The Generalist PT

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.

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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


The Struggles of Being a Small Physical Therapist

No, this isn’t Elite Daily or Buzzfeed. I’m not going to tell you the 37 reasons why being a physical therapist is “THE BEST” while using completely opinionated rationales.

This blog post, however, is based off of my opinion as well as from my not-very-extensive-but-still-valid experience of how being a smaller person has affected how I treat patients, how I treat colleagues, and how I have overcome others’ opinions of what smaller people CAN do in this field. Just FYI – I’m a 5’2″ petite girl.

To get you in the right mindset and to help you understand where I’m coming from (especially if you’re a normal sized human being)… Let me first give you a few quotes that have stuck in my head and/or are repeated on a constant basis from either patients, patients’ visitors, nursing staff, and/or other health professionals:
1) “You can’t lift me, you’re the size of my thigh.”
2) “I don’t trust you to lift me with those spindly arms.”
3) “You didn’t bring anyone else to help you?”
4) **calls over family member/any male nearby and says to them, “come help this little girl”**
5) “Oh, well my children are much bigger than you so even if you can’t lift me, they will be able to. It will be different then.”
6) “YOU are going to help me stand up?”
7) “There’s no way you could catch me if I fall, I’d take you down too.”


I think you get the idea..

So, we could go on a rant here about how “it’s so much better to be a small person than a bigger person in life” or “you don’t know how great it is to be tiny” yada yada yada. That would be another topic which I will not get into because frankly, every body type and size has their pros and cons. FACT. If you need more validation, I’m sure you can find a Buzzfeed article about whatever it is you need validation for. Again, I will not go further into that because I hope you all have an open mind and can appreciate what everyone, big, small, fat, skinny, etc. goes through.

As I am still a recent new grad of this year (May 2015), I realize I do not have a ton of experience. I do, however, hear quotes such as the above at least once a day. I’m not going to lie, it has been discouraging sometimes, but it is very important you don’t get personally offended in this job (as we may all know).

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Let’s take it back.. As a young lass, a few years ago, entering PT school, I realized I was one of the smallest people in my class, as I have been my entire life. I didn’t realize how this would affect how I treat people when I first entered, until labs began. Instead of being able to muscle my manual muscle tests or physically lift someone with my arms, I realized quickly I had to master my own body mechanics in order to get the proper leverage needed to lift my patient/classmate’s leg to do an SLR or transfer them dependently from the mattress to the chair, etc. Here are some things I did in school/clinicals to help me adjust:

1) I worked with a variety of classmates (as I hope they would make you do in school to test different body types/sizes). A lot of the time I worked with males. Although I would generally end sweating, it was great practice for me to work with much larger legs/bodies in labs so that when it came time to see an actual patient with a larger mass, I would feel more comfortable. Would it have been easier to always be partners with other small people in my class? I’m sure it would. But, working with people bigger than me helped me to immediately figure out when I would need to use a stool (for example for mobilizations) or when I needed to stand up vs. sit down vs. kneel to get the proper angle and position my body so that I could utilize body weight.

2) Practice with high-low tables as well as without. Unfortunately, you may not always have an open high-low table pending where you work. In these times, you need to adjust and you need to be flexible, quick, and make sure you are effective with your treatment. There were times in school I would stand on two stools right next to each other because I was so short and needed to use my entire body weight to assist me.

3) If it hurts your back, STOP. Don’t lean over people, raise yourself up. Kneel down on the ground (I do this all the time now) instead of bending over. SQUAT SQUAT SQUAT also. Raise or lower the bed if you’re in an acute setting. If you are practicing something and you feel your back or neck or any sort of strain on any part of your body, STOP. Take a breath and take a step back. Look at what you are dealing with and re-adjust the environment. Remember you need to keep yourself safe in this profession as well, as we use our bodies A LOT to treat our patients.

4) Stop trying to muscle things, because most likely, pending the patient population you work with, you are going to end up hurting yourself. From my thoughts, the less I use my muscles and the more I use my body weight, the better off I am at preventing overuse injuries to myself. Because as much as I try to preach to my patients that they have muscular imbalances in their shoulders putting them at an increased risk for rotator cuff tear vs shoulder instability.. Am I really, honestly, out there making sure I don’t have any imbalances? I try, sure. But I know I am still predisposed if I overuse my deltoids, pecs, latts, etc etc. I’m not doing therapy for myself everyday… Make sense? So just take this risk away (or decrease it)!


Now, to put these learned techniques into practice, I do a lot of the following:

  1. EDUCATION: Yes, I am small, thank you Mr. ___ for acknowledging that. Yes, you weigh 3x what I weigh, I get it. BUT GUESS WHAT? I am trained in this, I went to school for this, I came out with my DPT because I am competent in this area. I ALWAYS make it a point to educate to the patients and families what it is I do, what I plan on doing, why I am doing it, and how it will benefit them and help them progress towards their goals. Although I am sure they are still hesitant, it really helps to talk patients through what is going to happen so they have somewhat of an idea what is about to happen. Plus, then they know you know what you’re doing..
  2. Build CONFIDENCE: Be confident in your ability, SHOW the patient that you can do whatever task it is so they become confident in you, SHOW the nursing staff that you are capable of doing a transfer alone so that they build confidence in you. It’s all about confidence, people. When a patient sits up, stands up, does any sort of movement for the first time, I immediately start building confidence in them. Many times, patients feel that they are unable to do something because they have back pain or they just had surgery, etc. I acknowledge, “Hey, you did that and you didn’t even need my help, GREAT JOB!” Because that is generally the goal, to get them to become independent once again. Many patients are fearful and can become very afraid their first few times doing any sort of new activity that may cause pain. When they do it, though, and we acknowledge it, it is a whole new game and they (generally) end up being proud of themselves, more confident in themselves, and more willing to work with you in the future. In addition, showing the nursing staff (in the acute setting) that you are capable of certain transfers gives them confidence that you can assist patients and can work with different patients of different functional levels.
  3. DON’T TRY TO BE A SUPERHERO: If you can’t help someone and you feel one person isn’t a safe option to treat, call for help. Use a rehab tech or do a co-treat. Once again, this is for the patient’s safety as well as for yours. Don’t risk yourself trying to be the *one and only* – use help.

As I initially began hearing some of these comments from patients, I did become discouraged (a few years ag0). I even started doing more weightlifting because I wanted my patients to trust me that I could lift them. Of course, I enjoy working out and this was probably eventually going to happen, but this “small-PT-syndrome” was very much a trigger for me to build up a little more muscle. Of course, that is not for everyone. The best recommendation I can give is to not get discouraged. You have your cranky patients and you have your sweethearts, that is life. Be confident in yourself and the patient will feel confident in you. And if not, get help from someone else to show that you respect the patient’s views and want them to be safe.

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I work in acute care currently, and I just had to share a side of really good news.. For the first time since I began PT school, last week a patient said, “You can’t lift me.” Her daughter then responded, “You can’t be deceived by her size, mom, she is trained to do this.” 🙂 #PTWIN. Obviously, that made my day. After treating this patient 2x/day for a week, the daughter and patient both told me, “You’re the only one I trust to help her move.” That was huge for me and helped me, as a new grad, build even more confidence in myself.

Again, I am very aware that I have limited experience compared to most people (besides my new grad friends), but I feel this is a topic that I have dealt with and had to manage from the beginning. If you are on the smaller size, I hope this helps you to become more confident in yourself as a “small PT” and helps you to not get discouraged, because there are plenty of us out here and we are very much capable of treating our patients effectively, too. WE GOT THIS!! 🙂

Jennifer Strack PT, DPT

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