I’m sure many of you have had patients who are transgender. One of the first things you look at before treating a patient is their medical history which often times will include evidence that the individual has transitioned. *gasp*

What now!?

How ever must you proceed??

Quite frankly, in many cases, you proceed pretty well as you would with any other patient. 

Is this part of their medical history relevant to what they are being treated for? Then perhaps it will be necessary to ask more about any operations they had and more specifics on the hormones or other medications they are taking. And I don’t believe you should feel afraid to ask them questions when it’s relevant.

But I do think you need to consider that last part…is it relevant to your treatment?

If it is relevant, then be mindful to ask the patient these questions in private. This is a very personal part of who they are and not all people who are transgender necessarily want to talk about it in the open clinic with other people around. They went through quite the ordeal getting to where they are today (much of which includes stress you have no clue about). So be respectful of this part of their medical history and ask them in private about details. Maybe you’ll find them to be quite open about it, but that isn’t your call to make, it’s theirs. Also remember transgender people suffer from gender dysphoria to varying degrees and some may not want any reminding or referencing of their former lives. This is doubly important with early transition transgenders where misgendering and deadnaming can be hurtful. Please make sure legal names are covered or out of the way to prevent these issues.

Another point I really wanted to make in this video is this: avoid gossip with coworkers regarding patients who are transgender. I’ve found myself twice already where a patient who is transgender is in our clinic and someone who saw that private piece of their medical history just couldn’t keep it a secret. These patients were well transitioned…it was NOT obvious that they were transgender. And now, suddenly, I saw this very intimate and private piece of who they were being shared without permission (and quite frankly in violation of HIPPA) and it really bothered me. I know it seems innocent and I think it’s important that I even mention that everyone I work with is cool with transgender folk (I don’t want to insinuate that they talked badly about these individuals and I’m so thankful that is not the case). However, privacy is privacy. It’s not your place to share any medical history with someone else in the clinic just for the sake of gossip. 

One of these patients was my patient and I had really good rapport with them…but even I never talked to them about it because it was not relevant to the specific injury they had and they gave enough written information on the medical history form that I didn’t feel the need to ask more. This person was a man. Simple as that. I saw them as a man and it was quite obvious that is who they identified as. Why bring up their history of transition to them or a coworker if it wasn’t relevant to treating them? If they volunteeringly brought up their story, that is a different situation where more conversation could be had. But there really are a lot of transgender folk who don’t want to be asked about it unnecessarily. They just want to be as they are and we owe it to them as their healthcare providers to maintain that privacy for them.

I am not transgender, but I really care about patient privacy, particularly so of a patient population that is already very vulnerable in society. Let’s try to care more for our patients who are transgender, respect who they are, and maintain the privacy of their medical history.

(Video1) Step 1: Where Should You Apply? 

• WHERE ARE YOU GOING? Some of you might want to go back home to be closer to family. Some of you might be moving to the city your significant other lives in. Some of you might have loved an internship so much that you want to work there. Some of you might be going to a new and crazy place. That’s all fine. 
  • But obviously you have to figure that part out first. Some people might feel like they should go where the ideal PT job is…but to be honest there are PT jobs ALL OVER THE PLACE. 
  • It’s a little overwhelming to just start looking for available PT jobs for any state, any city. Make it easier on yourself…FIGURE OUT the WHERE.
• Once you know the region, city, etc…start looking up available PT jobs. Look up “physical therapy jobs in ____” on google. Indeed.com and glassdoor.com often have a lot of positions available.
• And if it’s an option for you, don’t pick your housing situation until you know where you are going to work. 
  • Choose to live a little closer to where you decide to work, rather than work close to where you live. If you do the latter, you might say no to the better option simply because you have to travel further…and that’s not a great way to make decisions.

• FOLLOW YOUR PASSION
  • Pick a setting based on your passions: Go for what you’re most passionate about. Ortho? Neuro? Outpatient? In-patient? What struck your interest most during your internships? You may have a ton of interests, and that’s okay. But reflect on what stood out to you the most during your time as a student and let that guide you.
  • This might change during your first year as a practicing PT…that’s okay!. It’s natural for you to be figuring out what you are passionate about in that first year or 2.
• INVESTIGATE
  • Use your resources in the area: If you know PTs in the area you are moving to who may have advice about good PT companies…LISTEN to them.
  •  I had an advantage because I did an internship in Baltimore as a student, so when I returned to work here for my first year I naturally checked out the same company (which has several clinics in the area). I found a couple openings and I asked my past CI about his opinion on these companies which lead me to apply to where I work today. You see, even though he worked at another location, PTs  in this clinic cover at other clinics all the time so he had valuable information regarding what kind of a clinic it was, who the supervisor and regional director were, and if they were good. 

(Video 2) Step 2: The Interview

• INTERVIEW TIPS: 
• Tip 1: KNOW THEM, BEFORE THEY KNOW YOU. Look at their website, what is their mission statement? What do they specialize in? How many PTs work there? How old is this clinic or hospital?
  • This will help you come up with more specific questions about the position
  • **Not only are they interviewing you, but you are interviewing THEM. Show them that you did your research.

• Tip 2: YOUR QUESTIONS. 
  • Important questions to ask:
    • How many patients would I typically see in a day? I made my limit at 12. And in my opinion, if any clinic has you regularly seeing much more than that, you are setting yourself up for BURNOUT. BE CAREFUL. 
    • Is there mentorship? What does it look like?
    • Ask them how available they are for questions and advice on a patient’s POC.
    • Ask what their goals are for the companies growth. 

• Tip 3: THEIR QUESTIONS 
  • This will vary from place to place, but here is a starting point.
  • Your toughest experience with a patient and how you handled it.
    • Take time beforehand to really think about those tough patients you had as a student…think of a mean one, an anxious one, a fearful one. Have several examples in your head and write them down on a notepad if you need a memory jogger during the interview. 
  • Your toughest experience with a co-worker and how you handled it.
    • Maybe you didn’t have a bad interaction during an internship, but take time to think about if you did. If you did not, think about jobs outside of PT (after all, this is your first job as a PT so you may need to tap into prior experiences before interning). Again, write several examples down. Who was mean, demeaning, uncooperative, a bad team player…and how did you handle it? If you feel like you didn’t handle it well, say how you could have handled it better and how. 
  • Weaknesses…be honest. Don’t pretend you are perfect. What were common obstacles you faced in the clinic as as student? Documentation is a common thing to say, maybe it’s developing more confidence in performing an evaluation. But maybe try to say something that stands out a little more such as “I want to learn how to get a patient to trust me and the profession on day 1”, or “When a patient hates exercising, I know I have more to learn on how to get that patient to buy in”, or “I noticed CIs often had really unique ways of explaining a diagnosis to patients and I want to learn how to do the same thing.” Maybe add in “I’m hoping you can help me grow in those areas.”
  • Strengths…be confident in your strengths! What did CI’s compliment you on during internships? Those are strengths. Give yourself credit. Don’t hold back. Even if that strength was more neuro based and your applying for an ortho position, bring up any strengths. 

• Tip 4: SHOW THEM YOU ARE AN ASSET. 
  • Add what you could offer to help the company grow…maybe it’s an ortho clinic and you have experience with the neuro population…ask them if they are open to you helping to bring in these new populations to the clinic. Employers get excited to see someone who wants to help the company GROW.

• Tip 5: Be polite, kind, and CONFIDENT. Yeah, you’re a newby. Everyone knows it. But that doesn’t mean you have to act like your clueless. Be clear in the way you talk, make eye contact, and be prepared. 

(Video 3) Step 3: Which Job Do You Take?

• OBSERVE them before taking the job: See if you can observe/shadow before taking the job! This will give you a chance to ask other PTs what the workplace is like, how the supervisor is, what mentorship looks like, etc. And pay attention to how that PT is acting…do they look happy? Do they seem exhausted? Do they promote their workplace? What did you think of the quality of Tx they were giving their patients? Ask them how many patients they see on average in a typical day (was it the same number the employer gave you?). 
• REFLECT When you walk out of the clinic, take time to reflect on what the experience was like. Did they make you feel comfortable? Did they ask you good questions? Did they seem interested in YOU being a good fit for the company? Do you feel you are a good fit?
• GET SEVERAL INTERVIEWS – Never only do one. Even if you are not sure about your interest in a clinic, try to get several interviews. It will be good practice and you will learn something during each interview to help you do better at the next one. Plus you never know how you will feel after leaving an interview. You might think the first one sounded great, but then the 2nd or 3rd interview might be even better.
  • If you feel stuck. Get advice from PTs who you trust who are ahead of you in the profession. It can be helpful to have someone else’s input to help you make a wise decision. 

• Negotiating
  • Don’t ask about the income right off the bat. That looks bad and you don’t want them to feel that is all you are interested in. BUT, don’t leave an interview without asking about income and benefits. Those are important questions to ask.
  • And don’t be afraid to negotiate benefits or a salary when you are offered a job. Just because you are a new grad, doesn’t mean a company won’t give you a little extra. Especially if they really want you. And even more so if after offering you a job, you let them know you are deciding between them and one or two other positions. Now they know they have competition.
  • Be realistic, but don’t be afraid to ask. At worst, your request will be turned down. Whatever. As long as you were professional and realistic, they won’t think less of you for asking for more. Do some research online and ask other PTs in the company or in the area who you may know what average pay is for new PTs. That way you aren’t way out of line with a salary request.
• My personal experience
• Sometimes you can feel like you landed the perfect job…and it’s not. Remember that you are NEVER stuck. No matter what, there is some stress when starting a new job (new documentation system, getting to know the people you work with, over thinking every little thing that you do, etc).

• If the job you land makes you unhappy, miserable, or makes you feel burnt out…GET OUT. Don’t let a crappy PT job ruin your love for the profession.
• I’d say give any job 2-3 months. If there are issues, verbalize them to your supervisor immediately. Give them a chance to make things more comfortable or to give you the support you need to flourish. If after reaching out several times…you are still miserable, overworked, or feel like you are lost and without the proper mentorship or guidance…why would you stay there? If your supervisor is annoyed everytime that you ask them a question, they are going to be like that whether you stay 3 months or 12…so why do that to yourself?
• I’m all about trying to stick it out for a year or 2 with the same company because it looks good and can be really rewarding to get and give all you can over a longer period of time. But do that with a GOOD clinic. Not a terrible one.  Again, it’s not worth losing your love and passion for PT all because you tried to stick it out with a company that never had your best interest in mind. You are worth more than that. There are employers out there that will really help you grow and flourish. Find them. Go there. 

Today I’m going to talk about a topic that is somewhat of a hot topic in the PT field…I am frustrated that it even IS a hot topic, but we need to talk about this.  I made this video to break down the reasons why introducing ourselves as a “doctor” of physical therapy has become such taboo in our profession and what our role is in breaking out of this box.

History:

Physical Therapists haven’t always been Doctors. There is a History of our profession with big changes being made in relatively recent decades.

We went from a certificate (1900-1930) to a B.S. in another field with a certificate in physical therapy (1930-1950)  → B.S. in PT (1950-1980) → Masters (1980-1997) → to a Doctorate by 1997…and now, as of 2015, all PT programs are at the Doctoral level!

Why did this evolution occur? 

Because it needed to. Because physical therapy is an incredible field that can have a profound impact on people’s function for the better and healthcare began to see the way that PT could be utilized in treating patients. They saw decreases in the need of surgeries, decreases in the need of pain and other medications, improvements in function and increases in the independence of patients…and therefore an overall reduction in healthcare costs. Many PTs before us fought for our profession to be looked at more seriously as an alternative form of Tx for many patient populations.

This was exciting!

But as we came into the spotlight, we realized we had to prove that what we did worked. There wasn’t very much research happening before the 70 and 80s in this field and there were a lot of doubters out there challenging the efficacy of our treatment. And for good reason! Through research we have indeed found that former treatments that used to be commonplace in PT were indeed not effective, and through research we have found value in what is effective. PT used to mainly be modality based and very passive. In fact, did you know that for a long time physical therapy was not even a profession…it was a treatment or commodity or thing that one would perform. But now we are a PROFESSION. We are still fighting those old perceptions. The push in our profession is that A PCP should no longer be prescribing physical therapy, they should be referring to a physical therapist. See the difference? 

PTs began taking initiative to grow. They knew our field couldn’t stay the same and that if we were to be taken seriously as health care professionals we needed to up our game.

That’s why the profession eventually progressed to a Masters level program. This was a push to increase our knowledge of the body, anatomy, the study of movement and biomechanics and to teach PTs how to read and value research.

And we didn’t stop there, we went further. The doctorate programs began to arise as we realized more and more the need of an understanding of not only what we treat as clinicians but also the need to see what else the patient may have that requires treatment outside of our scope of practice. We have been pushing to have direct access to patients…in other words, we want to be able to have patients come straight to us by being referred to a physical therapist rather than getting a physician’s prescription for physical therapy. We want to be considered capable of being autonomous. But we can’t be trusted to this direct care without the ability to see reasons for them to be treated elsewhere. We had to be educated more on how to catch red flags and get our patients the help they needed. 

And beyond that point, having a doctorate pushes for a level of respect our profession has always had difficulty attaining. It is pushing insurance companies to recognize that we have a level of education worth respecting, reimbursing, and worth providing patients direct access to. It has also shown other healthcare professionals the same thing. There is still growth needed in this area, but growth is indeed happening!

There is actually a long history of some PTs being uncomfortable with the push our profession took to become doctors of PT, but for all the reasons stated above, I’m hopeful that you can see why it was an important evolution that occurred. There are PTs who have fought hard to get our profession to this point. The bar has been raised! And we are expected to rise to the challenge. 

This all leads into the hot topic.

Physical therapists who have graduated from a Doctorate of Physical Therapy Program ARE doctors of physical therapy. According to APTA we have the right to put the prefix Dr in front of our name due to our academic degree. When it comes to how we introduce ourselves to patients, different jurisdictions do mandate this a bit differently. But in many states, we have the legal right to introduce ourselves as doctors (of physical therapy) to our patients. And yet…a lot of us never do. And worse, a lot of us are ashamed to do so. And even worse than that, I’ve heard PTs tell patients they are NOT “real” doctors! 

What is going on?!

I’m going to touch on the reasons I’ve heard some PTs give for doing this (some of whom are my friends). I also want to hash out some counter arguments for each one.

• “Some patients have bad experiences and distrust of the “doctors” in their life. I don’t want them to think that way about me. I want to be fun and approachable.”

Then be the first doctor to give them a great experience! Why is it that patients get irritated at their PCP or other kinds of doctors? Because they don’t feel heard. So make them feel heard, which is something unique our profession offers our patients. I’ve had many patients comment on how thankful they are to have been heard by myself and other PTs. You don’t have to ditch your title and dumb yourself down to make a patient respect you. They respect you for the way you treat and listen to them. I personally have never had a patient run out of the clinic because I called myself a doctor of physical therapy. In fact, I have seen the respect increase by patients knowing that I am not just any doctor, I am a doctor who will listen to them. And this doctor who listened to them is a doctor of physical therapy. Score for our profession!

How many of you have gotten frustrating questions from patients like, “so how many months did it take for you to get your certificate in PT?”.  Well, you can’t get all that annoyed if you don’t allow space for your patients to know your title in the first place. Give space for even your patients to be educated on your level of education! It won’t run them off, it increases respect. I hardly gotten any of those frustrating comments since I started calling myself a doctor of physical therapy.

• “No one else in my clinic calls themself a doctor of physical therapy, so I feel uncomfortable doing so. I’m not sure where everyone stands.”

I hear you there. It was the same way at my first job and it was really hard and confusing to me why my DPT colleagues didn’t call themselves doctors or would even deny such a title. And I think respect towards your coworkers is very important regardless of differing opinions and that it’s not a bad idea to bring this up to your superior to see where the clinic stands. I did ask my supervisor about it and (in short) she didn’t have an issue with me using the title. It’s also very important to check what the law allows you to do in your jurisdiction. In my state, I can call myself a doctor of physical therapy. So once I did this research and asked some questions, I decided that at the very least, I was going to introduce myself on Day 1 as Dr. Walkup (your physical therapist) followed by the permission to call me Mel. This way I was able to accurately use my title with my patients while also not feeling uncomfortable by being the only PT who was having her patients call her “Dr.” all the time. This has worked great for me. Oftentimes a patient will even ask about my education on that first day or later which has helped me educate my patients on how far our profession has come and I find this very important and helpful for patients to know these facts.  I want every patient of mine to leave with a positive experience and with a new understanding that our profession is not what it was 20 years ago. I want them to know they were treated by a DPT who really took good care of them.

• “My mentor has her/his Master’s and it feels demeaning to call myself a Doctor when she/he has so much more experience, yet doesn’t have the title.”

I will never encourage any kind of belittling of our colleagues who do not have a Doctorate. Because they absolutely do have experience that is highly valuable and something we DPTs have a lot to learn from. So absolutely respect all levels of education in our profession. However, you are worthy of being respected as well. You worked hard to get to where you are and no one above you has the right to make you feel as though you cannot use your title of doctor. It’s your right! No one’s technically allowed to keep you from using Dr. in your name. I’ve heard of people who have been discouraged in the workplace by superiors to not use the title doctor and I believe they are doing the profession an incredible disservice by doing this. It is also demeaning to a DPT to tell them their level of education is not meaningful or that all colleagues should be looked at from the lowest level of education rather than as they are. That is lowering the bar. Not raising it.

We need to build each other up. We need to be on the same page about this. Our profession needs to stand together and push each other towards dignity and respect for each other and the route that got us to where we are in our profession. I think that for a long time our profession was so at odds with other kinds of doctors that many are still bitter towards the title. But we are in a new age now. If you are a DPT, you are a Doctor of Physical Therapy. And you are called to rise to everything that this title means. Be an approachable, listening, friendly, and professional doctor of physical therapy who has every intention to optimize your patient care and rapport. Whether you have all of your patients call you Dr. or you introduce yourself as a Dr. on day one with the permission to call you by your first name from then on…please know that you are indeed a doctor of physical therapy.

References:

http://www.apta.org/PTinMotion/2006/7/Feature/TheFutureofPhysicalTherapyEducation/

http://www.apta.org/PTinMotion/2014/11/EthicsinPractice/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076909/

http://www.apta.org/TermProtection/

http://www.apta.org/PTinMotion/NewsNow/2014/7/10/HoDDPTDesignation/http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Licensure/ConsumerProtectionthruLicensure.pdf#search=%22regulatory%20designator%22

• Learn from your Mistakes
  • Be willing to learn from mistakes and be guided by your mentors and colleagues.
  • Being humble goes a long way that first year (and beyond). You’re going to do some things wrong. Or it will be made to you how you could do things better. Try not to get defensive. Listen and learn. Ask clarifying questions.
  • It’s okay to make mistakes, the important thing is to learn from it and grow as a result.
• Embrace Critiques
  • It’s not okay to be constantly belittled by your supervisor or anyone for that matter. But don’t mistake helpful suggestions as an attack.
  • You don’t totally know what you are doing yet, it’s okay to have guidance
  • Having guidance from someone you work for or with can help you grow; in fact, I would ASK for critiques from someone you trust.
• Speaking of that, watch your colleagues…find their strengths
  • When you see your mentor or colleague is indeed a good PT and does really well with certain patient populations…listen to their critiques or even ask for advice on how to be better.
  • I’m sure most of us can learn a lot on our own, but I assure you it will take longer. Help speed up the process by soaking up the knowledge and expertise of the people around you.
  • For example, if one PT is particularly good with athletes, try to bring up discussions with them about an athlete you are working with and see if you can do even better based on tips they may provide.