7 Things to Ponder Before Going to Physical Therapy School: for yoga teachers, massage therapists and other holistic practitioners

Easily monthly, sometimes more frequently, I field an inquiry from a yoga teacher or other holistic practitioner asking to pick my brain about becoming a physical therapist. I thought I’d share some some big picture thoughts here as a summary to best serve you.

Know that I love my physical therapy job (20-25 hours a week that I set), but I’ve worked in 10 different clinical settings now (including hard-working clinical experiences as a student) and there are some realities not-obvious to the casual reader of Newsweek articles on job satisfaction.

Goal Clarity

1) The most important thing is to be ULTRA-CLEAR when making this kind of major life decision: What is your goal? i.e. what do you want to feel that you don’t currently feel? That feeling may be intellectual fulfillment, financial security (first chakra aligned), it may be social status/ego/self-esteem boost (all physical therapy programs in the US, for better or worse, are now doctoral programs), wanting to heal people (still do ask yourself why) or maybe you just want a job that isn’t in a cubicle.

Be exceedingly honest with yourself about your goals. All of them. Then compare them to reality.

Homework

2) Second, have you done your homework? Really done it. Do you know which pre-requisites you would need to complete or re-take? Which schools you may hope to attend (and are you willing to move or commute)? Have you looked at the mandatory course listings and professor publications? Perhaps sat through a lecture or toured the (in my case, frozen windowless basement. I wore a down coat to lecture during the summer.) department where you will spend many waking hours of 2.5 years of your life?

Are you ready to dissect a human being for 7 weeks? (Yes’m, it’s true).

Have you started shadowing physical therapists in multiple settings (nursing home, hospital, outpatient clinic) or seeking a part time physical therapy aide/ tech job? (This is hands down THE. BEST. WAY to know what you are getting into. I volunteered then worked on the stroke and traumatic brain injury unit at National Rehabilitation Hospital (NRH) and at least 3 other clinics for 9 months before starting school. Plus, it’s an application requirement for all schools as far as I know, frequently 100-200 hours minimum).

How does your undergrad GPA stack up against the pool of applicants and are you studying for the GRE? (I promise I’m being realistic, not snobby: The year I was accepted into my doctoral program, the department had over 350 applicants for 54 acceptance slots. The following year they fielded 550 applicants.) 

Are you willing to give up what you do now? Physical therapy school is a full time endeavor. Yes, as a student I continued to teach yoga 1-2 classes / week and work one weekend a month at NRH, and yes, I know some hyper-organized students who worked up to 20 hours a week (every one of us was overwhelmed). Most students smartly waited until at least the second year to work part-time. Are you ready to dive into your adrenal reserves to make it through?

Are you prepared to go deep in a field of study that is pretty darn conventional in lots of ways, and may not honor your more holistic knowledge and background? 

Cash Money Calculations

3) The second part of your homework: Financial considerations: opportunity cost (3 years full time + pre-requisites), actual salary upgrade (if any. In 2011, some of my peers fresh out of PT school were offered starting salaries of $56K). Feel free to calculate actual job benefits, but please don’t include the automatic 30% add-on included by human resource departments.  Have you looked at how you will pay for your pre-requisites classes, which activities (including income-generating activities) you will be forced to set aside in the meanwhile, and what your estimated loan repayments will be on a 10 year repayment plan?  I happen to know plenty of PTs who pay >$1200 month on their educational loans.

You’d do all of this research before buying a house. Trust me, this is the same as a mortgage, and may be your only “mortgage” for a while!

What Your Day Looks Like

4) Giving a hard look at the numbers, do you see yourself working full-time? In what setting? Doing what? Unlike a medical doctor who may be on call, physical therapists sort-of have the luxury of “turning off” when they leave work. However, I don’t personally know any full time PTs who work less than 9 or 10 hours a day 5 days a week. Many of my peers complete their patient documentation at home on evenings and weekends. A responsible PT keeps learning, and spends 2-4 full on 3 day weekends a year in continuing ed, and reads up on fresh journal articles at least monthly.

In the outpatient segment of the physical therapy world, when not treating patients (usually 7+ hours/day), you are writing notes. If you see only 12 patients a day and each note takes 5 minutes, that’s an hour for quite efficient documentation. Add in pee breaks (which all PTs will tell you are hard to squeeze in. I was reprimanded for taking a bathroom break once as an unpaid student on clinical), phone calls to patients / doctors, administrative tasks (occasionally checking work email), annual mandatory trainings and tests, conversations with peers about how to best treat your patients or pass off care, and other basics of reality…you quickly see that you’ll have to cancel all lunch dates in perpetuity and leave all those personal emails hanging until at least 7pm when you are home and settled. Checking social media? pshaw!  

Also, you may not get the vacation dates you want (and need!) since your peers were hired before you or someone else got first dibs 4 months in advance. 

Do you know about specialty residencies and fellowships? These are (pretty awesome) specialty trainings that pay very little or actually cost you more educational money and typically tack on 1-2 years to your education. By 2020, they will likely be mandatory for PTs. School itself only prepares you to be a generalist, and probably not the best one at that.

You are the Health Care System

5) Are you familiar with the sometimes-evil monstrosity that is the US Health Care System? How do you feel about being inside of this system? Sure, you could pop out of the school-womb and work for a clinic that accepts only private pay. There doesn’t happen to be a huge amount of job security in that segment, and you are frequently very limited in terms of peer stimulation. Want to start your own business? Do you have an accounting background, MBA or law degree? You might need one to comprehend insurance payments.

Job Searching Myth and Reality

6) Have you asked the hard questions about job searching? We have all heard that it is easy-peasy to get a job as a physical therapist. I agree: it is easy to get a job in rural communities, in acute care, in nursing homes, and part time gigs where you are paid per patient, not even per hour. The awesome-sauce full-time or salaried positions often require at least 3-5 years of experience, and prefer if you can demo some coveted niche skill or certification and self-market in off hours.

As far as I can tell, and it is highly unfortunate, yoga alone doesn’t YET count for much in the PT world. 

Tackling OPP – Other Peoples’ Pain

7) Have you spent 7-8 hours a day with people in pain before? Are you ready to treat whomever is in front of you, regardless of how they treat you?

Side note: in the last week, a patient screamed at me (because I reminded her of our attendance policy…I adored her but she missed more appointments than she attended*), was restrained by her own son in the same tiny treatment room that I was in, my boss opened up the door to check on me and my colleagues told me later that — hearing the screams — they feared for my life.

A day later, a patient who hasn’t addressed the stress in her life or sought care for her chronic neck pain (10 years+) tells me “You don’t care about me” after I spent an hour lovingly, tenderly, massaging the muscles of her neck (she barely removed the scarf, and still wore a turtleneck) and discussing parasympathetic nervous system activation in laymans’ terms.

Let’s be real: she is the one who has not shown care for herself; I do care very much about making her better. I just can’t do it all alone in two 30 minute slots a week.

I have many such stories. Fun times. And a very real hazard of the job. 

 

*see above…since I am part of Big Health Care, I have to track my productivity. No show patients knock down my “productivity” substantially so I frequently must cancel patients who show up irregularly, even if for good reason.

~~

If you’ve made it this far, congrats! Being a physical therapist is a true labor of love. For every frustration of working in physical therapy there are at least two joyous positives, not the least of which is watching people return to happy healthy bodies.

I still love my multiple jobs. I balance some of the challenges I mention above by working part time, working in two settings (public and private), keeping my yoga teaching as a major part of what I do, and having kick-ass peers and supervisors whom I love working alongside.

(All this could change, even in the near future as my personal goals evolve. My decent individual health coverage got cancelled because of the American Care Act and it’s been a wild ride applying on the dysfunctional DCHealthLink.org for new coverage that is costing me 30% more to have a $6000 deductible. Yep. I might full-time job search at some point in the future.)

So what to do if you are (still) thinking of becoming a Physical Therapist?

Edit 5/2016 – I am only accepting current students in DPT programs to shadow me in my physical therapy practice.

I invite you to shadow real-life physical therapists. Find diverse settings that treat every walk of life. 

But do remember it took me 2 years of working full time AND teaching yoga and having major bags under my eyes to save enough and build up my yoga student community enough to go part time with PT. I presume that’s at least 5 years from where you stand now. Definitely seek out full time PTs to shadow in a variety of settings (school will force you to try all settings anyway) who seem to have fulfilled your specific goals. Especially if one of your goals is to continue teaching yoga or other vocation / avocation on the side on a meaningful scale. 

There is always more to say, more details about how to leverage your years in school to prepare you for a satisfying career afterward, but I hope this helps as a start. If you have done the above tasks and want to bounce ideas off me and or for my advice specific to your passions and situation, feel free to set up a formal consult (I regret I am not able to give free consultations) by shooting an email to ariele@sacredsourceyoga.com. I’ll give you all the juicy details about how I sustain balance in my many endeavors. 

wishing you all the best with your big life decisions,

xo to the max, a

ADDENDUM 2/2017: P.S. Think being a physical therapist is just a slightly fancier yoga teacher? One person did think that and emailed me to tell me so ;). (So if you become a PT you will also field these slightly insulting comments!). Here’s a tiny fraction of why that ain’t the case (and the email transcript below):

and what I responded in the email:

“I came across your blog post on physical therapy/yoga today and loved reading it! Thanks so much for sharing your journey with the world! I’m a yoga teacher, and am currently transitioning out of my current field (engineering) to go into healthcare. I’m looking in PT, but the only problem is that I’m not finding much more value in PT than I do in yoga. Other than using ultrasound, braces, and cortizone cream, I’m finding that I already do the job of a PT in yoga. 
I wanted to know, if you don’t mind answering, how you felt going into PT as a yoga teacher? Do you find your work more valuable as a PT than as a yoga teacher? I don’t want to bash the profession in any way, and I so admire how much PTs know, but down to it’s very core, I can’t see how PT is much different than yoga. The basis of both is to restore functional movement to the human body, and I feel like the exercises we perform in yoga include, and exceed those that are performed in PT. Am I being naive? Maybe I don’t have enough shadowing experience yet… Anyway, thanks so much for sharing your story! 
Cheers,
[name redacted] “
MY RESPONSE:
“I guarantee you don’t do the job of a PT. And BTW I never use ultrasound, braces or cortisone cream.
Think through all of the steps involved in becoming a PT, think through the licensing and regulation and accreditation of programs. Go shadow PTs in acute care settings: PTs who work with patients with ALS who are dying, with MS who are young mothers, Or who rehab patients after bad motorcycle accidents or help 90 year olds to live independently until their death. Consider what it means to have a doctorate and pass a national exam.
Your line of thinking is quite dangerous and arrogant within the yoga community.”

^ Without taking a lick of offense (because…not worth it), I really do think this line of thinking is dangerous and arrogant. If you haven’t watched the video above, you’ll understand more about that when you do. Thanks so much for reading! 

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  • Camille Harris

    Great article, Ariele. That about says it all! So glad you still love your PT work, despite all the challenges! Your skills are helping so many people!

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  • Charles Hurst

    PT 15 years. I browse around to see if anyone else has any sense.

    Don’t go to PT school. That’s my advice now to a 19 year old shadowing me. Don’t do it and don’t think about it.

    Then the rah rah team tells me I shouldn’t discourage. Really?

    The debt is insurmountable. 100-200K for a start of 60-70K. The nonsensical “but I really want to be a PT” is utterly devoid of any forethought. I really want to be a full time writer. You don’t see me winging it in LA. It is not only not strategically smart but naive to think 150K in debt will bring you happiness if you love the job. That’s 250K with interest.

    And that brings point 2: The job. I’m a traveler because that is the only way I can keep control of new mergers destroying clinics. Most therapists, who are largely charlatans, and have been for many years see two at a time in OP and multiple patients in skilled. They let techs do treatments in inpatient and outpatient. That is most of the field. 80% at least. I get that figure because I turn down 4/5 contract offers. And it’s based on working across the country for 15 years. Trust me it is accurate. The fact I say it out loud that this profession is unethical bothers most PTs—-and is irrelevant—because it is a fact. So that’s how most of you will work—due to lack of guts and ethics.Most will be living in a career they hate. And even the few of us doing it right (possibly this blogger it seems)–it is still a bureaucratic mess. It is unwinnable now. We used to say the system will break—it is now broken. Treatment is no longer our best—many times it is the best we can do.

    In 1995 in my volunteer hours I would tell the 19 year old to go ahead and go to PT school. Not now and most likely not ever again. So heed my advice or golly gee go because you really want to be a PT.

    And you’ll be living in a large house of regret.

    FYI–yoga alone would solve most problems as most chronic pain is lifestyle—-we really have become quite ridiculous thinking we can solve the chronic pain of the person who is 100 pounds overweight. And in modern PT that person is half of your list–good luck with that

    • @charles_hurst:disqus i really appreciate your insights here. You bring up some good points: the semi-ridiculousness of a doctoral degree in a field with ever-lessening reimbursements, clinics run unethically / with a view only for profit, practitioners who are juggling patients to keep up with demands and perhaps ignoring evidence and not individualizing treatment (IMHO largely because of pressure of the medical model, not because people who become physical therapists want to be “charlatans”). It’s disheartening. You could say the same about many industries (yoga studios and yoga teachers have similar challenges). However, the difference with physical therapy is the deep resources that you must allocate in time and money to become a physical therapist, so the disappointment you may feel at the end of that road is deeper. There are paths out of that despair, but you have to seek out the best environments (which as you point out are few and far between)… Mine is still evolving, but I gave up a benefitted full time PT position after less than 2 years post-graduation because I could not be a genuine practitioner (and human being!) in that unhealthy poorly-run environment. I took a huge risk with the vast majority of my student debt still hovering, and accepted a PRN (hourly, promised only 10 hours / week) position at a highly respectable and fairly well-run clinic that pretty much only sees patients one-on-one. It’s still within the medical model (a teaching hospital), and I was only able to do it because my rent was reasonable, and I had a little extra income from yoga teaching, but it was the ONLY way for me to avoid burn-out. I’ve now opened my own tiny practice and continue as a PRN clinician at the teaching hospital. My private clinic is bare-bones, no fancy machines, just honest good one on one treatment for an hour at a time. my patients are happy and I am happy (and although they pay me upfront what I request, after getting reimbursed from their insurance companies, many are paying less than their co-pay would be at clinics that accept insurance). I am carving my own path. It’s nothing like the Newsweek “Top Job Satisfaction Report” surveys would indicate about physical therapy jobs, it’s more like I’m an entrepreneur, which is another skill entirely. and pre-DPT students need to be aware that they might have to carve their own path as well.

      • Charles Hurst

        Yep–and it’s sad as I know a few yogis (one who saved me from chronic insomnia as I now do yoga with my regular regime) who dropped traditional PT for exactly what you describe.

        I was lucky–pure and simple.I got out of the military after one tour in ’95 and took the pre med for two years then PT school for 2 years If it had been a doctorate back then I can promise I wouldn’t have taken even Chem I but would have become a cop. And I would have done well with that too. But I only got 38 K in debt and it was gone easily in five years. I stay a travel contractor now solely so I can keep control. Even if I find a decent clinic it could change on a dime with new management or CEOs or takeovers—so I don’t hire on ever anymore. And I’ll probably stay until there is nothing left at all in the field. I’m young so to speak but could get out in 4 years and vanish in south america if I wanted because I’ve been contracting for so long.

        Glad people like you are out there—if it ever falls apart with your studio you could travel and not pay rent—three years you could clear 100K off the debt –easily if you live smart. Generally I put away 35-40K a year traveling in remote areas like maine, alaska and wyoming.

        I’m surprised the PT field hasn’t gotten crushed by ACA—I wonder how much time we have before it does. Glad someone out there sees it–good luck Ariele.

        • Yay! Glad you found yoga helpful, @charles_hurst:disqus . I wanted to add that I had in-state tuition for grad school, and that was the smartest decision I ever made. I remember little tears forming in my eyes when I turned down Duke University (#3 PT school in the country and i fell in love with it on interview day), but that would have been a recipe for indentured servitude as I would have faced over 100 K in debt (while living in a very expensive city since I’m back in DC).

          Traveling PT is a great option for many (also you learn what is acceptable / not acceptable to you in clinical settings) — not so great for me as my sweetie would miss me and vice versa. Also it would be hard to hold down the yoga teaching, but I love Alaska and adventure would hop on it if my lifestyle and aspirations were different.

          It’s also true that the ownership of my current hospital clinic may shift in the future. I’d say generally to anyone in any job anywhere: don’t count on it forever.

          But I don’t overtly discourage people from PT school: i just advise 1) in-state tuition 2) no matter where you end up, see yourself as your own boss 3) be frugal financially otherwise that indentured servitude (even with relatively low debt) is crushing and 4) don’t do it for financial gain or financial security.

  • disqus_QYwGZYL7Ul

    very cool! I would love to connect with both of you. I’m currently in a DPT program – I did the unspeakable and left a great full time job, but yes I definitely wanted the ability to do patient care – in hindsight perhaps PA would have been more logical. However, I do believe in the field and feel as though I’m going to no doubt have my own practice one day. I see PT as a very adaptable degree, and one which allows for a tremendous amount of flexibility, while the training is a tremendous amount of learning and debt the degree I hope and feel will be versatile. I’ve been a yoga instructor for two years now and also know I’ll do that forever. I hope there is a light at the end of the tunnel 🙂 e-mail me if either of you are at all interested in mentoring a fellow yoga instructor + PT perhaps? rsalexan1@gmail.com

    • @disqus_QYwGZYL7Ul:disqus thanks for your comment. I agree it’s a fairly adaptable degree — so long as you work your butt off, have some business acumen, and are not crushed by debt ;). I’d love to keep in touch! feel free to sign up for my newsletter (link is above). best wishes, Ariele