• Carmen Scuito

The Career Plan


I'm not sure what inspired me into starting a blog, and I'm not sure how long that inspiration will last, but here we are. I've been wanting to do something more than Instagram for awhile now, but I'm the kind of person to have a million different ideas and have trouble deciding which avenue to explore. Thus, here I am, exploring a blog... along with some of the million other ideas I have. Which is weird for me considering I don't think I've ever actually read a blog. Why would anyone read these? And why would I even want to write one? Well, I've been looking to venture to more than Instagram. Plus, I'm sure I have a few family and friends who may like to know what I'm up to and what I plan to be up to. So why a blog? Well, the short answer, I'm hoping it will "pay off" in a sense one day. The long answer, keep reading.

I've been having trouble focusing in school lately. Not because of disinterest in my career - I want to be a physical therapist now more than ever, but because of a disinterest in the material. I actually found my own interest. I discovered my specialty. I'm motivated, and it is such a double-edged sword. I know what I want to do, and it's not wound care, it's not geriatrics, it's not neuroscience, and frankly it's not a lot of the courses I'm taking in school right now. Don't get me wrong, I know these classes are important and have their time and place in the world of physical therapy, and I'm doing very well in each of them. But when I'm more interested in writing a blog that no one may read than I am to start studying for my exam next week, something isn't right. The motivation isn't nearly the same as it used to be, and that's because my plan doesn't align with PT school. It actually doesn't even align with the traditional PT model.

So what is it? Yes, I want to be a physical therapist. I don't want to work for an Athletico. I don't want to work for an ATI. I don't want to work for a Select Medical. These are places that are referred to as "PT mills." As a therapist in a PT mill, you're judged more on how many patients you see in a day than the quality of care given to your patients. To be a "better therapist" in this setting, you need to see more patients. Period. More patients in the door is more insurance reimbursement. More insurance reimbursement is more money. The mill continues the cycle. Do you really think you're getting the quality of care you're paying for when you're spending 10-15 minutes with a PT and the rest of your appointment with an aide who just tells you what exercises to do as your PT goes to see the other patients they have scheduled for that hour? If insurance covers most your visit, then hey, you might be. Also, it very well could be possible that all you need is 15 minutes with a PT to fix whatever it is you came in for. But have you ever actually looked at a receipt for a PT visit? It's a lot, and if you had to pay that out-of-pocket to work with an exercise aide for most of your visit, you would never come back.

Before I entirely move on, I want to clear some air. I do not feel guilty naming these companies and referring to them as PT mills. I actually worked as an exercise aide at one of these places before starting PT school. I was arguably the most qualified aide on staff as I had an undergraduate degree in Kinesiology. Most others did not. To be honest, I almost felt like I could've been a PT as an aide. If I didn't know what I was doing, I could have easily made something up and made it look like I knew. It's easy to be a bad PT. I could've easily passed for one before spending a minute in PT school, and my patients would never have known. Well, not until they come back a few weeks or months later with another injury. Even then, they would hardly suspect that it was my wrongdoing. My point is, even as a well-qualified aide, I could not replicate the care of a skilled physical therapist no matter how hard I tried. However, most physical therapists on staff in my clinic were very good at their job. They could have been bad PT's, and unfortunately, bad PT's are definitely out there, but they weren't. The manager of the clinic was one of the most welcoming and genuine people on the planet. We were all friendly to the patients, and most patients were than happy with their time spent at the clinic and satisfied with the treatment.

So what's the problem here? Let me put it this way: if you're reading this, you're probably not "most patients" - unless you're a family member of mine who's reading this and just wants to see what I'm up to, maybe. You're probably a runner, an active adult, or an athlete of some sort. You may be training for your first marathon or your 20th marathon. You may be trying to finish 26.2 miles or qualify for Boston. Hell, you maybe even one of those crazy people we call ultramarathoners tying to run as far as your body possibly can. Your goals are so much more than to just be a functioning human being. You're putting in countless miles per week in your training cycle. Your body has been adapting for so long to such a high stress constantly placed on it by the high amount of activity you put on it. If something happens one day, you may be in pain, you may not be running the same, and maybe you're not even running at all. Do you think 3 sets of 10 clamshells on your side on the table will do it for you? Do you think stretching your hamstrings a few times for 30 seconds will do it for you? What about a few sets of calf raises on a high step? PT mills have a type of patient that they may work well for. That patient is not you.

Adding more into that is another blog post for another day. This one is about me and my plan. So what is it? It's not that I don't want to work for an ATI or an Athletico; it's that I don't want to work for insurance. I wanted to be a PT to help people achieve their goals. I worked hard in high school to get into a prestigious undergraduate program. I spent countless hours and years earning an undergraduate degree in Kinesiology. I took many classes outside of my undergrad program as pre-requisites to be eligible to apply for PT schools with single-digit acceptance rates. I worked over a year as an exercise aide. By the time I graduate, I will have spent 3 years in a rigorous graduate program earning my doctorate degree in physical therapy. I will have spent countless hours on clinical rotations learning first-hand on how to apply my knowledge and treat patients. I didn't do all of this for a person sitting behind a computer at an insurance company to tell me what I can and can't do with a patient, or how I need to be treating this patient, or how many times I can see this patient, or for how long I can see this patient. I didn't do all of this to spend my career proving to insurance that physical therapy is worth it for each of my visits for each of my patients. That doesn't make any sense to me. I don't want to work for an insurance company, I want to work for the patient.

So, how? Well, I want to have my own clinic. A cash-based practice free of any insurance strangleholds. I want to see patients who want to see me. I want to market myself and my practice to show that it is worth it. Luckily, I don't have to "sell" anything. By sell, I mean more of convince. Like, I don't have to prove anything - the evidence is there, I just have to show it. The differences between a PT mill and a one-on-one cash-based practice are vast in terms of patient outcomes and quality of care, and I don't have to sell the idea to convince people that this is true. Believe it or not, in most cases, this is actually the cheaper option as well. However, it takes quite a bit of marketing because this is something that most people just don't know about. As determined as I've been to become a PT, I didn't even know that this was a thing until starting graduate school. I'm very grateful to have a faculty member who introduced us all to this although it wasn't a part of our PT curriculum.

You may be thinking "So, if it's cheaper and the quality of care is truly that much greater, then why doesn't everyone do it?" Well, its really not that simple. On the surface, the price per hour will be more expensive at a private practice than a co-pay would be with insurance at a big clinic. Just seeing that is enough for some people to not look any further into it. What you may not know is that with the same injury, you can get better results going to this highly-specialized, private practice PT once a week for 4 weeks than you would going to the "big-name" clinic for 3 times a week for 6 weeks - which is a typical PT script written by a physician. A co-pay 3 times a week for 6 weeks may cost more than 4 visits to a private practice PT. Now, think about if you've been told you will most likely need surgery. Have you gotten an opinion from a PT who specializes in your type of injury? What if they can resolve your issue without the need for surgery? Can you imagine the amount of money saved in a scenario completely avoiding an unnecessary surgery like this? This is not a rare situation. This actually happens. But I'll leave it at that. Digging a bit deeper, again, is another post for another time.

There's plenty of people who need insurance for physical therapy. There's plenty (well, maybe not "plenty" according to multiple posts in Facebook groups for physical therapists, but some) therapists who happily work for these places. It's not a bad thing. These clinics are needed. There's definitely a time and a place for them, they're just not for me, and if you're reading this, they're probably not for you either. The population I integrate myself into and the population I want to work with isn't the population that thrives in an insurance-based setting. In short, that population is active individuals who have goals set for themselves that are more than "not being hurt."

I don't know where I'll be when I graduate - this is an expensive and time-consuming process, and student loans aren't so cheap either, but I do know where I want to end up. I'm hoping that this blog is a step in the right direction. I'm hoping it exposes you readers, runners, athletes, active adults, and those who even possibly had a non-successful experience with PT that there is more viable option.

I'm officially putting myself out there as someone who wants to "go against the norm" and become a specialized, performance physical therapist one day in my own private, cash-based clinic, and I hope you join me for the journey.

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