Since I have graduated from a neurologic physical therapy residency program and subsequently obtained a specialty board certification, I’m often asked if I would recommend pursuing a physical therapy residency program.
To best answer this, the question needs to be broken down into two distinct parts:
- Do you want to become a board-certified specialist in a specific area?
- If so, do you want to complete a residency to gain that certification?
With these two questions in mind, let’s take a look at factors that may help you decide whether or not to specialize and if you should pursue a residency in doing so.
BECOMING A BOARD-CERTIFIED SPECIALIST:
Let’s start by first weighing the reasons to either pursue or not pursue becoming a board-certified specialist.
1. Clinical Practice
When initially graduating from a physical therapy program, your program’s goal is to produce a competent and well-rounded physical therapist. If you exceed these expectations, especially in a certain area, that is fantastic. However, no matter the level of your skillset, pursuing a specialization can advance your clinical horizons even further and thereby help you provide the best possible care to your patients.
This may also allow you the opportunity to better assert yourself in treating your patient population of choice. By demonstrating your knowledge base and having a designation of your specialization for others in the physical therapy profession to see, both your superiors and colleagues may more readily direct patients in your area of specialty to you for treatment.
2. Job Opportunities as a Staff Physical Therapist
When applying for a job, it never hurts to have the designation of a specialist on your resume. Before an interview even takes place, it can give you the upper hand as having a specialty board certification is well-respected in the physical therapy profession.
3. Management Opportunities
Specializing can create opportunities for you to take on new responsibilities at work, which can make “climbing the corporate ladder” more easily accessible. Such responsibilities could include mentoring colleagues, teaching in a residency program that already exists at your workplace, or creating a new residency program that does not yet exist.
4. Increased Financial Opportunities
Specializing can open doors for you to create new avenues of income outside of your full-time workplace. These can include the following:
- Working as a teaching assistant at a DPT or post-professional physical therapy program
- Creating a cash-based business seeing clients in your specialty area
- Creating study materials to aide others in the passage of the specialty boards exam
- Creating continuing education courses
- Working as an expert witness
5. Volunteer Opportunities
There may be volunteer opportunities that you can act on now, but specializing makes these opportunities a better fit which can potentially help you contribute at an even greater extent. Examples of these include getting involved in the following:
- Conducting, presenting, and publishing research
- Running for an APTA special interest group board position
- Giving in-services to the community, colleagues, and physicians on your area of practice
1. No Increase in Pay
Gaining specialization does not automatically garner an increase in salary for the same line of work. Remember, insurance does not reimburse more for a therapist’s treatment if they happen to be a specialist, so why should you be paid more?
2. Specialty Designation Not as Well Recognized by Non-PTs
You may find yourself explaining to your patients, physicians, and other healthcare staff what your specialty is and what it means to have that specialty designation. Additionally, these groups may value your knowledge and outcomes more than having letters behind your name.
3. Maintaining Your Specialization Certification
This is a pretty involved process requiring regular payments, many patient care hours, fulfilling requirements throughout a diverse grouping of categories (ie research, teaching, giving in-services, serving on board positions, etc), and completing a portfolio. And, yes, every 10 years you still have to pass an exam to maintain your specialty board certification.
ACHIEVING SPECIALTY CERTIFICATION BY COMPLETING A RESIDENCY:
Hopefully, the above points helped you decide if specializing is right for you. If you’ve decided that you would like to pursue a specialization, that’s great – now you just have to decide if you want to attend a residency to obtain this board-certified specialization.
A recently published study in 2020 asked resident directors, resident faculty, and current residents to identify the most appealing reasons why physical therapists pursue the residency option. This study found that the main reasons residencies were pursued were due to a physical therapist’s desire to provide better patient care, to better prepare for specialty practice, to fast-track to expert practice, and for career advancement. Keep these findings in mind as the route to specialization either with or without residency training is compared next.
1. Faster Eligibility to Take the Specialty Board Exam
After graduating from a residency program, you can subsequently sit for the board exam in your specialty area. Since a residency is typically only one year long, this is considered the “fast-track” to obtaining your specialty certification of choice.
Since completing a residency allows you to take your specialty board exam so soon, it makes sense that residencies often include coursework that should help you prepare for passing the exam. Coursework can include lectures, reading research articles and textbooks, group discussion with residents from other programs, and tests to ensure your progress.
When I ask either current residents or graduates of residency programs why they chose to attend a residency program, mentorship is typically the first reason given. This clinical experience allows for the reinforcement of the coursework mentioned earlier through the honing of clinical reasoning and hands-on skills.
4. Potential Research and/or Teaching Experiences
Not all residency programs are the same, but some do offer the opportunity to participate in ongoing research projects or teach at a physical therapy program. Both of these experiences can help foster your career towards a specific avenue.
5. Potential Experience in Multiple Clinical Settings
Some residency programs take place in one clinical setting while others take place in multiple clinical settings.
If you already know which setting you’d like to practice in, getting experience with a certain patient population in that specific setting can help make you a quick expert. On the other hand, if you would like a more diversified clinical experience, having exposure to your patients from your specialty area in more than one setting can make you marketable for different job and side hustle opportunities.
6. Potential Increased Workplace Confidence
With all of the diverse experiences a residency can offer, it makes sense to feel more confident in your skillset after completing a residency. This can be especially valuable for a recent graduate of a physical therapy program.
7. Potential to Increase Chance of Getting Hired
A resident graduate may be viewed as more experienced compared to a new physical therapy program graduate as less mentoring is required.
Also, if your residency is well-connected, faculty may help you land a job once you graduate. Even better, they may offer you a job to stay with them.
8. Effect of Practicing in a Specific Patient Population You Love
Whether you choose a future in patient care, management, teaching, or research, once you graduate from a residency program, you will likely end up in a job that strongly relates to that area in which you decided to specialize. Since completing a residency program can make such a job prospect more immediately attainable, this may increase your happiness in the workplace.
If you decide to do a residency, there are more obvious direct costs as well as less apparent indirect costs to consider.
First, the residency program is not free. Yes, the amount of money a residency may charge you will likely pale in comparison to the amount of student loan debt you have racked up over the years, but don’t forget to include cost of living for an additional year as well.
Also, while you do earn an income in a residency program, the pay is significantly lower than what a new physical therapy graduate is making. In the business world, the opportunity you forego when making a choice is known as an opportunity cost, and this cost should not be taken lightly.
Think about this: Let’s say you are 27-years-old and hypothetically able to put $10,000 of the salary you earned that year towards saving for retirement. If a more conservative market return of 7% is anticipated, that $10,000 would grow to be $130,793 by the time you are ready to retire at age 65. If you were prioritizing saving for retirement and maxed out your 401(k) with a $19,500 contribution, that amount would grow to $255,046.
Or let’s say you want to prioritize paying off student loans? If you graduated with $100,000 in student loans and had a 7% interest rate, that means you would owe an additional $7,000 on your student loans by the end of the residency year.
Numbers can be manipulated in different scenarios all day, but the point is that the costs you need to consider include forgoing the opportunity for investment and/or debt repayment.
2. Does a Resident Graduate Provide Measurably Improve Patient Care?
Given everything we have covered that a residency provides, this would seem to be an unfair question to pose. Surprisingly, though, an article published in the Journal of Orthopaedic and Sports Physical Therapy concluded that “residency training did not appear to contribute to improved patient functional status change or efficiency.” The study did state that fellowship training may improve these, but a fellowship would include another year of training after a residency, and not all physical therapy specialties have a fellowship option.
3. Another Year of Education
Let’s face it – 4 years of college followed by 3 years of graduate school can feel like forever, and some of us take even less direct paths before graduating with a physical therapy degree. Therefore, no one should hold it against you if you are just not up for taking on another year of what will feel like school – a combination of clinical work with an instructor looking over your shoulder while you study didactic work during the few hours you have away from patients.
4. Giving Up the “Bird in the Hand” Current Job
Sometimes, you may find yourself already in the workforce at a job that you enjoy and don’t want to lose. However, if you do decide to pursue a residency, you may have to give up that position and that position may not be there waiting for you a year later after you finish residency.
THE FINAL VERDICT:
Overall, if you decide that specializing is not for you, that is also okay. In fact, having the option on whether or not to specialize is one of the unique aspects that the physical therapy profession offers.
If you do want to pursue your specialty by completing a residency, do know that the greatest sacrifice is the potential impact on your finances. The year of decreased income, cost of the residency, and potential loss of your current job if already in the workforce are all aspects to consider.
However, for physical therapists seeking to hone their skills in treating a specific patient population, the benefits of pursuing a board-certified specialization by completing a residency are clear. If specialization is your goal, I highly recommend completing a residency.
FINAL THOUGHTS. . .
I hope this article has helped you decide if you should pursue a physical therapy residency.
Are you considering a physical therapy residency? Do you have any further questions? Are you currently in or previously completed a physical therapy residency and have more information to add? Before moving on, please help make the Money Mobilizer a supportive and welcoming community for our current and future colleagues by leaving a question or sharing your knowledge below!