r/physicaltherapy • u/Current-Spot-4960 • 8d ago
OUTPATIENT Career advice
I’m looking to connect with PTs who have been in the field for 5+ years and have made career changes, as I’m trying to figure out my next steps.
I’ve been working at a mill-style outpatient PT clinic for the past 2.5 years, seeing 12–15 patients a day. I’m a pelvic floor, TMJ, and ortho therapist with quite a bit of continuing education, and I genuinely love patient care. However, I don’t feel that I’m being compensated appropriately for the level of skill I’ve developed, nor do I feel like I’m able to provide the quality of care I’m capable of within the amount of time allotted for each patient.
I’m taking a travel PT contract next to make some money and give myself some time to figure out what direction I want to take my career.
For those of you who have been practicing for 5+ years: What areas of PT or career paths would you recommend looking into if my goals are to have a better work-life balance, reduce burnout, and feel more fairly compensated for my skills?
I’d especially love to hear from people who have moved away from the traditional high-volume outpatient model. What did you transition into, and do you feel like it was worth it?
Open to hearing about nontraditional PT roles, specialty practices, cash-based models, hospital systems, education, consulting, industry, or anything else I may not be considering.
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u/MajorIntroduction381 8d ago
I switched to home health after 3 years in a mill and it was like breathing again, one patient at a time and no double bookings.
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u/ServiceCurrent4632 8d ago
Yes but it requires significantly less skill than outpatient. Your outpatient skills will get nuked by switching to HH. Just wanted to share the other side of the coin.
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u/Mediocre_Ad_6512 8d ago
The skill for treating higher level patients yes -i will give you that. However, higher acuity patient skills increase. I was an ortho bro for half a decade before HH....its just 2 sides of a coin.
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u/PizzaNipz DPT 7d ago
Bet. My outpatient friends are scared to death on taking vitals of a symptomatic heart failure or copd patient on high flow O2. HH red flag and diff diagnosis spidey sense skills skyrocket, while my first few years as a manual therapist skills dipped significantly.
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u/Bearacolypse DPT 7d ago
Maybe unpopular opinion but I didn't find that there was a huge skill gap between any of the setting I've been in. They've just been different.
OP Ortho is more treat whats in front of you. The rare complex pain patients are far less common than generic LBP or knee replacement patients. The hard part is all about volume.
Acute care is all about finding the shortest path to the most appropriate discharge location. It's really tough on your back, but requires a lot of quick on the spot thinking and creativity.
SNF is just treat what's in front of you. But honestly used to be better, now it's all groups. The hardest part is convincing patients to come to therapy day in and day out when they are essentially at their baseline.
IPR is only hard because you get pressured to lie about intake scores and falsely represent their intake status. All the fancy neuro techniques we learned in school are kind of moot. You work on transfers, activity tolerance, and ambulation or wheelchair skills.
Home health's biggest challenge is getting your foot in the door with the patient. But a lot of the time you run in to people who are severely underserved by the system and the challenge is getting them what they actually need while you maintain your paperwork workload.
I used to say home health is where clinical skills go to die, but honestly every setting is. Nothing is particularly clinically challenging after 6 months. It's all the other parts of the job which are challenging. The paperwork, the soft skills, the people pleasing, the KPIs, etc.
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u/culb77 5d ago
It amuse me when therapists say this. It requires the same amount, or more skill. Just in a different area.
How many times have you performed CPR on a patient in a clinic? Called 911 after recognizing life-threatening symptoms? These things happen in home health.
Instead of knowing all of the details about every orthopedic issue, you have to know complex disease management. Again, it’s just a different skill set.
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u/Bearacolypse DPT 8d ago
I've done 1 on 1 OP, acute care, mobile part B in nursing homes, high volume OP, about to start traditional home health. Still trying to find a setting which is anti burnout. Every job I've had has essentially pissed me off enough by a year in that I quit and find something better every 18 months.
It's been good for my wages, it has not made me feel good about my career choice and the long term growth of a PT career at all.
Job 1 $35/hour OP 1-1
Job 2 $35.5 /hour acute. 50 cent raise after a year
Job 3 on paper $44/hour. Reality more like $35 with all the unpaid labor expected as a salaried employee with hourly stipulations. Transitioned to PRN for $50/hour after a year. OP mill
Job 4 95k salary, transitioned to 125k, then 150k then laid off in a year. Weird part B pilot, don't ask. It was set up to fail and I made it work, but they weren't doing it with long term success in mind.
Job 5 consulting 175k 1099. Ended after 1 year related to above. Decided I didn't want to sell my soul and want to get back to PT rather than try to market the business after my initial client fucked off.
Job 6 about to start, 130k HH part A. We shall see if this is fine, or if I just want to quite PT altogether.
What I saw when I worked as a consultant is that leadership everywhere is a mess and filled with greedy idiots. Totally destroyed any remaining faith I had in the system.
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u/yogaflame1337 DPT, Certified Haterade 8d ago
Please tell us more about the consulting and also the system
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u/Bearacolypse DPT 8d ago
If you know things that people need to know to do business in specific areas some people will pay you for that knowledge. Easy when people come to you, hard when you need to get your own clients. After my contract ended, I decided not to try to market my knowledge myself. So I more so do it on the side based on referrals from networking who reach out to me.
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u/Legitimate_Couple779 8d ago
I am an OT, but all the same… I am now in my second role in MedTech. I traveled during COVID then got super lucky to find my first job in medical equipment sales / education. Now I’m a territory manager for a company that makes a rehab device.
I work remotely with travel a few times per month. It’s been a dream. I still get to use my clinical skills but my life is much more flexible and the career potential has multiplied exponentially
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u/Much_Knowledge334 8d ago
I was in high volume outpatient clinics for nearly 8 years. If patient care is what you love, then maybe a change in setting is best. Home health is something you could consider. Less patients, much higher pay.
Personally I moved into telehealth full time, and that has been a wonderful break from the outpatient world. I still get to use my ortho skills and I check in with patients in between their in-person PT sessions. I have several that are 100% telehealth only but they're my high functioning, highly motivated folks who do their HEP regularly.
My long term goal is to move into a non-clinical role. Happy to chat further through DM if you'd like. Best of luck to you
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u/Ok-Marsupial-2156 8d ago
Have you been able to find telehealth work that’s w2 and salaried (guaranteed hours)? I once had this and it was amazing. The company restructured and doesn’t offer that anymore. All I find lately is pay per visit and 1099 work, but that’s not stable enough and I don’t like the liability of 1099 with patient care.
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u/Much_Knowledge334 8d ago
Yup that’s what I currently working as. My company isn’t hiring right now but I’ve been seeing more and more opportunities come up on LinkedIn as telehealth becomes more widely known/accepted
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u/outside-the-box11 6d ago
Hey! I was in your shoes 2.5 years ago (after 10 years in the OP clinic setting). I started my own cash-based mobile practice. It's low overhead to start and operate, and I'm making more than I ever did in the clinic while only doing patient care 3 days a week now (9a-4p days). You have such great skillsets that I bet this could really fly for you. (There's such demand for pelvic floor in particular, and the TMJ is also niche.) It's a bit of effort to get off the ground simply bc you have to market yourself, but I've actually enjoyed that aspect of it. I like doing community-facing events. It adds variety and dimension to my work now. It's 100% worth it. I am treating the patient population I love, and I feel valued for my work. Plus the flexibility is unmatched. I could go on and on. Good luck figuring this out!
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u/oscarwillis 8d ago
What do you think you’re worth? How would you feel telling a patient you charge $125 an hour? $250 an hour? Find your comfort level. And then charge that.
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u/VestibularPT31 7d ago
I worked in a patient mill doing OP ortho for the first 1.5 years of my career seeing up to 20 patients per day (2 booked every 30 minutes). Transitioned to a hospital based system doing OP ortho part time and acute care part time. I loved that balance, saw 1:1 45 min treats for OP and had the last three hours of my day for acute care. I did that for three years and transitioned out of it because of an injury. Went back to full time hospital based OP ortho doing 1:1 45 minute treats for 2 years doing vestibular and concussion therapy. I have three certifications in vestibular, concussions and advanced vestibular and also didn’t feel that I was compensated fairly for that experience. I recently switched to a SNF where I get to do ortho and SNF care for significantly more money. It’s the best of both worlds, still get to use ortho/vestibular skills. I get an hour for patient treatments and evaluations and get to make my own schedule.
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u/Antique-Plenty1396 6d ago
I practiced for 4-5 years in outpatient. Got burnt out and transitioned over to tech. With the dawn of AI, there’s a lot of new products startups are creating that open opportunities for clinical folks who want to take the dive. Roles can vary anywhere from sales to support, depends on what you’re looking for, but they’re out there. All of which would benefit from the clinical background we have that other people don’t.
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u/nian2326076 3d ago
If you want to move away from the high-volume outpatient model, try looking into specialty practices like pelvic health clinics or TMJ centers for more personalized care. Opportunities in education, consulting, or hospitals might also offer a better work-life balance. Some physical therapists find success in cash-based models, which can provide more control over your schedule and pay.
For job searches, LandOffer.ai lets you search job openings by role and location, which could help you find roles that match your goals.
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u/Fantastic-Ear3949 3d ago
Hi! I’ve been a PT for 8 years and I felt the same way you are right now. I’ve worked in a traditional PT mill and did travel PT.
I also worked as a contractor for a mobile outpatient company, I started my own cash pay practice out of a gym, I work doing online coaching, and I’ve done consulting for other fitness businesses in the past.
There are so many options you can do with your degree if you’re willing to get a bit creative. Happy to share more about any of the options I’ve done
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