On this episode of the #AskMikeReinold show we talk about transitioning back to outpatient orthopedic physical therapy or sports medicine from the inpatient or neurologic settings. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 201: How to Transition to Outpatient Orthopedic Physical Therapy
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Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about some advice on making a transition from inpatient or neuro or anything outside of our realm, and back into orthopedics or sports medicine.
Mike Reinold: Tommy says:, “I’m a new-ish grad PT looking for advice on shifting my area of practice. I’m an undergrad athletic trainer, but my last three years I’ve been working in inpatient and outpatient neuro.”
Mike Reinold: So he’s working in neuro, in the neuro aspect of our physical therapy field. “But, I’m looking to transition back to sports medicine and performance. What advice would you have for this transition? Question number one, and do you think this is an instance where a year long residency would be beneficial for more intense mentorship?” People are still asking that question. That’s funny. So interesting. So neuro, which is pretty good, right? And Lisa, you’ve got some experience with some of this stuff, Dan too, right? Didn’t you work a little like inpatient at one point or something?
Dan Pope: No, clinical affiliations, but I did see some neuro my last outpatient clinic, so a little bit, but not much.
Lenny Macrina: Maybe. Maybe that was me. I had my first job was acute care. I did that for eight months.
Mike Reinold: Nice. All right, good. So you’ve got some experience that went through this. So that’s good. So, let’s talk about the transition first before we talk about some advice on what to do because I think that might answer the mentorship question. But I don’t know, Len, how long did you do acute care for?
Lenny Macrina: Let’s see. Probably January through October at my first job, but I did eventually get an outpatient job and I worked both jobs at the same time.
Mike Reinold: Oh wow. Wow.
Lenny Macrina: In North Carolina.
Mike Reinold: And what did I got to ask? Because I just know that you didn’t have any personal interest in that. You were just waiting for an opening in that clinic?
Lenny Macrina: I was waiting for an opening, couldn’t get a job. This was in 2003, and ended up working basically full time PRN in acute care at Durham Regional Hospital down in Durham, North Carolina. And then got a job at Raleigh Orthopedics but then worked both the weekends at Durham Regional and then my full time during the week at Raleigh Orthopedics outpatient.
Mike Reinold: Super interesting.
Lenny Macrina: Yeah. It was interesting. It was a good combination of acute care to see, I did basically musculoskeletal acute care, so it was like hip replacements, knee replacements and some strokes. But then I would freak out and just go back to the total joint floor and just… But it was good to see the total joint floor people come out of surgery and had like back fusions and discectomies and see where they progress to after that when I was in outpatient. So it was a very good experience.
Mike Reinold: Nice. So when you made the transition back to outpatient, obviously I know you had a lot of interest in that, so I’m sure you’re still paying attention to it and stuff, but what’d you do to get back into it? Especially as a new grad, I think you’re pretty close to a similar situation here. What’d you do to feel confident?
Lenny Macrina: I worked in a facility that had a ton of experienced PTs. So Raleigh Orthopedics in North Carolina had six or ten PTs for the doctors right above us. So I was freaking out as a new grad, right? I mean I had no idea, even though I did an internship with you, I was down in Birmingham at Health South for my last internship and you think you’d come out all powerful and then you get your first low back pain patient, or your first post op ACL and you’re like, “What do I do?” So I had a ton of PTs that I could learn from, and get their advice and talk to them and obviously use my knowledge that I acquired. But when you’re on your own it’s completely different world. You’re trying to read and try to read protocols and trying to just not hurt the person and just to make sure that they do well and you don’t like result in a stiff knee.
Lenny Macrina: I remember a stiff shoulder that I had, she had a rotator cuff repair ironically, and she ended up getting a stiff shoulder and I thought I was like the worst PT when I was down there because I could not get the shoulder to loosen up. But it was having the experienced PTs, it was having the ability to read and get journals. And back then 2003, this is going to date me, but I don’t think there was a lot of online learning. So it’s not like I could just take a course online. So you just take the course. I went to Kevin’s course, he came to North Carolina, I took his course and that’s how actually I got my job. But it was just trying to get con-ed stuff, any way I could.
Lenny Macrina: And then the company that I worked for sent me to con-ed course for low back type stuff. So it was just trying to learn and just trying to pick those brains of those PTs. They were very helpful. I’m still friends with them. So very helpful.
Mike Reinold: I like that. So two big things I got from that stuff, Len. One was if you’re going to make the transition and it’s something you haven’t done in a while, it’s probably best to try to find a place where you can jump in and be surrounded by some other people with a variety of experiences, so you can have some built in mentorships. I think that’s important.
Lenny Macrina: Yeah, very valuable.
Mike Reinold: And then two is, you got to have some self discipline to learn. So, just start going to a bunch of journal articles and now there is no reason not to learn. You know what I mean? You can say, “All right, there’s this is great course coming to my town in three months.” But that doesn’t mean you just sit around for three months. You can sign up for a couple of online courses in that time. So sweet. How about you Lisa? I know Lisa, you’ve had some experiences as well. It wasn’t neuro though, right? What was your non-
Lisa Russell: I was on… So I worked per diem anyway. I was at the Spaulding Rehab Hospital in Charlestown and I hopped between the neuro floor, or the stroke floor, the spinal cord injury floor, the just general orthopedic floor. I did a little bit of everything inpatient rehab wise. And that was… I worked weekends for the first gosh, five years. So fairly regularly was in that setting.
Mike Reinold: I know when we started talking about you joining us at Champion, one of the big things was like, “Oh man, I feel rusty.” Right?
Lisa Russell: Oh, yeah.
Mike Reinold: So, what’d you do to not feel rusty? Because by the way, I like how that was… I phrased that. Did I just compliment myself? I think I did. But it’s feeling rusty. It doesn’t mean you are rusty. It’s this internal self doubt that you may have that you may be rusty, but what’d you do?
Lisa Russell: Well, so even before coming to Champion, I had another outpatient ortho job and then I just hadn’t been in that setting for a while, even before I came here. And when I shifted over to that job, the original ortho, I did a lot of the online learning. I would watch a lot of MedBridge courses during my lunch breaks. I watched a lot of Lenny. And in the evenings I read a ton depending on who the patients were. I did what Lenny was talking about. And then in getting ready to come on board at Champion, I feel like I’ve constantly been trying to just keep up with stuff and learn more as I’ve been ramping things up.
Lisa Russell: Honestly, this is the first job I’ve had where I’ve actually had good peers and mentors to learn from. Otherwise, I’ve been on my own. The ortho job I had before, we were in private treatment rooms, we didn’t have collaboration time. I was pretty much isolated and not a good setting for anybody to work in.
Mike Reinold: Not preferred.
Lisa Russell: So, I essentially was first true post clinical ortho, totally by myself. So I depended on the online stuff and all of that. But then, the amount I’ve learned and how much more comfortable I feel with certain things and just like the resources I feel like I have, and having good mentors around me is a huge difference. I don’t think it really matters what background I had prior. All of us have that ortho stuff somewhere in our brain. You had to learn it in school, you had a clinical of it in school or whatever and it’s not not there anymore. It’s just a matter of what you’re using all the time. I’ve had lots of things, even patients I had on clinicals and whenever it popped back up into my head of like, “Oh yeah, with this person who was like that, I did this, and this worked.” And it’s there, you just don’t think about it until you have to use it.
Mike Reinold: Yeah, especially too, remember this particular situation we have an undergrad athletic trainer too. So you’ve got a bunch of experience.
Lisa Russell: A lot of foundation.
Mike Reinold: You got a bunch of experience here. I really, really think that we’ve all been in your shoes. We’ve all had some self doubt on if we’re prepared and feeling ready for this next venture here. I personally don’t think you need a year long mentorship to be able to work in transition to the outpatient setting. I think that’s a little excessive. Would you learn a lot? Yeah, absolutely. Would it be beneficial? Yeah, absolutely. Do you need it? No. I would say not at all. I don’t think you need it at all. Everybody’s got a little self-doubt going into a new setting like that.
Mike Reinold: I think if you’re a dedicated worker, and you can actually put some time in. So Lisa’s reading at night, she’s going through things, which is really good. What I liked what Lisa said, which was pretty neat too, “It’s not just like preparing for that transition, but once you get in there, you’re going to find out, ‘Oh, in this setting I’m seeing a ton of shoulders and elbows’ Or, ‘I’m seeing a ton of knees and ankles.'” Right? And then focus your learning on that. And start there. And then you can grow from there based on the setting that you’re in. So, that’s the first thing I always say is when somebody is trying to like go into a new setting and you’re trying to do that, is get in there, make sure you’re surrounding yourself with good mentors and peers and stuff. That was I think a big message we heard from multiple people.
Mike Reinold: But then the first thing you do is you assess your situation. “Okay, what am I seeing a lot of here?” Because you maybe you’re affiliated with some surgeons in the building next door and they do a ton of knee surgeries, right? So you’re seeing a ton of post-op knees. Figure out what you’re going to see a lot of, and then seek that knowledge out. Then when you get comfortable with that stuff, now you can almost take an audit of yourself and say like, “All right, what do I not feel good at? Is it my evaluation skills, my manual therapy skills, my treatment design, my programs system? What do I not feel good at? And then seek out those little pieces, or joints, or sports like, “Oh, I don’t feel comfortable with the knee. I don’t feel comfortable with baseball players.”
Mike Reinold: Whatever it may be, seek that out. But that’s next level stuff. So, I think that’s the best way to answer it in my mind is you got to work. This isn’t just going to come naturally to you, but it’s probably in your head. Right? What do you got, Len?
Lenny Macrina: What about his question about the residency thing? Should he do a residency?
Mike Reinold: I said I didn’t think he needed it, but anybody think he does need it?
Lenny Macrina: Yeah, everybody’s situation is different, but to take a 50% pay cut, I don’t know what your student loans are and all that, but you’ve probably got to make a little money during your residency. Yeah, it could be valuable information, but do you want to take that pay cut and have to move across the country and all that stuff? So I don’t know. I think working with experienced PT or PTs and the facility is your residency.
Mike Reinold: Yeah. What do you got, Mike?
Lenny Macrina: Could be your residency.
Mike Scaduto: Yeah. I don’t want to turn it into like a doomsday podcast or anything like that, but it’d be very interesting to see what the physical therapy job market is like in six months to a year from now and how residency programs are doing. And I don’t necessarily know if we can guide people based on what’s going on in the world right now, because there’s a lot of unknowns, but it’ll definitely be interesting to see. And I think things will change within physical therapy with more services going towards tele-health and you know, maybe we haven’t really put an emphasis on that in the past, but I think the market’s going to change.
Mike Scaduto: There may be some companies that go out of business and there may be a shortage of jobs. There may be a shortage of clinics. So, I think there’s a lot unknown. I think if I was trying to prepare for the next year, I’d probably want to go with, try to take the simple route and try to eliminate complexity from my plan and maybe taking a residency at this point is a little bit risky. I might want to find a job that I have good mentorship at a good company that is doing well, that can offer some guidance to me. I think that may be a more secure route at this time.
Mike Reinold: Yeah, that’s great advice, Mike too. And I really like that too because I guarantee you this quite well. I know the question came in through our form before the COVID situation that we’re in. So how about you Dan? What do you think?
Dan Pope: Well, I think the one thing that it was already partly talked about, but it’s free. And it’s pretty easy in your spare time to just go to the clinic you want to work at, or a very similar one and just see what they’re doing there. When I first started and I didn’t have a long stent at a neuro facility and then try to go over to orthopedics, but I didn’t necessarily know if I was completely ready to be working in a sports oriented facility. And I actually spent a bunch of time at multiple different facilities, but the one I ultimately wanted to be at, just learning to see how other people treat. How do you handle these basic orthopedic problems? How do you handle these basic sports injuries that come through the door, see how they’re doing it, start to get the juices flowing like, “Okay, okay, this person has this problem. All right, I kind of remember that. How would I treat that? What’s my plan look like? Okay, what do I develop? Okay, what’d you end up doing? Okay, what do you think?”
Dan Pope: And you can talk to the PT afterwards and generally, you can just bring some coffee to the clinic and they bring us donuts and there’d be super pumped to have you for the day. So that would be my very first step if I was making that transition.
Mike Reinold: I like that.
Lenny Macrina: He works in inpatient, so maybe try to go into the outpatient aspect of that hospital and shadow some of the PTs after work or weekends or something like that and try to get some experience.
Mike Reinold: Right. Nice. Awesome. So Tom, some good advice. I think it’s going to come down to you, Tom. It’s going to have to come down to you put in the work in right here, but going to do an intense residency type thing, obviously, there’s some concerns may be in this market, or with it right now, but that seems like fear of the unknown. I don’t think you necessarily need that. So, hopefully, that helped. If you have a question like this and we can help in any way, just head to mikereinold.com and click on that podcast link, and we’ll hope to answer it on a future episode. Thank you. See you in the future.