It’s 2018. I’ve been out of PT school for about 2.5 years now. Time flies, right? I can’t believe it. I’ve been working in acute care mainly, a little PRN help in SNFs and outpatient facilities… Ya know, the typical post-grad-need-to-pay-off-my-loans thing. Meanwhile, I feel like everyone around me is getting certified in a million different things. I mean, I’ve been doing my continuing ed (and some extra), but I still feel like I’m behind because I don’t have any certifications…

But do I want any? I’m honestly not sure. Each certification is hundreds to thousands of dollars, and of course certain ones require that you get approved before you can sit for the exam. It’s a lot of time and money to dedicate to something that I’m not 100% sure and confident that I want. But what do I do then? Am I falling behind? Am I going to be able to keep a job without adding letters to my name? Am I overreacting? Probably, but maybe not. I truly feel like so many PTs around me are doing residencies and fellowships and publishing articles and doing these amazing things. And for that, I applaud them (and you if you’re one of them). Frankly, I think I’m a little jealous that others know exactly what path they want to take in this career. I want to make a difference, but I want to be in it 100% – not just to add some letters or pad my resume. Not to mention I’m still drowning in over 100k of student loan debt.. and trying to experience life a little here and there..

These questions and thoughts go through my head on a very regular basis. I have looked at various certifications that I think would be good for my “life goals” but continue to have a difficult time deciding which one I want to choose (commitment issues, much?). Truthfully, I feel like I want to continue learning and improving my skills as a “General PT.” I think I made this up – but basically, I want to be like the “family practitioner” of PT. I want to learn as much as I can about a variety of things so that I can be that primary care PT who can help with differential diagnosis so that the patient can get the appropriate treatment – whether that be from me or not.

I want to work with a team of nurses and physicians and other healthcare workers to derive the best plan for a patient – whether they are a pediatric patient or geriatric patient, total knee replacement or post-CVA. I want to understand and learn as much as I can. I want physicians to look at me and ask me questions when they are deciding the best plan of care, so that they have my respected perspective on it too. I want to collaborate, I want to help.

I want to keep taking continuing ed on clubfoot and the Ponseti method and then next month take it on traumatic spinal cord injuries… and then in a few months on treating Parkinson’s. I want to confidently know the difference between an allergic reaction and cellulitis when a patient walks into my clinic. I want to understand the McKenzie method and other ways to treat low back pain – never settling with using only one tool, one technique, or one specific method.

I want to be able to read diagnostic imaging, maybe hopefully down the road (pending the state), even order it. I want to be able to determine if someone just had a stroke or if they just have facial droop from Bell’s palsy. I want to be able to notice that a patient’s back pain is caused by something that needs medical treatment instead of physical therapy treatement. I want to be an expert in differential diagnosis. Not just good, but great.

I essentially want to be that New Grad PT… but better. I want to not be pigeonholed into one category – afraid that I may lose my manual skills (which truly has already happened only 2.5 years out after mainly working in acute care), afraid I might forget how to talk to a 2 year old and be creative during treatment, afraid I may only want to do repeated extensions for everything musculoskeletal, afraid I may keep repeating the same treatment for every older person who has a fall without personalizing it.

I want to interact with people all over the world in the PT profession. Because even though I know I will always want to stay up to date generally, maybe there is something else out there, somewhere else, where my skills are in need and can provide the greatest benefit. Maybe I just haven’t found it yet.

But how? How do I demonstrate this on my resume? How do I keep improving as a generalist PT? Are there any certifications for differential diagnosis and understanding pathologies at this primary care level? Are there any interdisciplinary courses that are offered that involve all members of the healthcare team? So that we can learn and grow together?

I think this is okay to feel like this. Again, I’m not sure, but I think so. But how do we change this? How do we make these thoughts and notions about being a generalist PT feel okay? I’m simply not ready to step into the neuro world, or the ortho world, or the pediatric world, or becoming a yoga therapist… I’m not ready to fully dedicate my life to one area. And, yes, I know this doesn’t mean I can never take courses in those again, but it does mean I will be characterized by the OCS, CSCS, COMT, or the GCS or whatever letters appear behind my name. People may feel that because I did a residency with the geriatric population that I am only equipped to treat them – and completely leave out my love for the sports population. I don’t want that.

This blog isn’t meant to have answers. Mainly questions and insights for us as a profession (and other professions) to build and grow together. And for other “generalist” PTs that may feel lost to know that you are not alone. I’m not advocating for certifications or not – I’m simply saying I am personally not ready to commit, and I’m not sure when I will be. But until then, I want to keep improving my skills to show that we, as PTs, can be great as generalists.

It shouldn’t be frowned upon to be a generalist, as long as we are improving ourselves in whatever way will lead us towards our goals. And again, I’m not saying it is frowned upon necessarily, but I do know that I personally feel pressure all of the time from the advancing PT world to pursue one specific area. I’m not ready for that, and it’s okay. I’m allowing myself to feel okay about it. I know I will do my best to make a difference however I can.

Until then, I will keep seeking opportunities, progress a little, fail a little, and learn as much as I can. And I hope you will too.

– Jen

21 responses to “The Generalist PT”

  1. thefrugalpt Avatar

    I love this! It seems like now many people are hyper-focused on certifications. “You don’t have a certification? I guess you don’t have the experience.” But there is so much more than taking an exam that really speaks to your clinical abilities. I’m a new grad, so I haven’t had a chance to really get out into the “real world,” but I really appreciate your thoughts. I’ve been pondering myself about the path to certification or the aspects of being a generalist.

    1. Jennifer Palmer Avatar

      Yes! New grad or not – I’m just happy I’m not the only one feeling this way. Best of luck!!

  2. Grace Avatar

    love this! I am right there with you! I’m 1.5 years out and have been traveling. Now that I’m staying put, it’s difficult to decide on a setting (much less be considered for any position given “only” several months experience in any given setting). I worry about being stuck in one setting and losing my other skills. I’m glad to know I’m not the only one with this mindset. Keep up the good work in and out of the clinic!

    1. Jennifer Palmer Avatar

      Yes! I did one travel job and then have had to travel recently due to my husband’s work (to Japan – where I can’t work for a short period of time). It has left me with a lot of thoughts on settling in which area! Best of luck to you!!

  3. Fd Avatar

    I totally get this. I’m a new grad too, and all I want to do is to get better at serving my patients. But I’m with you, all we can do is learn as much as we can. Everything that we are learning now and our experiences now can be used as tools for our future patients. Even if we do decide to specialize, we can extract from our previous experiences and apply our knowledge to the patient that has several things going, or isn’t responding. Kudos to you Jen for trying to learn all that you can.

    1. Jennifer Palmer Avatar

      Exactly! I think all of our experiences are important – clinical or not! We just have to keep learning and pushing and if we’re meant to specialize – awesome. If not, welp… we just have to keep progressing anyways! Kudos to you too 😉 Best of luck with everything!!

  4. Ashley Avatar

    I love this! Thank you for posting this as it makes me feel that I am not alone with the exact same thoughts and constant personal mind struggle. I couldn’t agree with you more, and I think that being a “well-rounded” (generalized) PT is just as great and will lead you in many walks of your professional career.

    1. Jennifer Palmer Avatar

      Yes! I’m so glad I’m not alone. I go back and forth in my head all the time trying to figure out if I want to specialize and in what.. ahh! But we got this! Best of luck!!

  5. Kelsey D Avatar
    Kelsey D

    Thank you for posting this and opening up the idea of a “family practice PT”. As a PT in EI there are many times that I want to help the caregivers because they are the most important tool for their child – ie the ability to play on the floor, play catch as they get older or help with daily needs like transfers and maintaining strength if their child as a significant neurological disorder. But I’m stuck in the “you only work with my child, how can you help me?” And I don’t love ortho but I the ability to modify so many things and can direct them to a PT who can safely perform manual therapy.

    1. Jennifer Palmer Avatar

      Yes!! Even though you are very much capable of helping them, specializing or sticking to one area makes me nervous that I will almost get “pigeonholed” and seen by society as only being able to work with a certain population. Crazy! Keep up the awesome work, best of luck!!

  6. Janelle Avatar

    Jen I think your initiative with the global PT connect IG is a solid foundation for your goals… keep telling everyone you meet that that is your goal. People notice others on a mission… just keep connecting. Maybe one day you can start a consulting group of sorts for care providers to collaborate.

    1. Jennifer Palmer Avatar

      Thanks, Janelle 🙂 I think that would be awesome! I’m definitely working towards making it into something..slow and steady!!

  7. Kaylee Avatar

    This is everything I’ve been feeling put into words. Thank you so much for bravely writing this! You’re not the only one, and I’m glad I’m not the only one!

  8. Paul Marquis Avatar

    Great blog post! My name is Paul Marquis PT. That is it no long list of credentials but I have just met my 25-year mark as a physical therapist. I have been to numerous continuing education courses, was an Adjunct professor at a university for five years, have lectured in California and Massachusetts for a CME company. I am the vice president of clinical operations for 5 clinics, I am the founder of Ortho Eval Pal and have treated patients from two-month-old to 98 years old. I have seen it all and then some. When it comes to hiring people we don’t care what their credentials are. We care that they pass their board exams, are kind and caring and willing to learn and work hard. You can be great without credentials. Be passionate about what you do and all will work out.
    In good health,
    Paul from Ortho Eval Pal

    1. Jennifer Palmer Avatar

      Hey Paul! This sounds amazing. I love reading all that you’ve done!! I am pretty confident I would like to become a professor at some point, or even just help out with education as a lab instructor.. Either way, I’m hoping a variety of experiences may help me – at the right school..when the time is right. Thanks so much for your input! Best of luck with everything!!

  9. Giovanna Avatar

    Love this! I’m on my third year/completing all my clinical rotations and you expressed how I’ve been feeling so perfectly! I have enjoyed all the settings I’ve been placed in (OP ortho, acute, OP peds) and feel so much pressure to make a choice as soon as I graduate. I don’t want to lose different skills I’ve learned by only practicing with one patient population. Thank you so much for sharing this. It’s very reassuring to know I’m not the only one that feels this way.

    1. Jennifer Palmer Avatar

      Yes! I thought I was so set on OP until my last clinical when I fell in love with the burn trauma unit in my second acute care affiliation.. I love all the settings in different ways! Keep doing you and definitely know you’re not alone! (I’m happy to know that too, haha). Good luck!!

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