Generally speaking, there is no “typical day” for a physical therapist, since career paths and daily routines vary so widely. After two or three years of general practice, a physical therapist may find a special area of interest and devote energy and training to a specific patient population or specific treatment technique. For example, a physical therapist in Reno, Nevada may find that his special area of interest is prevention of injuries in high school students involved in team sports and he may set up a private practice teaching adolescents and adults stretching and strengthening techniques and conditioning routines. A physical therapist living in New York City may have found her niche in evaluating and treating women living with breast cancer after total mastectomy procedures.
A day in the life of an entry-level physical therapist at an acute care hospital in a city will consist of seeing an assigned patient load which can range from 8-12 patients a day in a quality facility. Too many patients a day equals an understaffed facility and compromises on care. Treatment times range from 20 minutes to 40 minutes, a much shorter time frame compared to the days before managed care, when typical treatment lasted 40 minutes to an hour. A physical therapist conducts her evaluations, treats her patients, documents all treatments (often written documentation can take 20-30% of the work day) attends inservices, which are educational training sessions for physical therapists by in-house and outside experts, and participates in interdisciplinary meetings. Physical therapy work is physically demanding, as therapists must use their own strength to transfer, gait train and exercise patients, and the new physical therapist will have to learn how to economize her own physical energy by scheduling time to document notes or other non-physically demanding activity in between exercise sessions.
It is important for an individual pursuing the field of physical therapy to understand how wide the opportunities for practice in the field are. There is ALWAYS more to learn.
Case Study: Outpatient Rehabilitation
Cara Mateo works in an outpatient rehabilitation center in New York City that treats stroke patients, head injury, spinal cord injury, multiple sclerosis, Parkinson’s and other neurological diseases. Cara is one of five other physical therapists working in her department. She reports directly to the director of physical therapy, who reports to the director of rehabilitation. Cara has been working at the rehabilitation center for 2 years.
7:30 AM: Cara walks from her Upper West Side apartment to her job to arrive at 8:00. Her work day begins at 8:30 but she would like time to review her patient load and have a cup of coffee at her desk.
8:30 AM: Cara has reviewed her emails, phone messages and schedule for the day. She attends an interdisciplinary care meeting with the rehabilitation team from 8:30-9:30 to review two problem cases.
9:30 AM: Cara’s first patient is called over the loudspeaker by the receptionist and Cara goes to the lobby area to receive her patient. He is a post-stroke patient and is wheelchair bound. He is accompanied by his wife. Cara works with her patient in “gait training” or walking with a quad cane (a cane with four prongs). Her patient is excited about his progress in terms of the distance he can accomplish. Cara suggests that in another two weeks she may progress him to a straight cane. Cara sits with her patient and his wife after the gait training to perform stretches on his upper extremity (arm) that have become tightened in a pattern typical of a stroke (called a synergy pattern). The three, therapist, wife and patient work as a team to review home exercises. The session ends at 10:30.
10:30 AM: Cara documents treatment in the patient’s chart and includes reports of pain by the patient or reports of difficulty performing the exercise program. Cara also includes all exercises and gait training that she performed with the patient. She concludes her documentation with goals for the next treatment and a plan to carry these goals out.
10:45 AM: Cara’s second patient is called. This patient has multiple sclerosis and is also overweight. Cara’s challenge, and the patient’s, is to increase the patient’s aerobic endurance without causing a relapse of fatigue (termed an exacerbation of symptoms cycle) typical of this condition. Cara checks the patient’s vital signs, including blood pressure, heart rate and temperature. She also checks the patient’s weight. Cara supervises the patient on aerobic circuit training, which includes the stationary bike, treadmill and upper body ergonometer. The patient is able to tolerate 15 minutes on each piece of equipment. Cara and the patient talk about when in the patient’s day she feels most fatigued and what she does to alleviate this fatigue. Cara notes that the patient is wearing too much heavy clothing for the temperature of the gym and advises her about the effect of heat on the fatigue patterns of MS patients. Together they review the home exercise program. Cara walks her patient to the reception area after reviewing the next appointment time.
11:45 AM: Cara documents the treatment of the MS patient.
12:00 AM: Cara attends an interdepartmental inservice given by the director of the psychology department on cognitive deficits in stroke patients.
1:00 AM: Cara sees her third patient of the day, a spinal cord-injured patient, aged 25. Her goals for this patient are to improve the patient’s ability to move from the wheelchair to the mat and to increase his abdominal strength using the Bobath Ball (large gymnasium ball) for core (trunk) exercises. After a vigorous treatment, Cara and her patient talk about the fact that her patient would like to go back to work at some point. Cara makes a note that she will talk to the rehab team about a referral to the vocational department for training to return to work.
2:00 AM: Cara documents her treatment.
2:15 AM: Cara has an hour staff meeting to talk about the schedule for accepting PT students for the year from neighboring educational programs. The director would like to assign these students to a therapist. This is Cara’s first time supervising a student and she is looking forward to the experience. Cara receives her assignment for a student from NYU.
3:15 AM: Cara leads a group therapy session consisting of 5 post-stroke patients. The patients and Cara go through a series of exercises to improve balance. Cara has integrated some TAI-CHI techniques into her group session and the patients enjoy this very much.
4:15 AM: Cara documents the group therapy session in all 5 patient charts.
5:30 AM: Cara reviews emails, phone calls that she received during the day and gets ready to leave for the day.