Name: Sara Ochoa, MOMT, PT
education: Master’s in Orthopedic Manual Therapy, Physical Therapy
title: Clinic director
workplace: Physio Therapy Associates
location: Geneva and Aurora, Ill.
At my job “I’m an administrator as well as a clinician, so my typical week is 80% patient care, 20% administration. Since we’ve been nice and busy recently, I’ve been focusing primarily on patient care. In order to finish all of my administrative work, I have had to work during my lunch or come in on my own time. My clinical duties involve evaluating and assessing patients—dealing primarily with orthopedic concerns and then determining a treatment plan based on their needs. Part of that includes delegating to the patient and thoroughly explaining what their responsibility is in their rehabilitation. A lot of what we do as physical therapists is teaching—we teach our patients what they need to do to be successful in their recovery.
I was drawn to physical therapy (PT) as a profession because of the peer relationship I observed between the physical therapists and the physicians. There also seemed to be more of a one-on-one relationship between physical therapists and their patients. When I was a student I noticed that there seemed to be a lot of teamwork involvement in the physical therapy department. Everybody helped each other out, and I really liked that atmosphere. I was also attracted to the field because of the numerous areas of specialization. You can specialize in elder care, pediatrics and neonatal care; you can specialize in hands, sports, physical and neurodevelopment therapy. There’s always another challenge or opportunity, so the likelihood of getting bored in this profession is minimal.
There is little to no management or marketing course work or training in PT school, but it’s an area of my job that I’ve actually found to be very exciting. I’ve had to learn about management by observing my mentors and asking a lot of questions.
I also really enjoy mentoring my own staff. The success of the clinic is largely based on the strong supportive staff we have, which includes the office personnel as well as the staff physical therapists. One of the biggest challenges as a director is dealing with various personalities in the clinic and trying to get them all to meld and work together as a team. It’s inevitable that you’re going to have people with different work ethics and with different belief systems—it’s a challenge to get people working together in an orchestrated manner.
The only really negative aspect of my job is the paperwork, which is difficult because insurance companies change their requirements frequently. The challenge is to meet the patient’s needs within the confines of the insurance company. Frequently the insurance companies relegate how many visits we can schedule for the patients. It can be hard for the patients to understand—especially if they’ve never been in the “system” before. Sometimes we’re seen as the “bad guy” because we can only see them for a particular number of visits; to me that’s the hardest part.
Right now I’m working in the Geneva, Ill. office two days a week. On Mondays I’m scheduled for 12 hours, from 8:00 a.m. to 8:00 p.m., but I’m usually here 13 hours. On Wednesdays I’m scheduled from 8:00 a.m. to 4:00 p.m. and I work without a lunch. I go to the other office Tuesdays and Thursdays. I’m scheduled for 10 hours from 9:00 a.m. to 7:00 p.m., but I may stay later in order to accommodate patients who are running late. In addition, I’m currently covering Fridays because another therapist is on maternity leave. I’m there from about 9:00 a.m. until 3:00 p.m.
If I’m scheduled to start at 8:00 a.m., I’m usually the first one in the clinic. I open the office and make sure the rooms are clean and ready for patients.
The first patient today was a person with a cervical and mid-back problem. I did soft tissue work to the muscles that were restricted. That was preceded by the modality of ultrasound, which helps to improve the connective tissue elasticity. That allowed me to get in there and work the soft tissues more effectively. I then reviewed her home exercises that were geared toward improving her general mobility of the neck through the trunk area. I did some passive stretching to the pelvic girdle muscles and then did some gentle cervical manual traction. We reviewed any upgrades in her home exercise program, and then she went through some conditioning exercises.
The next patient came in and it was the same routine. This patient was only scheduled for a half an hour. She was having more pain today, which is pretty typical for Mondays because unfortunately people tend to overdo it on the weekend. I addressed the areas where she was having more discomfort and reviewed what she had been doing with her home program. I made some modifications so that she would not be hurting as much. I followed it up with a pain modality called intereferential stimulation. It helps decrease pain and guarding in the muscle area. I then did soft tissue work and some passive stretching to the upper quarter and neck muscles and to the shoulder girdle area. She was having some particular restrictions in the right arm so I did what’s called neurotension release and we reviewed some specific upgraded home exercises to help resolve that pain. She did not stay and do an independent program because she was having some discomfort— although it had subsided by the end of the treatment.
My next patient had a Cervical TMJ problem. We utilized our PT techs at that point so I could catch up on paperwork and note writing. The PT techs got her started on a modality called ultrasound combo. Then I went in for a half hour of soft tissue work and stretching. We also did some neuromuscular reeducation for the jaw muscles and some strengthening exercises.
My day continued with patients every half hour until my lunch hour at 2:00 p.m.. There were no new patients this morning.
I ran out to grab a sandwich and came back and finished my note writing for the morning while my patients were still fresh in my memory. I also spell checked and word checked the notes we had dictated on the evaluations we had seen last week. My lunchtime is rarely just lunchtime, it’s time to meet with my staff, answer any questions or concerns they have, catch up on paperwork, and get progress notes faxed and/or mailed to the referring physicians.
My first patient came in and she had an exacerbation of pain so I checked her reflexes and sensation in the legs to make sure there was no nerve compression or significant involvement that would warrant contacting the physician. Since she was in so much pain that I could hardly touch her, I chose a modality that would give her the most relief. One that has in the past helped her tremendously is something called iontophoresis, it’s a combination of a local anesthetic and a subdermal steroid and that helps to get rid of pain inflammation and facilitate healing in the area. So she was on that and we went way back to her initial exercises where she wasn’t having to move too much and reviewed what I wanted her to work on between today and tomorrow. When someone’s in a lot of pain you do what you can to get them at least moving a little bit because you don’t want them to stiffen up and become tighter. It’s what we call controlled exercise, controlled rest activities. So that’s what I reviewed today for her.
My next patient is probably going to be having surgery. She came in to get some relief of pain in the neck and upper shoulders as she’s waiting for her surgery date. What’s helped her the most in the past is moist heat ultrasound and some deep soft tissue work, so I did that as well as some passive range of motion techniques called mobilizations to the upper through lower neck area. That helps to maintain mobility in the joints and is very specific so as not to provoke any pain. I also reviewed what she could do at home to help resolve some of the arm symptoms she was having.
Right now I have a break in my normal day because some patients are out of town for the holiday week. My next patient isn’t until 6:00 p.m., so I’m utilizing this time to catch up on administrative work. Normally I would still be seeing patients.
During this time I’m also doing my invoice control log. All the bills from supplies that the staff has ordered need to be given a control log number so when we send this in to our corporate office they pay the bills for us.
This patient will be new to me; a different therapist evaluated him last week. Before I see him I’ll review his chart. Once he’s here I’ll introduce myself and ask him if he has any questions or concerns regarding exercises he was given last week. I’ll review the exercises he was given last week so I know he’s doing them the best way he can. Since this patient has had recent shoulder surgery, we’ll be following a specific protocol as dictated by his physician.
My last patient has a significant weakness in the scapula and neck area with some referred pain into the head and jaw. This is my second time seeing her so we’ll review what we did last week in regards to her home program and answer any questions or concerns she has. Then we’ll do some specific passive range of motion exercises for the jaw. I’ll do something called cranialsacral release and myofacial release to the upper quarter to help relax everything and that will help promote improved alignment of the bony structures and soft tissues. Following that I’m going to get her started today on some specific exercises to start strengthening the cervical scapula area called cervical scapula stabilization program.
I’ll be here till almost 9:00 p.m. During this time I catch up on my paperwork, type my progress notes for the physicians and finish everything I need for the next day.
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