Why does it seem that PTs are so against the hospital setting?

[Bad0 Fish0]

This has been discussed on other forums I'm a part of, but I'm interested to hear a different set of opinions. It seems that many therapists are very against acute care, couldn't stand it in school, and refuse to work in a hospital. I've heard all types of negatives remarks about this and reasons for it, but I'm curious if anyone on here works (or has worked) in a hospital setting, and why they do or don't like it. It also seems that the APTA leans more toward private practice as the preferred setting for PTs to work in.

Comments?

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[PTbecomingDDS]

I remember hospital work being very physical with moderate to max. patient transfers. I think this is why I stayed out of the hospital environment. As for the APTA, I think the push for more private practices is to reduce the number of physician owned ones and to make PT's more autonomous, as PT's work under a MD/DO in the hospital setting.

 

[PT2MD]

1) Longevity - hard to make inpatient a career
2) Poop
3) Pee
4) Puke

 

[Bad0 Fish0]

1) Longevity - hard to make inpatient a career
2) Poop
3) Pee
4) Puke

I understand that, but we aren't caretakers, we're therapists - is that really our job to deal with that?

 

[Taylor355]

Aside from rehab & burn units, the work done by most inpatient “acute care” PTs is not skilled care (IMO).

Unarguably it is important for patients to maintain mobility for many physiologic reasons while in the hospital, but often times this could be delegated to a PTA, or even a tech for more stable patients. Part of this responsibility is the PTs, but part of it is department managers not supporting PTs who want this practice to change. Internally much more can be done to educate other hospital providers when and when not to consult PT. (Physical therapy is a profession, not a service.) However, I haven't interpreted any action against inpatient practice by the APTA to encourage autonomy through private practices. PTs work for the hospital, not for the MD/DO.

Many inpatient PTs must also refresh their exam and treatment skills beyond how to read and interpret a chart, assess gait and transfers, document, and clock out at 4pm every day. These PTs are often very smart people who I think either chickened out, or copped out. When there are patients who need to be admitted for pain control for a musculoskeletal conditions, and inpatient PTs will d/c without treatment because they "don't know what to do for these patients—that’s ‘outpatient’ therapy". That is a bad excuse!! (Read articles, take a continuing ed. course, or even try e-stim!)

As a student, I recall seeing a patient admitted for chest pain, given a 10K work-up, and when things were looking like chest wall--the astute physician called PT to see what we though. My preceptor was freaked out by this unusual request, and wanted to just give her a hot pack (and walk with her). I convinced the preceptor to allow me to do a more detailed exam found and treated a rib torsion and the patient's symptoms completely resolved. Not too tough. (This is now part of why I work in the ED.)

Hopefully with more doctorate-level PTs entering the profession this practice will advance from it's dark ages. It could be much more useful, cost effective, and attractive to other PTs.

Other thoughts?

 

[Bad0 Fish0]

I really appreciate your reply, Taylor. Great thoughts.. and ideas, too. I'm with you - I surely hope we will see this change in the future. PTs could have a lot to offer the hospital setting.

 

[truthseeker]

I really appreciate your reply, Taylor. Great thoughts.. and ideas, too. I'm with you - I surely hope we will see this change in the future. PTs could have a lot to offer the hospital setting.

I work in a rural hospital, 25 beds, but started in OP ortho. Still, 75% off my patients are OP and mostly ortho. The reason IP is maybe less satisfying is that many people do not understand that the changes in a patient in OP are often easier to see. The goals the patient sets are sometimes easier to reach because of a lack of co-morbidities. Take an old lady with hx of compression fractures and serial pneumonias. She wants to be able to climb the stairs to get to the bathroom in her own home where she raised her kids. You can't fix the shape of her spine but she can do some things to make the pneumonia less likely to occur. Also, some of the IP we treat don't have all that good of a prognosis so treating them exclusively, like some people in large institutions do, can get depressing over time.

Personally, I agree with Taylor's post. That said, I much prefer the OP ortho patients because there is a beginning and an end with their treatment. Job well done, thanks and I will see you on the golf course.

With the IP, often their deficits linger compared to younger patients but small improvements might mean a lot to them. Either patient group can be satisfying.

 

[PT2MD]

I always thought similar to Taylor. Inpatient PT was too unskilled for my tastes. Now in certain areas such as the ICU or NICU, things are very different. On the med/surg floors, I always felt like I was around to lift heavy objects (i.e. patients). Once the patient could walk 200 feet, they were gone. Not exactly what I would like over the course of my career.

Inpatient PT's might disagree with me strongly, so it is likely a matter of perception here. I'm not saying inpatient PT's are unskilled, but inpatient PT doesn't match my interests which is outpatient ortho.

That being said, even with outpatient ortho, I know way more than I'll ever use in the clinic. Sometimes even that feels pretty underwhelming. Treating ACLs, TKRs, SLAP, Bankart repairs etc, and mechanical LBP get's a bit routine sometimes. It's good to have some variety and a reason to stay sharp. I routinely take PT students at the clinic on their rotations and that helps keep me from sleepwalking.

 

[blast7]

It really depends on where you work and what your leadership is like. I work in a level 1 trauma center with great staff and good leadership. We are encouraged to educate MD's on appropriate/inappropriate referrals and discharge patients who do not need skilled P.T. Inpatient work can seem to be boring at times because with the acuity of the patients there are only so many things you can do. However at other times you can also do some other very cool stuff. For instance I taught someone how to walk with 1 broken femur and 2 broken tibs s/p ORIF. It was very cool. Also inpatient requires much more medical knowledge(i.e.labs, contraindications/precautions to exercise, surgical procedures, pharmacology). I think it is a great place to start and there are many opportunities available.