndromes treated by 930 physical therapists participating in the Focus On Therapeutic Outcomes database in 1999–2000. Physical therapists and staff answered questions concerning years of experience and practice setting when starting their participation in the outcomes system. Patient self-report HRQL data were collected at intake and discharge from outpatient rehabilitation. Discharge HRQL data were risk adjusted using patient characteristics. Data were aggregated by physical therapist. Risk-adjusted discharge HRQL scores were used to classify physical therapists whose patients reported mean HRQL improvement above the 90th percentile as experts and physical therapists whose patients reported mean HRQL improvement between the 45th and 55th percentiles as average. Results. Therapists classified as expert had fewer patients in the database than did therapists classified as average (X̄±SD) (19±17 versus 29±22). Mean treatment duration was different between groups (32±11 days for the expert group versus 31±8 days for the average group). Discussion and Conclusion. The results challenge assumptions that extensive clinical experience is necessary to achieve superior patient outcomes, and they provide information about the relationship between therapist characteristics and patient outcomes.