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.
7:45 a.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.
8:00 a.m. 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.
9:00 a.m. 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.
9:30 a.m. 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.
10:30 a.m. My day continued with patients every half hour until my lunch hour at 2:00 p.m.. There were no new patients this morning.
2:00 p.m. 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.
3:00 p.m. 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.
3:45 p.m. 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.
5:00 p.m. 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.
6:00 p.m. 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.
7:00 p.m. 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.
8:00 p.m. 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.
“PT is a great career choice, not only because you have the opportunity to truly help people in times of need, but working with the people in PT is great too. I think you really have to enjoy working with people in this profession.”
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.”
The Society Pages
The American Physical Therapy Association
This is the national professional organization representing more than 63,000 members. Its goal is to foster advancements in physical therapy practice, research and education.
The Federation of State Boards of Physical Therapy
This organization provides standards for physical therapy practice across the U.S. They develop, maintain and administer the National Physical Therapy Examination for Physical Therapists and Physical Therapy Assistants.
When Reggie Brown of the Detroit Lions was tackled in a game against the New York Jets on December 21, 1997, it appeared to be just another good hit. That is until he didn’t get up. Immediately, Kent Falb, the team’s head athletic trainer, ran out onto the field to determine what was wrong. Unfortunately, the impact displaced Brown’s first and second vertebrae, but it was impossible diagnose that on the field. All Falb knew at the time was that Brown was struggling for every breath. But it was Falb’s quick-thinking reaction along with the help of team doctors that helped to stabilize Brown and prepare him for transport to the nearest trauma center.
While the public may automatically associate athletic trainers, also referred to as sports therapists, with professional athletic teams, their expertise reaches far beyond the playing fields of the NFL, NBA, NHL or MLB. It’s an allied health specialty that’s gaining respect among school districts, sporting clubs, hospitals, physicians, and even in the field of industrial manufacturing.
In fact, the profession has been experiencing significant growth for nearly 30 years. Membership in the National Athletic Trainer Association (NATA), the profession’s leading organization, has grown more than 520% since 1974. Its most recent statistics reveal that membership topped the 28,000 mark in 2001.
And it’s a specialty that continues to create new jobs for sports medicine graduates. In fact, NATA forecasts continued job growth of at least 2,600 more jobs by 2005, and another 7,000 jobs by 2010.
In some ways, athletic trainers assume many of the same responsibilities as triage nurses—they’re usually the first ones on the scene and in charge of making split-second assessments. “The trainer is the first-line soldier, working in the trenches with the athletes,” comments Dale Baker, the Smith and Nephew chair for director of education at the American Sports Medicine Institute, based in Birmingham, Ala.
As in Brown’s case, Falb was able to gauge the urgency of the situation and prioritize the initial treatment steps. In less traumatic cases, trainers determine whether or not an athlete’s injury is severe enough to warrant transportation to the hospital. If not, they treat the injury on site and follow up with a rehabilitation plan.
“We’re trained to splint a fracture, perform cardiopulmonary resuscitation (CPR), assess injuries and illnesses, and rehab an injury,” states Laura Harris, PhD, ATC, assistant professor of athletic training at Ohio State University, School of Allied Medical
Professionals in Columbus.
But trainers also work in preventative capacities, such as strength training, conditioning, exercise instruction and overall health maintenance. “Athletes are expected to do a job and the trainer is trying to get them back to work as soon as possible,” notes Michael Mandich, ATC, an independent consultant based in Lewisville, Texas.
Because their responsibilities cover such a wide spectrum of health care tasks, athletic trainers and sports therapists are typically required to have a four-year degree that includes classes in anatomy, physiology, psychology, nutrition and conditioning. Employers also require a variety of certifications, namely athletic trainer certified (ATC), CPR and first aid. Additional certifications focus on specific areas within the profession, and requirements vary depending on the needs of the job.
Of course, to practice at the professional sports level, trainers must have several years of experience and usually an advanced degree. Even at the collegiate level, the competition for positions is extremely stiff, and a master’s degree can be a deciding factor.
“Most trainers recognize the need for advanced education in order to be competitive. It’s difficult to make it to Division I, II or even III without a graduate degree, and it’s especially difficult to get into the professional level,” asserts Harris. “It doesn’t necessarily matter what your degree is in, but it proves you’re someone who has challenged your critical thinking skills.”
Unlike physical or occupational therapists (PTs and OTs, respectively), not all states mandate athletic trainers be licensed. However, 43 states currently demand some form of regulation, from licensure to registration, and the average starting salary hovers around $28,000.
Almost without fail, an individual’s introduction to sports medicine comes from sustaining an injury while playing a sport. “I would say about 98% of us in the profession were injured as an athlete and had to be treated by a trainer. We didn’t know about [the field] until a trainer took care of us,” says Harris, a former gymnast.
Of course, there is that small percentage that simply saw sports medicine as a way to stay directly connected to sports without becoming a professional athlete or coach. Mandich is one example: “Growing up in Green Bay, Wis., I always wanted to work for the Packers. I knew I was never going to play for the team, so I thought the closest I could get would be to become a trainer,” he says.
While Mandich hasn’t landed that dream job with an NFL team yet, he has been able to expand his skills through various positions. Since graduating from the University of Wisconsin at La Crosse in 1997, he has worked at PT clinics, hospitals, and with a number of school districts. “I especially like working with kids because it’s challenging work and always changing. You never do the same thing two days in a row,” he comments.
Many athletic trainers start off their careers treating high schools athletes, getting them in shape, and prepping them to compete at the more advanced collegiate level. Unfortunately, there are very few individual schools that can afford to hire a trainer to solely attend to students’ needs. Rather, school districts usually contract with local clinics or hospitals to have staff trainers work with the schools on a part-time basis. These specialists split their time between patients and students. “I like being part of the fast-paced environment during the day and working at a high school in the evenings,” Mandich says.
“In more rural environments, some of the education budgets are not as lucrative, and schools may have to hire a trainer to service the entire district instead of one trainer per school,” notes Harris. “At the high school level, trainers are more often used in the game settings for emergency medical situation rather than for their rehab or prevention skills.”
Yet another sport medicine career path is teaching. In this scenario, individuals are in the classroom during the day and on the field or court after school. “However, that’s a job with a high amount of burnout because they are there from early in the morning to late at night,” states Harris. “Typically after five to seven years, many trainers find a spouse or start a family and want better hours.”
Neither the health care nor the educational communities overlook the importance of having certified trainers to support young athletes. Recent studies have shown that too many children are insufficiently trained and, therefore, sustain unnecessary injuries. According to U.S. News & World Report, there is an alarming rise in the number of overuse injuries among children, such as persistent heel problems among young soccer players.
Complicating matters is the fact that many youth teams are coached by parents or sports enthusiasts who may know about the sport’s fundamentals but aren’t necessarily trained in the finer aspects of conditioning. Without a balanced approach to practices, weight training, and overall conditioning, children are at risk for injuring themselves or, at the extreme, causing permanent damage. Additionally, the medical community has expressed concerns about undiagnosed concussions, particularly among football and soccer players.
With more than 30 million children playing on school or recreation-league teams, it’s no wonder that there’s a growing call for change. More organizations and schools are recognizing the importance of appropriate training and, where budgets allow, are seeking the expertise of professional athletic trainers. Even the American Academy of Pediatricians has publicly advocated the use of ATCs for high school sports. Therefore, industry analysts believe this is a work setting that will continue to grow for entry-level sports medicine grads.
The Practice Arena
For those who prefer treating a broader range of people, doctors’ offices, PT clinics and hospitals also offer interesting career options. In these settings, the ATC works along side PTs, OTs, doctors and nurses as part of the health care team. Additionally, patients vary in age, race and socioeconomic backgrounds. Specialists may see professional and collegiate athletes, weekend enthusiasts, children, and even the elderly—all of whom may have suffered an injury or require additional training in order to avoid further complications. Says Mandich, “Athletic training is a very interdisciplinary approach. You’re still treating an active population, they’re just not all athletes.”
Regardless of the environment, sports therapists are required to function under the supervision of a physician and are often the link between patients and the rest of their health care team.
“We work with the primary health care team that consists of the patient, parents if a minor, coaches and physician. Then there is the secondary team, which consists of a rolodex of consultants, such as PTs, exercise physiologists, nutritionists, psychologists, social workers, school nurses and chiropractors,” explains Harris. “Our co-workers run the gamut of the health care professions.”
Additionally, trainers in the clinical setting assume more of a rehab perspective, including exercise prescriptions and patient education. In a time of heightened cost-consciousness, ATCs have proven to be a valuable asset. The NATA reports that physicians have indicated a higher rate of reimbursement when employing trainers. Additionally, ATCs free up doctors’ time to see more patients while continuing to cater to an individual’s needs.
As the population ages, industry analysts anticipate a significant increase in the need for sports therapists in the clinical arena. As people grow older, they become more susceptible to activity-related injuries. Therefore, there will be a greater demand for specialists who can help individuals return to their daily life, which includes instruction on how to prevent further injuries.
Another promising development for ATCs is the recent changes in insurance policies that now agree to reimburse providers for sports medicine treatments. “The list of companies that will reimburse trainers is growing, whereas PTs have been billing for their services forever. In terms of reimbursement, trainers have been undervalued and underutilized,” says Mandich.
“As we gain more progress toward reimbursement—and the number of potential services that are covered by reimbursements—we will also see salaries increase,” adds Harris.
The Professional Team
Perhaps the most promising employment environment for ATCs is nowhere near a football stadium, ice rink or hospital. Rather, it’s within the walls of high-rise office buildings and manufacturing plants. Corporate America has taken notice of the benefits of being physically fit, including the financial results. At its most basic, active employees are less likely to use up sick days and make fewer medical claims against insurance policies—they even add to high company morale.
Although most evidence is anecdotal, more and more companies are encouraging employees to exercise and maintain healthy lifestyles by providing workout facilities, discounts to private gyms, and even perks like free movie tickets to those who prove to be physically active. But back in 1985, Honda of America Manufacturing (HAM) simply wanted to give its employees and their families a place to exercise, get in shape and enjoy recreational activities. That’s when the automotive manufacturer opened its first Wellness Center in Marysville, Ohio.
Now, nearly 20 years later, HAM boasts three Wellness Centers, each with degreed professionals on staff to assist employees with their physical needs.
“Each center promotes wellness with education. There is nutrition information from a registered dietician, and associates can discuss their wellness concerns and have one-on-one consultations for issues like stress management. The centers’ program departments plan recreational activities, such as intramural leagues and holiday parties. The aquatics departments run the pools, swimming lessons and aqua aerobics. The fitness departments’ staff have the capabilities to help individuals with any from training—from a marathon to body building,” explains Dave Litzke, the coordinator for the Marysville center.
While the centers are designed to accommodate individual needs, their staffs also help HAM employees recuperate from injuries, whether suffered on the job or during their off time. “Injured athletes need to return to playing at the same level of competence in the shortest period of time—that is what the athletic trainer does. A lot of those same treatments also work on other workers and athletes, including the weekend warrior,” notes Baker.
“Nowadays, larger organizations are recognizing athletic trainers as entities that are viable options to help offset or deter health care costs,” adds Casey Kirk, coordinator at one of HAM’s Wellness Centers.
Athletic trainers are particularly valuable in the industrial environment where assembly workers are expected to do heavy, monotonous functions that can lead to workplace injuries, if the workers are not properly conditioned.
“When you look at the volume and repetition of movement an associate does in a fast-paced manufacturing environment, the amount of trauma on the body equates or supercedes that of an athlete. Upon their gaining employment at Honda, some people may not have the baseline physical condition that’s required,” explains Kirk. “Associates who work in these facilities need a high level of conditioning.”
Both Litzke and Kirk agree that it’s satisfying to help people not only obtain better performance on the job, but to also enhance their lives as a whole by becoming physically fit. “We work with a diverse group of people in very different ways. In the morning we could be working with a senior citizen, in the evening we could be working with mom who just had a child, and at night it could be helping a high school athlete,” explains Kirk.
In order for athletic trainers to be effective with their clients, regardless of the setting, a holistic approach is required. Lifestyle, motivations and health care goals are all taken into consideration. “Most of the time, you’re not dealing with sick people but people with health care problems nonetheless. You have address the whole person in treatment,” advises Baker.
And it’s this complete approach that places sports therapists in a unique position within the allied health field. Their broad knowledge, multiple applications, and adaptability to numerous environments make them an asset.
Indeed, it was Kent Falb’s expertise that helped Detroit Lion Reggie Brown not only survive that tumultuous tackle, but allowed him to make a remarkable recovery. Less than a month later, Brown was jogging and doing other prescribed exercises on his way back to a fully functional life and a winning athletic career.
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