"Maintain the Spectrum or Master the Specialty" -- Which is better?

[markelmarcel]

For those of you that don't know, when you are a new grad and a member of the APTA you get a magazine called "Perspectives" with your monthly PTJ/PT in Motion. Perspectives is for PTs/PTAs in the first 5 years of their careers. So, it offers articles and advice on things that newer clinicians may have questions about. So far, this magazine has been a really good read, and I appreciate that the APTA thought this up!

In any case, in the Sept. 2014 issue there is an article about whether it is better to maintain the spectrum (or becoming a well-rounded clinician) versus specializing to the patient population you are treating. I found both points to be interesting, but wanted to bring the conversation here.

So, for those of you that are new grads and for those of you that have experience-- which do you feel is more advantageous? Focusing on being a well-rounded clinician or focus on becoming an expert in a specialty?

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[Fiveoboy11]

Well rounded AND specialized.

 

[jesspt]

For those of you that don't know, when you are a new grad and a member of the APTA you get a magazine called "Perspectives" with your monthly PTJ/PT in Motion. Perspectives is for PTs/PTAs in the first 5 years of their careers. So, it offers articles and advice on things that newer clinicians may have questions about. So far, this magazine has been a really good read, and I appreciate that the APTA thought this up!

In any case, in the Sept. 2014 issue there is an article about whether it is better to maintain the spectrum (or becoming a well-rounded clinician) versus specializing to the patient population you are treating. I found both points to be interesting, but wanted to bring the conversation here.

So, for those of you that are new grads and for those of you that have experience-- which do you feel is more advantageous? Focusing on being a well-rounded clinician or focus on becoming an expert in a specialty?

Which do you think your patients prefer? I can tell you that mine want a specialist. Whether it be their surgeon, therapist or another ancillary health care provider, they want to know that the clinician they are consulting is specialized in their particular area of need.

 

[DesertPT]

I'm not a PT yet but I think I hope you'll permit me to hazard a response anyway.

I have to agree with jesspt. I think there is a lot to be said for being a master of your chosen trade or profession. My father-in-law worked in construction using a blade rig and a scraping rig (road graders) to build roadways and building surfaces. Most nowadays have gone to GPS/laser guided equipment, but he always did it with the old fashioned all manual machines, and everyone he worked for said he was the best they'd ever seen. They said he could use that 14 ton machine to pick up a dime without making a divot in the dirt.

That obviously has nothing to to with healthcare, but it has served as an example to me of how to take great pride in your work and be an expert at what you do, and how much people respect that. In PT it is definitely important to have a thorough all around knowledge of how to treat all varieties of injuries and illnesses for which physical therapy in indicated. Indeed it is important to have a good enough knowledge of human health and healthcare to be able to also know when physical therapy is not indicated, or when referral to a different clinician is more appropriate. But just as I would rather see a rheumatologist for an autoimmune disorder, though an endocrinologist certainly has enough know-how to provide basic advice on the issue, I would rather see a PT who is highly trained in neurorehabilitation after a stroke, thought the PT working at Top of Your Game Sports Therapy could probably provide some measure of assistance.

I believe there is a lot of value in PTs becoming more and more specialized, but as this happens we need to make sure that PTs are willing to refer patients to someone more qualified than themselves when appropriate (which can be difficult financially sometimes) and that patients are able to get access to PTs that are trained in their area of need. I don't know what the solutions to these issues would or should be. There is also a danger that PT will continue to experience the credential creep unaccompanied by equivalent compensation increases that the profession has seen over the years (eg residencies becoming mandatory without notable salary increases). We would certainly have a lot more highly specialized PTs if things worked like medicine, where residency/fellowship/board certification in a specialty equaled much greater compensation than being a general practitioner, but I don't see that happening to the profession anytime soon. I guess only time will tell how the role of specialization evolves in PT.

 

[markelmarcel]

I agree with both of you. I didn't have time to post my opinion with my OP (and I'm sure there are some horrid grammatical errors in that post) as I was rushing out the door; I just wanted to get a conversation going.

I feel that, as jesspt stated, that my patients would value me more being a specialist, rather than a well-rounded therapist. I think it's important to be at that entry level so that no matter what job you get into you can succeed, but I can tell already that after only 7 months of practice, I would be able to help my patients even more as I consider specialization.

I just thought it was an interesting point/counterpoint.

 

[jbizzle]

I actually agree with both. I need to find this issue as my student APTA membership has expired.

I haven't started practicing yet but this is actually a good discussion and wanted to hear from more people.

I have actually been thinking about this for a while now, 2 years to be exact, when I first started my clinicals and realized how "clinical skills" can deteriorate if you don't practice, which usually happened to me because how our program was set up. But since then I always asked myself "if I stayed in just one setting would I lose my "clinical skills" in the others."

As I was heading into my final clinicals before I graduated I asked my CI (who hadn't worked in an outpatient clinic in about 20 years and has been working in the SNF this whole time) if he would feel comfortable performing an outpatient ortho eval for low back pain, rtc, impingement, etc. and he said he wouldn't be able to with confidence, and would need supervision. I also asked another CI (who initially worked with pediatrics for 3 yrs, and was my CI at an inpatient rehab hospital for 3 yrs as well) and she said it would probably take her a while but eventually she would get through it, but she would need supervision.

So the thought of being well rounded so you could "succeed in whatever job you get into" sounds really good to me BUT like markel and jess had said, I have worked with patients in a SNF with neuro disorders and would have loved to have more knowledge for them to benefit from.

The only thing I could think of at the time was to work in multiple settings PRN and specialize in what I was passionate about but thats not realistic…for me at least.

Wow this is great, wish I still had the monthly issues.

 

[DesertPT]

Ultimately specialization is going to require you to give up a lot of other areas...some people are hesitant to work in inpatient world for fear that they will lose the more "technical skills" learned in PT school, but it is a totally different specialty. Both outpatient and inpatient experts have to be their if every patient is going to get the best care possible. Economically speaking, carving out a niche for yourself is almost always a good thing too.

It's the same in any field...we all forget 90% of the details we learned in undergrad...and you wouldn't trust your cardiologist to treat you for cancer...I'm sure most cardiologists know more about cancer than the layman, but its just not their specialty.

 

[markelmarcel]

jbizzle, I can try to scan the article and email it to you, if you'd like!

 

[callmecrazy]

Ideally, of course it would be great to maintain skills across the spectrum. But in reality, I'd choose being deeply knowledgable about treating in my setting over having new-grad knowledge in everything. As a pediatric school-based PT at a specialized special needs school, my role is unique compared to most PTs and even unique compared to other general school-based PTs, so I feel I should respect it and treat it that way. I'd rather give my 25 kids great care than know I could give generalized care to anyone. I'm committed to the pediatric path though, and I'm honest with myself in knowing I'd make a terrible outpatient ortho PT today without a lot of refreshing. At this point, and I'm only a little more than two years out of school, being well-rounded means working PRN with outpatient peds so I don't loose my skills with infants and higher function children!

The only exception that would make me lean the other way is if you have plans and aspirations in a setting different than where you are. If it's your passion, you're going to stay informed and keep learning anyway though.