Hospital-based and private-practice facilities offer physical therapists unique learning experiences.

Deciding whether to pursue a career in a hospital-based or private-practice facility is a significant decision for physical therapists (PTs). While some PTs have skill sets or personal interests that clearly suit job functions at hospital-based versus private-practice facilities, other PTs experience a self-assessment process to find out which career path works best for them.

Starting Off

Upon finishing graduate school with a doctorate in physical therapy degree from the University of Southern California in Los Angeles, I knew that I wanted to focus on outpatient orthopedics with an emphasis in sports physical therapy. However, I also knew that I needed clinical experience. I was fortunate enough to have had a long-term clinical rotation at Cedars-Sinai Medical Center’s Outpatient Physical Therapy clinic in Los Angeles. My clinical instructor was excellent, and I learned a tremendous amount clinically from him and others in the facility. As graduation neared, I was left with the decision of whether to accept my first job at Cedars-Sinai or in a private practice that catered to the more athletic population, which was exactly the patient population in which I wanted to specialize.

I knew at the time that my long-term goal was to own my own practice, but I realized, more importantly, that I needed to gain clinical experience. Therefore, I decided to accept the position at Cedars-Sinai Medical Center. Cedars-Sinai is an excellent hospital with an amazing outpatient physical therapy department. There were many reasons for starting at Cedars-Sinai and foregoing the opportunity to go right into the world of private practice. First, Cedars-Sinai offered a mentorship program that placed new graduates with an experienced PT, which enabled me to discuss patient problems and treatment methods with that person. These meetings provided a safe place to ask questions regarding patient care and to review clinical and documentation issues, giving me the opportunity to foster confidence in my clinical skills.  Furthermore, the patient load was manageable for a new graduate, which left time for charting and other managerial work. Being affiliated with a large teaching hospital, I also had the opportunity to be involved in research—which would have been otherwise difficult at any other smaller outpatient facility. The hospital also provided weekly grand rounds on a variety of topics presented by physicians at Cedars-Sinai for all health professionals willing to attend. Having these learning opportunities readily available promoted an environment of continued professional development.

Most importantly, at Cedars-Sinai I was exposed to a broad scope of patient diagnoses within all different age groups. Treating a variety of patients gave me the opportunity to get a feel for the type of patients, diagnoses, and injuries I really enjoyed treating. As time went on, I found that I was developing a passion for treating patients with spinal disorders and running injuries. I also started to meet other health professionals, including physical therapists, physician assistants, and physicians. Meeting these professionals would eventually prove beneficial when I searched for my next job. I learned early on that the more people you know in the business, the better it is with regard to possible future jobs and referral sources.

Transition to Private Practice

After 2 years at Cedars-Sinai, I felt that I was ready to move on and find a job in private practice to continue toward my ultimate goal: to own my own physical-therapy clinic. My motivation to move to the private-practice setting was to learn the business of a physical therapy practice—which includes insurance and billing issues and proper reimbursement—and most importantly, to learn what sets a successful physical-therapy clinic apart from not-so-successful ones. I was fortunate enough, through a recommendation by a physician, to be hired on at a well-established private practice in Beverly Hills, Calif, that has been providing physical therapy to the local area for many years. It was important to me that I work for a well-established clinic that had already gone through its initial growing pains. Because of my experience in treating spinal-injury patients and working with athletes, I was hired primarily to develop a spine program and promote those programs to the local physicians.

Five Key Lessons

While graduate school prepared us to be excellent PTs, we were not exposed to any form of business classes. Therefore, I had no understanding of what it took to run a business, let alone a physical-therapy practice. While working in a successful private practice, I have learned a few key elements that are crucial to the success of the business of physical therapy.

First, communication between the therapists, management, and front-office staff is crucial for the flow and productivity of the clinic. It is essential that everybody knows what their role is in the clinic, that goals are established, and that everybody is working to achieve those goals. For each employee to understand their role in the company, there needs to be organization. Employees want to know the how, what, and when within the clinic, and this organization allows for clarity in the workplace.

Second, getting to know physicians and other referral sources needs to be a constant work in progress. Know early on what type of physician and patient you want to market to and why. This can be answered by committing to understanding the strengths of the PTs and the clinic, and to use those strengths to market yourself appropriately. This can be done daily through writing progress notes, calling physicians regarding patient care, and performing community services through lectures and pro bono work when appropriate. I have found that donating time to a local high school, junior college, or club is a great way to meet potential patients, and most importantly, is a wonderful way to give back to the community.

One of the best marketing tools that I have found is something that PTs inherently should display while working in the clinic—pride in their work. A patient who is satisfied with the treatment and care they receive more than likely will report back to the referring physician. This, by far, is the best marketing tool, and it is invaluable to the growth of any new physical-therapy clinic.

Third, make it a priority to understand billing and insurance issues. To be successful in any business, you need to know how to get paid. Really understanding the ins and outs of billing and how different insurance companies reimburse for services is important for the clinic to be successful financially. Today, it has become very difficult to get paid for our services. A good physical-therapy clinic should have one person that makes billing issues their priority. This will help ensure that the clinic gets paid for the services it provides. Unfortunately, if you do not have smart billing practices, it will be difficult for your clinic to survive—no matter how good you are as a PT.

Fourth, having a good ancillary staff, one that can multitask and troubleshoot patient situations when necessary, is important for clinic flow. Finally, and most importantly, the employees need to share similar professional values and work ethics, and be self-motivated clinically and professionally. This will enable the managers to support their employees with issues that may arise with patients and physicians.

One of the major differences between a big hospital-based facility and a private practice is that a hospital-based facility has well-established referral sources, which take little energy to maintain. Within a private practice, referral sources are the cornerstone of a good clinic. It takes energy to establish and maintain quality referral sources. Nurturing that professional relationship is crucial to the growth of a practice. In addition, hospitals are large, well-established facilities, which can make change very time-consuming and difficult. There are usually multiple levels of management, which can also make those changes difficult and frustrating.

Within a private practice, it is important that there is a firm foundation. However, room for improvement should always be welcomed. This makes changes to the documentation and paperwork, equipment, and scheduling manageable if it can help the clinic be more successful. I have learned to use every day, every patient, and every professional experience as a learning tool to make the practice better, with the ultimate goal always to provide patients with the most up-to-date care possible so that they may return to their desired activity or work as soon as possible.

Deciding which type of facility works best for one’s career can be a learning experience in itself. Being open to gaining the skills needed to optimally perform physical-therapy duties in both hospital-based and private-practice facilities will make your career in physical therapy as dynamic as the field itself.

Jeff Moreno, DPT, currently works at Orthopedic Therapy Specialists in Beverly Hills, Calif. His emphasis is in treating disorders of the spine and sports-related injuries. He can be reached at jrmorenopt@hotmail.com.