Doubling Down on Non-Surgical Conservative Care

In recent years I have gone out of my way to educate clients, colleagues, and others on the success of non-operative, conservative care for a variety of conditions. The #GetPT1st campaign has been a big motivator for me and is a great resource for PTs wanting to educate those around them on the potential to avoid surgery for a variety of conditions through PT. In my own clinical practice, in a ski town, I have become somewhat obsessed with the idea that the majority of clients with ACL tears should be put through a mandatory 6 week waiting period before electing surgery. Here, the tendency is for skiers to elect immediate surgical reconstruction for their ACL-deficient knees. The thought is “surgery will add stability and decrease the likelihood of premature arthritis,” “skiing is different than other sports, you need an ACL,” and “our population is just different here, everyone is extremely active.” I have been fighting these misconceptions for a couple years now, but change is slow – some of my PT colleagues still don’t buy that there is a percentage of people who can live an active, fruitful, physically elite life without an ACL (if you guys are reading this, I will get you eventually… you’ll see). I think the idea of the active non-surgical ACL is gaining some traction – if not yet with the medical community in town, at least more patients are starting to self-select a waiting period before surgery. Just to be clear, evidence tells us that there is a significant percentage of the population that can return to full function without an ACL – this percentage includes division I athletes and downhill skiers. Studies have specifically been done on ACL deficient elite athletes, there is a significant percentage who return to sport without an ACL – in fact, for those with a well informed sports medicine team, the non-surgical option can be a quicker way back to competition. Repairing your ACL does not decrease your chance of early arthritis – the life of a knee without arthritis following ACL reconstruction is about 15 years according to the literature. So there. People just don’t want to be patient and do 6 weeks of strengthening for a less than 50% shot at avoiding surgery – hey, if that’s the choice they want to make, I don’t really blame them…. But I feel strongly that they should be accurately informed.

We’ve had a couple injuries in the Spencer household lately and we’ve had to choose conservative care over surgical intervention.

Here I am pressing my thumb into the counter to keep it extended while I work to re-tape the splint for support. The morning ritual takes longer than you’d think and has evolved to my using 10 separate pieces of tape each time.

I had an unfortunate water polo accident (said no one else ever). Goofing around between actual play, I had a shot blocked and my thumb went tip first into a swatting palm. I immediately knew something wasn’t right – I instinctively grabbed my thumb. There wasn’t much pain at all, but I had heard a small pop and my thumb would no longer actively extend – I could easily push it straight with the other hand, but could not hold it there without assistance. I don’t do a lot of hand therapy (I’m spoiled by having some great hand therapists around me), but I knew enough to know immediately that some sort of tendon no longer existed. The next day, I got bootleg-assessments from one of our talented OTs and a trusted Orthopaedic Surgeon next door – the good doctor diagnosed mallet thumb. Mallet thumb? “Yes, it’s mallet finger but in your thumb,” he said frankly. This is not common. The extensor pollicis longus tendon is broad, thick, and fibrous – it doesn’t usually rip. Because it’s relatively rare, there’s not a whole lot of research on mallet thumb – but I did find some case studies. It seems I could surgically have a pin put down the length of my thumb bones for 8 weeks and have a return of most of my thumb extension pretty much guaranteed …or… I could wear a splint on my thumb for 8 weeks – no bending the thumb, ever. I can take the splint off to clean the thumb with the tip pressed against a counter-top for extension, but if the thumb bends, the 8 weeks starts over. Most people do well with the conservative treatment, but full return is not as guaranteed as with surgery. I figure with a small army of OTs, PTs, and Orthopaedists at my disposal, I should do well – we’ll find out in about 3 more weeks. The idea with both the surgical and conservative treatments is that the tendon will scar down to the bone wherever it is – hopefully it scars down somewhere useful. I’m just happy that I’m able to keep working, and, more importantly, continue skiing.

But my little thumb injury has been put to shame by Kate who went out and tore her ACL. I need to pause here and quickly explain that Kate is pregnant and we are excited to be adding a baby girl to our gypsy caravan in April! So, needless to say, many exciting changes ahead. I’ll do a separate blog soon about how this will affect our traveling life – for now, let’s stick to the current topic.

Kate had been skiing cautiously and picking her ski-days judiciously. She was simply coming to meet me for breakfast on the mountain and for one ski run. She was skiing on a wide open run 5 minutes after the mountain opened when she was clipped by another skier. The fall wasn’t bad, but it was enough to tear Kate’s ACL (no other injuries to momma or baby). After struggling through our planned breakfast, we called ski patrol, and Kate got a ride down the mountain.

What we have here is a situation where we have no choice, Kate won’t be having surgery (at least not until after the baby is born) – we must try our luck at conservative management of Kate’s knee. Although, I did receive a call at work this week from another pregnant woman in town who had torn her ACL. She had tried skiing on it again already, but “it didn’t feel right” so she stopped. Her OB, suggested that she should have the ACL repaired soon, so she would avoid crutches while super-pregnant or while caring for a tiny baby. I guess it just goes to show the persistence of the myth that an ACL is absolutely necessary.

Anyways, Kate’s knee swelled up pretty big and there was some visible bruising. Kate did get an X-ray just to make sure there is no fracture. As we have progressed only a few weeks from the injury, Kate has started formal PT with one of our coworkers and she is already hiking lightly without a brace. So, she’s doing all she can do and hopefully when this summer comes, more vigorous hiking is not a problem. Perhaps next winter, she will ski comfortably without an ACL – her early success at walking without a brace seems encouraging.

Onward we both go. We’re doubling down – no surgery here unless we absolutely need it. Surgery is, and should always be, a last resort.

What Questions Should I Ask On An Interview?

When you have an interview for your travel assignment, it is usually your only chance to ask questions directly to the facility you might work at. Asking the right questions can tell you a lot about your potential job. Missing key questions can lead to you taking a job you otherwise would have avoided. Let’s go over the must-ask questions that will help reveal potential red flags.

Do Your Research

Employers check your social media pages and anything they can find on you, why shouldn’t you do the same for them? First, go clean up you Facebook page, then do some research on the company you are interviewing with. Check out their website, look for reviews on their practice, even plug some therapist names into google or facebook if you have them. The amount of info you can grab online in a few minutes may give you an indication of whether you think this practice will be a good fit for you or not. Since many assignments are initially presented to a traveler generically (i.e. “an Outpatient Practice near Portland, Maine”), you may have to ask your recruiter for the name of the practice shortly before you interview.

In addition to the benefits you get from knowing more about the practice you are interviewing with, it’s nice to be able to demonstrate your knowledge to the interviewer. When they describe their practice, tell them you  had seen some of the basics of what they do when you went on their website. Employers love it when you go out of your way to learn about their practice, feel free to to flaunt your knowledge a little bit.

Who works there?

Knowing who you will be working with can tell you a lot about what work will look like on a daily basis. As a new grad, knowing how many other therapists you be working with can help you anticipate what opportunities might exist for mentorship and learning from your coworkers. I love to know if there will be OTs or SLPs – an interdisciplinary team has so much to offer each other and the patients. As a therapist or a therapy assistant, it is essential you know how many assistants you will be working with. Definitely avoid the factories that have more assistants than therapists – not a good situation. By asking about the mix of people you be working with, you can identify opportunities and red flags that may exist.

Who is the owner? Who is the boss?

I once worked for a clinic where the wife/PTA was the primary financier of the practice. The husband/PT was the head clinician. They did not get along, at all, on business topics. If I had known of this arrangement ahead of time, it wouldn’t have necessarily been a red flag, but it might have raised an eyebrow. On a different assignment, which I ultimately terminated the contract on, I was at a clinic run by an unlicensed South African educated Chiropractor. Ask who owns the practice and who your clinical supervisor will be. This question, if not asked, can be the single most important piece of information that would help you avoid an awful, but otherwise decent sounding job. I would have avoided the only nightmare assignment I have ever had if I had asked the right questions.

For info on how the interview is arranged and the steps leading up to a traveling therapist interview: Finding Your First Travel PT Assignment.

What are the productivity expectations?

I don’t think I really need to say much more on this, but I will. Briefly. Over the last 8 years , I have worked only jobs that allow a full hour, one-on-one with patients. I have had 1:1 for an hour in hospitals, private practice, and home care in many different regions of the country. Some areas of the country are more notorious for high-volume standards, but you don’t have to be one of those therapists. Multiple patients per hour is not best-care, don’t trick yourself into thinking it is. If you are working in a permanent job seeing 2-3 patients per hour, reconsider your current professional life, it doesn’t have to be this way.

What is the patient population like?

This is a great question to get an idea of what you’ll be working with. It also gives you a chance to describe (or brag) to your interviewer what your treatment style is like. Many travel assignments are in areas that need someone to cover a variety of conditions – many community hospitals that treat all sorts of disease and dysfunction hire travelers. If you allow yourself to go slightly outside your comfort zone, you’re likely to gain a wealth of new knowledge about treatment. Once upon a time, I was an outpatient ortho-only therapist. By repeatedly reaching just a little outside of my comfort zone to different patient populations and treatment settings, I have gained a huge amount of information on a very wide portion of the spectrum of physical therapy. Travelers that are open to new clinical and cultural experiences can grow to be the most well rounded clinicians anywhere. Ask about patient population where you are interviewing to try and find an assignment you’d enjoy, but also so you can prepare and be the best clinician you can be to those patients. Being a traveler is can be a primarily selfish endeavor to satisfy a desire for travel and exploration – or, done right, it can be an incredible opportunity to give your skills and knowledge to the populations that are most at need for good care.

Must-Visit Outdoorsy Communities

The best places to live are those that mix a life surrounded by the great outdoors with a great community. Many of the places that offer endless opportunities outdoors do not have the support of vibrant communities, and many great communities are far from the great outdoors – the places on this list offer the best of both worlds. These are smart, cultural places that center around outdoor recreation – consider seeking them out on your next road trip… or even for a travel assignment if you consider yourself lucky.

Boulder, Colorado

Up playing in the hills surrounding Boulder – easy to get off the beaten path fast.

The ol’ Colorado standard. Set just West of Denver, some consider Boulder America’s Biggest Mountain Town. Boulder is inhabited by a huge number of the world’s elites in skiing, rock climbing, cycling, and triathlon. Boulder is close enough to almost any-kind of outdoor recreation you could crave while also having a large enough community to find the creature comforts you need just outside your door.

Boulder’s outdoor community centers around the Flatirons – a series of 5 jagged peaks jutting out of the ground. The peaks are around 8,000 ft from sea level, of course town itself is a mile high. The bigger mountains are less than an hour away in Rocky Mountain National Park and there are 14,000 foot peaks nearby in almost any direction. For entertainment, Red Rocks Amphitheatre is close by and brings in some of the biggest names in music to play concerts each summer. The venue is highly unique – the amphitheatre is open air, naturally formed, and set within several large crags of red rock. If you need the big city, Denver is only bout 45 minutes away.

Bend, Oregon

Downtown Bend, Oregon in the shadow of the Cascade Mountains. Industrious people self-making everything.

I recently visited Bend, and it blew me away. Bend is surrounded by huge (HUGE) mountains. Mt Hood looms in the distance at over 11,000 feet (7,707 ft of prominence from the surrounding land). Mt Hood is home to six separate ski areas including year-round skiing on glaciers (available limited time only, while supplies last). While Mt Hood is the pinnacle of outdoor activities in the area, Mt Bachelor is closer and more accessible to Bend – it offers much of the same recreation on a slightly smaller scale. Many of the mountains in the area are volcanic and, therefor, dramatic in their look – steep slopes that standout from much of the surrounding high-desert.

Second to the impressiveness of the mountains, is the very impressive local beer selection… I’ve never seen so many different beers in my life. Breweries abound – many brands you’ve heard of, many you haven’t. But beer isn’t all that Bend makes. If the end of our society came today, Bend would go on. These people are self-sufficient in making everything. Coffee, bread, gluten-free dairy-free bread, locally-sourced everything, local clothes companies, Hydroflask water bottles – you name it, Bend makes it. I definitely see the appeal of Bend.

Lake Tahoe, California/Nevada

I’ve never been to Tahoe (hence no photo), but I hear it’s awesome. Suddenly, I have about half-a-dozen friends living around Lake Tahoe. I personally equate Tahoe with skiing – there are 12 ski resorts in the area with Squaw Valley and Heavenly being the two biggest. But Tahoe, being a huge lake, offers many summer-time opportunities that other mountain communities don’t have. Boating, wind surfing, and everything else you can do with miles of open water. But Tahoe’s greatest strength might be its location and ease of access to everywhere else. Heading West, you’ll end up in Sacramento, wine country, and San Francisco. East will send you into Nevada with quick access to Reno and Carson City. South shoots you straight into the Sierra Nevadas and with a few hours of driving, Yosemite Park. If you’re spending time in Nevada or Northern California, make sure your next ski trip or summer lake trip includes Tahoe.

Montana, The Big Sky State

Montana is huge. The mountains are huge, the lakes are huge, the sky is huge. This is in Glacier National Park in far Northern Montana.

I don’t know how they’ve done it, but the sky is truly bigger in Montana. I have rarely seen landscapes as majestic as your average commute in Montana. My only experience with Montana was a roadtrip that entered in the south through Yellowstone and exited North to Canada through Glacier National Park – every single mile between felt like I was still in a national park. We stopped at Chico Hot Springs, just outside Yellowstone, and enjoyed their massive outdoor pool fed by natural hot spring water – the stars at night were perhaps the most I’ve ever seen (on account of the sky being so big). In the past, the hot springs were a spa for the sick in the early 1900’s. I couldn’t help but think that there is something special about that place and that the water does indeed have to be healing. We stopped into Bozeman for a quick meal while on the road and found it to be a fun, happening college-town. Other small cities in Montana have their own unique personality and have a lot to offer as well – Missoula, Billings, and Whitefish all offer outdoor recreation in the wilderness that stretches out in every direction. Get to Montana where the Wild West is alive and well – you will not be disappointed.

Experience Before Travel PT vs. New Grad Travel PT

new grad traveling therapy

James of HoboHealth worked in private practice before going into traveling PT and believes gaining professional experience is the right move to make before traveling.  April of The Vagabonding DPT has had professional success and happiness through becoming a traveler immediately as a new grad. These two traveling Doctors of Physical Therapy from different personal and professional backgrounds have connected to provide you diverse perspectives on travel PT.  This is their first blog post together of a series of topics.

What are the advantages of being a New Grad PT vs. being an Experienced PT then going into Travel PT?

 

headshot-square-finalHoboHealth:
Professional Experience – I only worked for six months between graduation and starting as a traveling PT. The brief time I worked in private practice before traveling did a lot to shape who I am as a clinician today. Getting just a little bit of experience as a clinician allowed me to become grounded in a healthy work environment before setting out into the less predictable and less stable world of traveling.

Personal Marketability – I believe the little bit of experience I had in private practice prior to traveling gave me a leg-up on other candidates looking at the same jobs. My first traveling job was (primarily) outpatient in a community hospital outside of Boston with other therapists around to help continue my mentorship and growth. Without a little experience, I don’t believe they would have taken on the risk of hiring a near-new grad. Six months in private practice, followed by 10 months at my first travel assignment with strong mentorship set me up for 10 years of positive traveling assignments. Bottomline, if you get a little experience before travel, better employment opportunities are available to you as a traveler.

Vagabonding DPT:april-fajardo-headshot
My life was as compact as possible.  I already had sold all my furniture and everything I owned fit into my Honda Civic. I was as mobile as I ever would be.  If there was any opportunity to travel and explore, now was my moment. I had just spent my 3rd year completing my clinical rotations in Oklahoma City, OK; Salt Lake City, UT; Springfield, MO; and Dallas, TX. I was moving about every couple of months.  In essence, my clinical internships provided me the opportunity to live the life of a travel DPT as a student.  I was used to learning at a rapid rate and had to learn to adjust to a new city and clinic every few months. Because of this, It was quite an easy transition to go from a DPT student on clinical rotations to a DPT on the road for work.

You have “less” responsibility. As one begins to settle into their career and life (in general), the natural progression is to get settled into a specific location, get married, buy a house, have children or furry kids, and/or take care of ill, elderly parents.  Although I think it is absolutely possible to travel with all the aforementioned circumstances, these factors require far more extensive benefit/cost analysis. For myself, I wasn’t married, I didn’t have a house, nor did I have children.  So I made the personal decision to take the plunge straight into travel PT for further domestic exploration and adventures!

Money
Although I believe that this shouldn’t be your primary reason for going into traveling therapy.  It definitely doesn’t hurt. Students are coming out with a tremendous amount of debt and this is definitely a great way to pay down those student loans.

What are the disadvantages of being a New Grad PT vs. being an Experienced PT then going into Travel PT?

 

HoboHealth:
When I first thought about this question, my gut reaction was, “There’s no disadvantage! What could be wrong with having more experience going into a job?” …but then I thought of the hardest day of my PT career – the day I had to quit my first job. The day I told my mentor and friend that I wouldn’t be able to work for him anymore was a really stressful day. Quitting a job, especially one that you like, is hard. I can see how someone with the intention to travel could go get a steady job and never end up leaving it. While I do believe strongly in getting experience before traveling, I can see how you risk getting “stuck” in a permanent job. I remember the phrase one of my professors told me to make quitting professional and simple, “It’s an opportunity I can’t pass up.” Remember that phrase, it’s a good one.

Also, the traveling lifestyle is only available to those in the right life situations to have the flexibility to take short-term contracts. Sometimes you have to strike while the iron is hot – waiting to take a permanent job, get several months of experience, and then quitting can shift you into a phase of life where the idea of travel isn’t as easy as it once was. New family obligations, meeting a significant other, and simple logistics like year-long rental leases can obstruct your path to the open road.

Vagabonding DPT:
Mentorship:
Off the bat, one’s initial thought may be the lack of mentorship.  There are some travel companies that may market mentorship opportunities.  I challenge you to ask them what exactly this looks like.  Just being in the same clinic as other physical therapists does not constitute as mentorship.  This can be countered by building an army of mentors while being a student.  Based on my interests, I’ve inadvertently built an army of specialists from Neurologic PT to Global Health to Nonprofit Leadership.

Mentorship does not have to be limited to our profession. There is something to learn from everyone.  Quite frankly, our patients become our first mentors.  If you learn to listen intently, they will lead you to the answer.  In addition, a firm understanding of other disciplines such as occupational therapy and speech & language pathology can help us maximize our role with a focus on patient-centered rehabilitative care.

Lack of Experience:
James touched upon this and it is true.  There will be some jobs that will require that you have more experience than what you have had. However, I secured my second job assignment by highlighting my strengths and experiences in that setting.  I applied for a position in inpatient rehabilitation that required 5 years of experience.  So during my phone interview, I discussed my experience.  I worked for two years as a PT aide in outpatient PT, then did an additional two years as a rehab aide prior to even applying for physical therapy. I also completed two clinical rotations in inpatient rehabilitation. I felt I was more than qualified for the position at hand.   I’m glad that the rehabilitation manager was pleased with my response as well because she essentially hired me for the position. I’ve extended my contract since then.

Being a traveler can isolate you from the typical learning and professional development paths that may be available in more traditional PT careers. What have you done or do you plan to do to continue your professional development?

 

HoboHealth:
Board Specialty
Shortly after completing my transitional-DPT, I soon felt ready to pursue my Orthopaedic Clinical Specialty (OCS). I spent more than a year reading every piece of ortho research I could get my hands on and reading a couple comprehensive ortho books cover-to-cover. The constant studying kept me focused on a fixed goal for quite some time. Specialties through ABPTS are available in variety of practice areas. A couple supervisors on travel assignments have told me they hired me specifically because of my board specialist certification. In total, my tDPT and OCS combined filled the first  4 years of my professional life with a structured, focused learning path.

Some universities are offering post-doctoral learning paths that culminate in sitting for (and hopefully passing) the specialist exams. My alma mater, Northeastern University, offers a Certificate of Advanced Study in Orthopedics. Essentially, you take 5 online classes focused on advanced orthopedic practice, earn college credits, and become more prepared for the OCS exam. Programs like this can help you keep a structured learning schedule that can otherwise so easily fall out of priority while working as a travel PT.

Certifications
Generally, I am skeptical of programs focused on one clinical belief system and the alphabet soup that comes along with them. Courses that all come from a single guru will help you dive deeply into a treatment strategy, but are typically lacking in variety outside of that one strategy. However, as a way to provide a structure for learning towards a final goal, they can be very useful. I currently am about to set out on earning my certification in Dry Needling. Over the next year, I have my learning laid out for me and a fixed goal to be certified in Dry Needling and Cupping by the end of 2017. There are some other great programs available that offer several courses on different topics culminating in a single certification – do be discerning, not all certs are created equal.

Vagabonding DPT:
With the constant change, rapid rate of learning, and high productive expectations expected as a Travel PT, you can get burnt out and/or apathetic as a PT.  It is pivotal that you “Be fearless in the pursuit of what sets your soul on fire.”  Since graduation, I have done exactly that through social media, leadership positions, national PT conferences, and continuing education courses.

Social Media
I didn’t understand Twitter.  I didn’t get the point.  However, a few years ago, I ran for the position of APTA Student Assembly Director of Communications and thought that I should get one in the event I got elected and had to manage one. I’ll be honest.  I had no idea what I was doing.  With the Twitter mentorship of Matt Debole, PT, DPT, OCS and Stephanie Weyrauch, PT, DPT, they opened up a world of passionate students and clinicians from all over the country and the world.  I started utilizing pound signs…I mean hashtags and twitter handles in my tweets.  A few years later, I had the pleasure of engaging with these professionals virtually and in person.

If you don’t have a twitter account, get one.  The best way is to just dive in and follow a few hashtags such as #ChoosePT, #DPTstudent, #SolvePT, #FreshPT, #PTFam and/or #TravelPT, just to name a few.

Still don’t get it? Start one, follow me, then tag me @AprilFajardoPT in your first tweet! Be part of the conversation.

PT Conferences
National Conferences: Have you ever been to National Student Conclave, Combined Sections Meeting (CSM), or NEXT?  It’s how the kids say, “lit?”  Yesss, LIT!!!! Everyone comes to this conference to learn, but one of the most important aspects of these conferences is the opportunity to formulate connections.  If you’ve been active on social media, meet some of those you follow on Twitter at one of these conferences.  You get to attend a multitude of receptions based on your interests and involvement from Alumni events to Section events.  The exhibit hall is equipped with the latest physical therapy gadgets and with recruiters from every corner of the US.  The

International PT Conference: This coming year, I plan on attending the World Congress of Physical Therapy on July 2nd-4th in Capetown, South Africa.  I look forward to the opportunity to learn from and engage with physiotherapists around the world.  Sounds enticing, doesn’t it?  Well, the early registration deadline is November 30th.  Join me and check out their website at http://www.wcpt.org/congress.

Professional Leadership
I’ve been on the go as a traveler; however, I’ve stayed engaged through the pursuit of my passions in professional development, engagement, APTA membership, global health, and service.  I currently serve as The Academy of Neurologic PT’s membership and public relations committee member, an Early Career Team committee member, and the PT Day of Service’s Global Affairs Chair.  My role in all these leadership positions has been location independent.  If I can do it, you can too!  Not sure where to start?  Fill out the APTA Volunteer Interest Pool at http://www.apta.org/VolunteerGroups/ or email the APTA Executive Director of the Section you want to get involved in at http://www.apta.org/Sections/.

Continuing Education Courses
Every state has a different set of requirements for continuing education courses.  However, I’ve found that the most helpful courses have been those developed by a specific section of the APTA.  I’ve taken a continuing education course on Parkinson’s Disease developed by the Academy of the Neurologic PT.  Terry Ellis, PhD, PT, NCS of Boston University  and Lee Dibble, PhD, PT of University of Utah taught the course through the integration of the evidence and its clinical application.  So if there’s a specific topic you want to learn about, check out what courses are provided by the appropriate APTA section.

Last Day of a Travel Assignment

I just came in from fishing on my kayak on the eve of my last day of this travel PT assignment. As usual, I caught nothing, but got a killer view of the sunset. Tomorrow, my wife Kate and I will work the last day of our contract on the island of Molokai in Hawaii before heading back to our winter home in Aspen, Colorado. This transition seems a little more subdued than usual – maybe it’s that we have some time between assignments and aren’t in a rush to get on the road. I used to lose all motivation to do paperwork during the last 2 to 3 weeks of any assignment – of course the paperwork eventually had to get done, but it wasn’t pleasant. As time goes on, the switch has become a bit more mundane for me – one job ends, another begins… just like they always do. But I’m better at keeping my nose to the grindstone until the very last days.

Here I am fishing out front of our apartment on a similar evening where similarly, I caught nothing.

Here I am paddling out to fish in front of our apartment on a similar evening where similarly, I caught nothing.

With ending a job, there’s all the finals steps that need tending to: cleaning out/off your desk, finishing all notes, tying up the loose ends on the cases of any patients who may have gone missing, and preparing for the other therapists to take your patients. Bottomline is: you don’t want the last memory of you to be all of your unfinished work left behind for the other therapists to handle. There’s typically some pageantry as a traveler gets ready to leave an assignment. I try to avoid too much fanfare, it feels awkward to me – I’m very used to coming and going. If it were up to me, I’d leave the office on Friday with the typical wave of my hand and a “have a good weekend!” …and never come back. In the PT Department earlier this week, we had a nice, simple ice cream bar with just the 5 of us in our department. It was nice, simple, perfect – it was a wonderful, delicious gesture, but not over the top. This location has trouble finding a permanent PT because of its isolation, so they are used to a revolving door of travelers. Perhaps that explains why my style of a “goodbye” matches with theirs. Someone, Vikki, will come in on Monday and take my place. She seems nice, and I hope she is – I’ve been telling all the patients she seems good, and I bet she’ll take all the placebo effect she can get. The patients definitely don’t like it when a traveler leaves, but I still laugh when an unassuming grandma threatens to come to Colorado for PT this winter.

The greatest challenge that comes with moving along to the next job is the process of getting the next job arranged. After traveling for 10 years, and returning to the same seasonal job every winter, finding the next job isn’t usually too much of a process anymore, but it used to be! Figuring out where to go is the first major hurdle, and it needs to happen well before the last days of the job. If you’re on a 13 week contract, you should have a pretty good idea of where you’d like to go very early on in the contract – especially if you need to get a new license to go there. When it’s time to find the next job, it’s not uncommon to find me in little corners of a hospital, between appointments, making calls to recruiters for quick updates on potential jobs. There’s a lot that goes into getting the next assignment, and it can, and usually does, happen at a pretty fast pace in the middle of a busy work week.

I just read a couple articles in a ski magazine and it got me pumped to be headed back to Colorado for the winter. I cannot wait to get my skis out of storage and onto the mountain (it’s snowing there right now as I write). Kate and I have ordered a fair amount of ski gear on sale over this summer while we’ve been here in Hawaii, so we’ll have to box all that junk up and ship it ahead. We have almost two weeks of hanging out in Hawaii before we have to leave – I really think this is the ultimate traveler’s hack. I haven’t had to pack a thing while I’ve been working. It is so refreshing to not have a car full of stuff before my last day of work tomorrow.

Here's the Shasta camper we bought. I can't wait to get to work sprucing her up!

Here’s the Shasta camper we bought. I can’t wait to get to work making her shine again!

When we do leave for Colorado in 2 weeks, we’re going to swing through Oregon and visit some friends in Bend before flying into Denver where we’ll be buying two cars. The original plan was to have one car when we returned to Colorado and have some time to find a second car, but while we’ve been away, the Colorado car’s engine stopped working. I’m not very mechanically-inclined, but my understanding is that the engine is a fairly essential part. So, we’ll buy at least one, maybe two cars in Denver – one has to be able to pull the 1970 Shasta Camper we bought from a friend sight-unseen (more on this in the future). After we’re done visiting Oregon and vehicle shopping in Denver, I have a dry needling course in Colorado Springs to attend for 3 days. So excited to finally be a needler (but not excited to be needled for 3 days straight)! The course ends Sunday, and work will start Monday – guess I won’t be starting this assignment well rested regardless of my 3 weeks off.

Despite all the excitement that lies between today and work starting 3 weeks from now in Colorado, I’m bummed to be done here. It’s a community I have grown to know and love and the bitter is mixed a little more heavily with the sweet this time. I guess I’ve got a pretty good thing going here, I could keep working here for another couple months, but it’s that time of year to move on. This is our second time doing a contract on Molokai. When Kate and I came over from the Big Island 2 years ago for an interview, we thought it might be a once-in-a-lifetime visit to Molokai. Three contracts later, Molokai is a part of our life. We’ll be back. I don’t know in what capacity we’ll return, but we will return.

Hawaii, it’s been a blast and I shall return. Oregon, let’s see what you’ve got (I hear you’ve got mountains, ocean, and beer – I like those things). Colorado, I can’t wait to hit the slopes and reconnect with all the friends back there. Nose to the grindstone, one more day of work.

Where Should I Work This Winter?

As pumpkins take over the world, traveling therapists begin to think about their next assignment that will last a good portion of this winter. Where do you want to be this winter?

Ocean, check. Mountains, check. Yeah, I could do San Diego. Does anybody know what San Diago means?

Ocean, check. Mountains, check. Yeah, I could do San Diego. Does anybody know what San Diago means?

On the beach? On top of a snowy mountain? Somewhere exotic and outlandish? Are you going to hibernate, or are you going to thrive? I’ve got you covered, here are some of the best places I’ve been in the winter and other places I would love to go in the future.

Southern California

I always wanted to do an assignment in San Diego, but somewhere along the way it fell off my list. It seems like it would be a great place to get a January tan. I know lots of people who have taken assignments throughout Southern California and absolutely love it there. Home care offers really good pay rates in SoCal if you’re willing to try out that setting. The only hitch to working in California is that getting a license can take 4 to 6 months, so get started now if it’s on your list.

Ski Country

Pop Quiz: Question: How does a snowboarder order a meal? Answer: "Hey Bro, you gonna finish that?" Question: 2 Snowboarders are in a car, who's driving? Answer: The cops.

Pop Quiz:
Question: How does a snowboarder order a meal?
Answer: “Hey Bro, you gonna finish that?”

I love skiing, so I do the opposite of the snow birds. I love living in the mountains with skiing right outside my front door in the winter. There’s a lot of places to find jobs near skiing, but to actually live and work in a ski town is an experience that every avid skier (or snowboarder) should have.  most hospitals in the Colorado Rockies hire directly (without staffing agencies) and you’ll need to pick up the phone and call or go check the hospital’s website for employment opportunities. You might have more luck around Salt Lake City which has more employment opportunities and all the world-class skiing you could dream of within a 30 minute drive. Wyoming and Montana offer more rural settings with great back country access and beautiful, pristine landscapes. New Hampshire, Vermont, and Maine all have quick access to big mountain skiing – some of the best skiers (and snowboarders) in the world come from New England – Bode Miller, Ted Ligety, Simon Dumont, Jeremy Jones. If you’ve wanted to see the Northeast and you’re a fan of winter sports, winter can be a great time with a lot of job opportunities and decent access even as far south as Boston.

Hawaii

Hawaii, idyllic for any traveller anytime of year. Plan ahead, lots of people want to go to Hawaii and jobs are competitive.

Hawaii, idyllic for any traveller anytime of year. Plan ahead, lots of people want to go to Hawaii and jobs are competitive.

I love my time in Hawaii, but I am never here in the winter time due to my aforementioned affection for skiing. Although, the summit of Mauna Kea at over 13,000 ft does offer enough snow to ski on in depths of winter – so there’s that option. During the Hawaiian summer, the surf is more calm and better for swimming – the summer brings less rain too. But the winter is when Hawaii really displays its beauty. Migrating whales visit Hawaii by the thousands in the winter. The increased rain brings deep green colors to the hillsides that are brown and parched during the summer. And the surfing world gets together on Oahu’s North Shore to hold competitions on the best waves in the world during the winter months. If you want to go to Hawaii, you have to be flexible – a lot of people want to go there, so finding an assignment or getting your resume in ahead of other people can be hit or miss. I normally recommend making sure your recruiter presents jobs to you before letting them submit you. But Hawaii can be competitive enough that getting your name in first can be a real advantage – when it comes to Hawaii, you may consider giving your most trusted recruiter the green light to submit you to any job that fits your criteria.

Antarctica

Huh? Antarctica. Hang with me here for a minute. Our winter is the southern hemisphere’s summer. The University of Texas Medical Branch staffs the 3 US research stations in Antarctica with contract workers. Each year they look for, “Licensed Physical Therapists who have a strong clinical background and a taste for adventure.” I think both of those qualifications need to be strongly met. In a position where you may end up being a fairly solitary clinician with limited resources, you must know your stuff, and you have to be able to improvise with whatever is available to you. A “taste for adventure” states it lightly. I have heard this job is essentially like working on a submarine except that you get to go outside occasionally. My understanding is that you rarely get off base, and when you do, there is NOTHING (except hungry polar bears)… but, you’re in Antarctica and that is pretty cool. I have also heard about the “Race Around the World” – A 5K race in a loop around the South Pole – that’s just hilarious and awesome.

US Virgin Islands

Did you know the US Virgin Islands are a part of FSBPT, the same body that all US states belong to for PT licensure? Oh yes. It is as easy to transfer your license to the Virgin Islands as it is to any other US state. There are jobs available in the Virgin Islands, it’s easy to transfer your license, and they are a short flight from anywhere east of the Mississippi. I’ve talked with a couple people who have worked there, and they’ve loved it.

On a side note, while FSBPT is in the conversation – if you are a traveling Physical Therapist or recruiter and you are unaware of the Physical Therapist Licensure Compact, educate yourself now. PT licenses between certain states will be reciprocal within the next two years – very exciting, make sure your state is included!

Choose Your Own Adventure

Don’t be limited by these 5 options. Choosing where to go as a traveling therapist is as personal choice as you could make. There’s all kinds of opportunities available in the Southeast and the Southwest – great, warm places in the winter. I’ve seen and heard wonderful things about Lake Havasu in Arizona and San Padre Island in Texas – I just know nothing about them, so they aren’t mentioned here. Why not make an adventure. Try finding an assignment in the Florida Keys. Don’t let any list limit you, go out and find the place YOU love, that’s what traveling therapy is all about.

Celebrating and Promoting Physical Therapy

“What can I do this month to help celebrate and promote Physical Therapy?” I imagine a lot of other travelers ask themselves the same thing and come to the same usual outcome as me during National Physical Therapy Month – you do nothing. This year my job has been made easier by PTDayofService.com. #PTDOS aims to bring PTs together on October 15th to serve their communities locally and around the globe. While many will be participating in activities that are specific to PT, others will be grouping local PTs together to serve in food banks, homeless shelters, and a great variety of other community programs that need some hands to help. I don’t think that it’s necessary to find something PT-specific to do this month, just get out and serve in any way that appeals to you in the name of the Physical Therapy profession. If you happen to read this before the weekend of October 15th, you can hop on PTdayofservice.com and contact an ambassador in your area who may have a project you can join.

Traveling PT Hawaii

The fish pond we will work on is in the dead center of the picture. There’s another, bigger one off to the right with a thinner wall. There’s a lot of mangroves filling in the ponds in this picture, which is one of the things we will be working to remove. I know scale doesn’t do justice here, but the fish ponds are HUGE.

Here in a rural community in Hawaii, we only have 4 PTs locally. The 4 of us, with our families and staff, will be joining a local non-profit to help restore an ancient Hawaiian fish pond. The fish ponds were unique to Hawaii compared with other Pacific cultures. The fish ponds are lava rock walls built in shallow water forming a large contained semi-circle of ocean. As the tide comes in, water and small fish pour in through the rocks, but the fish are trapped inside, creating a high density area for fishing as they grow bigger. Some of the best fish ponds, like the one we will be working on, were reserved specifically for Hawaiian Royalty to eat from. Should be a great morning of hard work (at least as hard as it gets on a beach in Hawaii), followed by a potluck meal to reflect on our experience.

I’d like to take my usual October question and flip it on its head: Rather than asking what can I do this month to celebrate and promote my profession, I’d like to pose a question that I think any traveler can ask him or herself: “What can I do on each travel assignment to celebrate and promote my profession locally?”Here’s a few ideas, some I have done in the past, some I would like to do in the future. Some are specific to National Physical Therapy Month, but others can be done on any travel assignment, anytime.

Change Your Work Desktop

APTA has resources on their website which include PT Month Logos, links to PT Day of Service, ideas to promote #choosePT, and templates to send to local legislators to legally pronounce October National Physical Therapy Month. Find APTA’s resources at www.APTA.org/NPTM. Changing your desktop is one simple way to get the word out to co-workers and patients that October is PT Month.

PTDOS - Fish Pond Clean up in Hawaii

The fish pond restoration is a monthly project, Here I am with a bag of gorilla ogo, an invasive seaweed that we are working to remove. In the background, you can see the wall of the fish pond stretching out in the distance just below the horizon.

If #choosePT is a new phrase to you, let me do my PT month work right now and let you know about it. There is an ongoing epidemic in America of opioid abuse. There is a clearly documented path from the abuse of prescription opioids to using other illegal hard drugs. While there are people whose pain is being appropriately managed by prescription opioids, many others are being inappropriately prescribed these drugs. We in Physical Therapy are uniquely situated to educated and treat people with acute and chronic pain who otherwise would need opioids to manage their pain. The CDC has named Physical Therapy one of the main alternatives to opioids for pain management. This is the #choosePT campaign – choose Physical Therapy to manage pain rather than entering the potentially harmful cycle of longterm opioid use.

Health Fairs

Many communities have health fairs on a regular basis. It’s easy to show up, take some blood pressures, screen people for falls, or do a postural analysis – but are those typical heath fair activities too easy? I challenge you to get creative and take it to the next level. As a PT, you could offer free bike fits, set up a mock-office and do ergonomic education, or do functional movement screens – all are quick, offer valuable information to the attendees, and demonstrate a meaningful PT skill.

Write A Letter

Write a letter to the local paper about whatever hot topic is in the air and in your arena. There are always new bills running through congress that affect the care patients will receive in the future. These are great topics to sound off on. Write in and let people know why they should be excited about possible changes in law that could improve their personal healthcare experience – urge them to contact their congressional representatives. Sometimes you get lucky and topics come up locally that beg public input from working healthcare professionals – local partnerships aimed at driving down the cost of healthcare, efforts to stem prescription drug abuse (#choosePT), or discussions in a community about the need for improved elder services. If you keep your eyes and ears open, you’ll find all kinds of topics you can meaningfully contribute to by writing a letter to the editor in the local paper.

Make An Appearance on Public Access Cable

Physical Therapy on TV - ski injury prevention

The best screen shot I have of myself on “The Lift” – the daily morning program on channel 82 in Aspen, CO. Me and Tory had a great chat about ski injuries while atop Aspen Mountain. Also, our jacket colors were complementary.

Whatever your role in healthcare, there is some topic that you know forwards and backwards and you love talking about it. Other people find this topic hugely interesting and would love to hear about it. For me, my topic is ski injuries. When I’m working in Colorado in the winter I talk ski injuries constantly for 40 hours a week. Sitting down with the local cable host and talking about this topic for 3 minutes was easy and fun. Pick a topic that’s in your wheelhouse, something you know so well that you don’t even have to think about it. The right local cable show would die to interview someone who is living locally for a short while and has something interesting to offer on a health and wellness topic – give them a call!

Community Classes

There are classes going on every day in every community. The class might be yoga, tai chi, aging gracefully, CrossFit, a community speakers series, self defense, a workplace safety meeting, or any number of other things – as a health professional, you have knowledge to contribute.
My wife Kate, also a PT, somehow found herself giving injury prevention talks to pregnant women. First, here in Hawaii one summer, she filled in for the regular PT to give the usual talk about potential orthopedic issues encountered during pregnancy. When we returned to Colorado, the local community center got word of her pregnancy talk through a friend, and she did a presentation there as well. So random, especially considering she had no specific experience or expertise in the topic, but I think this is a great example of things we quickly write off common knowledge that is not known at all! People do not know where the ACL is, they do not know to stay relatively active following a run-of-mill back injury or ankle sprain, and they don’t know about the orthopedic changes that can occur when pregnant. There are so many people out there who want a little piece of your knowledge in their brain – go find those people!

Volunteer at a Road Race or Triathlon

National Physical Therapy Month 2016…but mark my words, DO NOT give massages.  Soft tissue mobilization is only one small intervention in the broad scope of PT. There’s so much more we have to offer at these races than sports massages – set up a quick footwear consultation booth, offer mini-consults to give home exercise programs for minor aches and pains, or offer a brief injury prevention program. Whatever you choose to do, show off the skills we have as PTs. For a traveler, this particular suggestion might be more along the lines of things to suggest to the owner of the clinic you are working for.

Dust Off Your Elevator Speech

You have a few seconds and one sentence to describe what a Physical Therapist does. Ready. Set. GO! This is the classic elevator speech. I think most PTs do a great job serving their clients in the clinic, but do a poor job of describing exactly what it is we do. In your one sentence, did you mention we are the experts in human movement, did you mention we are the primary non-surgical option for musculoskeletal injuries, did you mention that PTs are educated at the Doctorate level? Probably not – but take some time to think about how you would like to concisely present to a stranger what it is a PT does on a daily basis. It’s the least you can do this October.

Happy Physical Therapy Month everyone! Get out there and represent our profession well wherever you are. If we all give one day to PT Month with half of the enthusiasm we greet our patients with each morning, I know we’ll accomplish a lot.

Originally Written in Collaboration with Fusion Medical Staffing to celebrate and promote physical therapy during National Physical Therapy Month.

Choosing the Right Camper to Live In

As we have done our traveling in the last year, we have slowly but surely made some changes. One of those changes that we came to was the decision to buy a trailer and live out of it full time. Our journey to the trailer probably took way longer than necessary because Kelsey was very particular about what she did and did not want our trailer to look like. Phil was more concerned about the inside, which is more important in the end. When we actually looked at all the possible options we each wanted in a trailer we knew we had our work cut out for us.

Here are some things Kelsey wanted/needed in the trailer:

Phil and Kelsey normally blog on their website at minimalistlifemaximumresults.com

Phil and Kelsey normally blog on their website at minimalistlifemaximumresults.com

1. NO STRIPES – Kelsey likes to be unique and she did not want her trailer to look like the other trailers we often see on the road, this means no stripes decorating the sides. If you like the look of the trailer or RV with stripes that’s fine, but you see those trailers everywhere. It is kind of hard to find a trailer or RV without stripes nowadays. We want to be unique and that’s what we were looking for.
2. Solar energy – This wasn’t exactly a deal breaker like some of the other items on this list. It is relatively easy to put solar power into an already existing home, whether it’s a standalone home or a mobile home. It makes it much easier when it is already installed for you. If we were going to pay big money for our new home, we preferred it already done for us.
3. No shower – This was kind of a weird one since most people think of a shower as a necessity. Kelsey did not want to deal with the hassle of the shower and fell in love with the idea of having to join a gym in order to shower. That little incentive to shower can be a huge motivator to go to the gym and get in better shape. This is a tip not just for people on the road but for all you home dwellers out there too! Another benefit of not having a shower is reducing the amount of water used. The average American shower uses 17.2 gallons of water. That can equal out to over 6000 gallons of water used per year, per person. Just on showers!
4. Small in size – We like downsizing and quickly realized we tend to have more space than we could ever need. We also like getting rid of stuff and living as minimalist as we can (hence the title of the blog). By doing this and going as small as we can, we are forcing our hand even more. Sometimes a big (or small) change can do a world of good in your life if you feel stuck.
5. Enough room to change comfortably – We looked into the van life a little bit, but we are still working professionals. That means we have to dress business casual – so looking presentable in a van would be tough. Not impossible but definitely becomes more difficult if you have only a small van’s amount of space.

Phil’s lists of wants:

1. Towable by a small SUV or crossover – Phil has never wanted a truck and has always wanted a vehicle that optimized gas mileage. Anything bigger than an SUV or crossover would really impact this ability to stay eco friendly in the car department.
2. Decent amount of windows to give open and outdoor appearance – The draw of the trailer is that you’re outdoors, you can walk outside at a moments notice. If your trailer is stuffy with no windows, it makes it feel like you live in a small box, not a tiny home.
Camperlife3. Kitchen of some kind – Phil isn’t really big on cooking but we have made healthier food choices in the last 12 months. Cutting out Cheetos, pop tarts, potato chips, chicken, beef, etc has been great for us. By making a big life change for the better, we didn’t want to make a big life change for the worse. Our kitchen is only an induction (energy saving) stove top and a mini fridge, but we are able to use that efficiently to keep up our healthy lifestyle.
4. Toilet – This one is kind of important to Phil as he goes roughly 20 times a day. Technically, he also wanted a shower but after some negotiating the no shower lifestyle ended up winning out. And the toilet in this place is composting! So less water and even better for the environment!

It turns out finding a trailer that meets all of these needs is way more difficult than it sounds. By way of luck (or more just constant searching) Phil came across an all wooden solar paneled travel trailer that actually fit all of our wants. The company is Homegrown Trailers, and they are amazing. Not only did the company already meet the needs we had laid out on paper but when we went to look at the trailer they came up with ideas to customize the trailer even more to fit our needs. It was perfect timing since the company has only been running since early 2016.

We do have to give some honorable mention to Air Stream as that was our top choice until we found out perfect match with Homegrown Trailers.

Suggestions to finding the trailer for you:

philkelseybeds1. Make a list of what you want and categorize by what is and what is not negotiable.
2. Set a budget – Don’t go over your comfortable amount to spend just to find the perfect trailer. If it’s perfect and you still want it, it will always be there later. We ordered ours back in July and are happy to make money and get ready to pick up in December.
3. Do research – And a lot of it!
4. Don’t settle – wait until it is exactly what you want. Kind of going along with the budget point above. If the trailer doesn’t have what you want, it’s not the trailer for you – unless you are very interested in the DIY trailer, which some people are.
5. Make time to call the company and see what other types of options or customizing is available.

Everyone is different and that’s perfectly fine. If you want to live on the open road go check out some awesome vans, trailers, RVs and mobile homes. There is no wrong choice as long as it fits your needs and is what you want! Thanks James for the awesome opportunity to write about our beginning of nomadic, eco-friendly travel trailer PT and thanks to everyone for following along with our journey!

Home Health as a Travel PT

home-health-travel-pt-hobohealthI never considered working in home health when I was a new grad fixated on my career as a sports PT. But, when I started traveling, I quickly noticed there were a lot of home health gigs available. As I began yet another home care assignment a few weeks ago, I realized I was starting my 5th contract working in home care. When did this happen? How did this happen? How have I allowed this to happen!?

Turns out, home health is a pretty good shtick for traveling therapists. As I launch into this blog about “home health,” I’ll make a clarification up front: I’m going to use “home health” and “home care” interchangeably – I feel like most people prefer “home health,” I personally prefer “home care.” Whatever, it’s semantics, don’t worry about it.

I think of home care as more of a lifestyle than a job. With the right employer, home care can offer a flexible schedule that is great for people in a variety of stages of life. Flexible schedules typically bring to mind new parents or late-career therapists looking for per diem, but, for me, in 2010 in Hawaii, flexibility meant completing all my patient visits by 3 PM, then surfing for a couple hours before going home to finish paperwork with a cocktail in the evening. The right employer will allow you to control your own schedule – this can be a great way to get more out of the daylight hours in a work week. Paperwork and case management (calling doctors, other clinicians, and patients) do account for significant time during your work day – the good news is that you can do paper work and case management at a coffee shop, outdoors on a sunny afternoon, at home, or where ever you feel like it.

Productivity

The flexibility does not come with every home health job, it is essential to ask about productivity expectations during the interview.

The two major factors that will affect how busy you will be are: a. how many visits you are expected to make weekly and; b. whether more complex visits are weighted to be worth more than one normal follow-up visit.

Basically, without getting into the nitty-gritty jargon of home health, an evaluation visit may be worth more than 1 regular visit (ideally 1.5), but an admission, which can easily take 3 hours of your time, should definitely be worth 1.5 to 2 visits. This is called weighting – where a visit that requires more work counts more on your total productivity. A job with a company that doesn’t weight any visits, is a job worth walking away from.

Number of visits: 5 daily is perfect, 6 is usually fine, 7 is just too many – think about the weighting of eval and admission visits when you think of these numbers (i.e. 7 with heavy weighting may be OK, 6 without any weighting could be a lot of work, 5 with weighting is a great job to have).

The distance and amount of time you’ll be driving plays heavily into the pseudo-equation as well, so ask about your territory during the interview. Also consider looking at a Google Maps of the area you could be working in during rush hour to get an idea of traffic.

Home Health Lifestyle

I got to do some visits inside the famous gingerbread houses of Oaks Bluff (Martha's Vineyard) in the summer of 2015. Strange sitting in my patients' living rooms with tourists going by the windows taking pictures of the houses... neat, strange houses with a fascinating history, but try gait training someone on narrow, steep stairs built in the 1800s' version of tiny homes.

I did some home health visits inside the famous gingerbread houses of Oaks Bluff (Martha’s Vineyard). Strange sitting in my patients’ living rooms with tourists going by the windows taking pictures of the houses… Fascinating history of how these houses came to be, but try gait training someone on narrow, steep stairs built in the 1800s Victorian version of tiny homes. The challenge and adventure of home care was very apparent.

Enough of the boring logistics of home care. It is full of action. You will go into people’s homes and see how they truly live. Truthfully, you will be completely appalled at how these people live. Hoarders, live chickens in houses, 8 people sleeping in a room with one bed, beautiful mansions, family situations that are wonderful, and family situations that are incredibly ugly – I will NEVER say I’ve seen it all, because in home care, you see stuff you would never ever see anywhere else. It’s a crazy adventure going into people’s houses. It’s also really educational. Home care will forever change your perception of what kinds of living situations hospital patients are being discharged to. It is wild out there… usually in a really fascinating way.

Professional Challenge

Clinically, home care can offer a stimulating challenge. Frequently, you may be the only clinician visiting a patient’s house, and you will have to make important decisions like whether to call 9-1-1 or not. I have called 9-1-1 from patients’ houses a number of times. Typically, it’s a pretty low-drama experience, but you might be the first to come upon a patient whose blood pressure is too low to ignore, or whose blood glucose is too high to wait it out, or who is just too medically complicated to be left at home alone. Home care does make you use a lot of clinical skills and judgments to make decisions that matter, and that’s one of the coolest things about it. It’s worth mentioning, that because of the judgement calls you will have to make, it is worth getting a year or two of experience as a therapist before venturing into home care.

A Setting You Might Consider

So, think about it. Consider home care even if it seems far from what you normally enjoy. It has aspects that will challenge your clinical skills, and it will most definitely change your outlook on how people actually live on a day-to-day basis. Not to mention, there’s a ton of available jobs in home health, and it pays well.

This is 100% true about today: For me, it was a pretty cool day at work. I worked in the mansion of a business man and sat across a very important-looking wooden desk from my patient discussing his mobility and what he wanted out of therapy (business meeting style, he wasn’t coming out from behind that desk unless he had to). I went to a small shed in a backyard to treat another patient, while she is actively in the process of being evicted from the shed… by her mother. In between, I enjoyed some moments outdoors during the work day and even paused for a moment beside the road to soak in a view of the ocean. I took an afternoon bike ride before finishing paperwork, which I wrapped up just before sunset. To summarize my work day, I went into a mansion, positively affected the life of someone near-homeless, and drove around an island …Not a bad way to make a living.

This piece was originally published in the summer of 2015 through thegypsynurse.com

Time Away – The Traveling PT Lifestyle

As I write this piece, I’m on a plane flying back to Hawaii from a couple weeks off work visiting with friends and family in New England. This flight is non-stop from JFK airport to Honolulu. While it is highly convenient to not have to make a connection on the West Coast, 11 hours in one seat is incredibly uncomfortably, and the lady in front of me is driving me nuts. The trip away from Hawaii was planned this winter while working in Aspen at my annual winter job there. My wife and I knew we were going to Hawaii for the original 13 week assignment, but weren’t sure if we would be extending our contracts for the fall. All the right things fell into place and we’ll be working in Hawaii until Thanksgiving. The break from work was a great 2 weeks away and got me reflecting about the traveling physical therapist lifestyle. As we fly back to Hawaii, the reality is setting in that we have another 3 months ahead of exploring some beautiful islands. I’ve been flipping through the pictures on my phone, looking at the last 3 months in Hawaii, and I feel fortunate to be getting back to a more peaceful and simple lifestyle than the last few busier (but awesome) days we just spent hanging out with friends in Boston, my home town.

DSC_5966-2

The front yard at the cabin in Maine. (Or “Upta Camp” as any Mainer worth his salt would describe it.) Mountain, water, and a lack of people – what more could I possibly want!?

I don’t know when I really began to like a slower pace of life, but I’ve definitely grown away from being a “city guy”. The highlight of the vacation I’m currently returning from was a week up at my wife’s family cabin in the Northern Woods of Maine. Time spent just beyond where the paved road ends and out of reach of cell signal was a nice re-set to return to work feeling refreshed and ready to push through the next 13 weeks. The relaxation centered around daily dips in the lake and a few steep hikes in the surrounding mountains which I’ve become more-and-more familiar with over the years. Sure, I’m returning to work in a beautiful, peaceful place, but it’s still work and I believe strongly in regular time away to refresh the mind and stave off burn-out.

On the seat-back display here on the plane, I can see that we are cutting a South Westerly line across the country and that we are passing right over Aspen, the place I now consider home because of our yearly return there for work each winter. If I could get to a right hand window seat, I think I could look down and see town or some of the familiar valleys, or at least I-70. While skiing in the winter, I have frequently wondered where those high up planes might be going as they pass over the mountains, and now I wonder if anyone I know might be out hiking today looking up wondering where this plane is going. Strange to be so close, but so separated – if I could, I’d hop on the phone and call a couple people to let them know I’m waving down at them. Weird feeling.

Enjoying the Aspen back country with friends. "Traveling Physical Therapist" is really just a euphemism for glorified ski bum.

Enjoying the Aspen back country with friends. “Traveling Physical Therapist” is really just a euphemism for glorified ski bum. (Aspen Mountain in the background)

The Aspen connection was indirectly made through another “get away”. Growing up, my family would  travel in the summer to a rugged family cabin in the mountains outside of Colorado Springs. This cabin, also, is beyond the end of paved roads. It was my favorite place growing up and has been joined on my “favorite places list” in recent years by the cabin in Maine – along with handful of other special places. Visiting in the summer as a kid was my introduction to Colorado, and it is what eventually led me back to the mountains and to Aspen. I initially enjoyed Aspen primarily for the great access to culture without living in a city. While I still enjoy the concerts, the culture, and all the action Aspen has to offer, I now appreciate it more for the great access to extreme wilderness. Within a couple miles of walking out my front door, I can be deep in the mountains, away from much of the busy nonsense of life in the 21st century.

Another one of my more recently acquired favorite places is the island of Molokai where I will return to work tomorrow morning. Hawaii is the most geographically isolated place in the world, so it’s only natural that you can get off the grid pretty fast in many parts of the islands, but Molokai is even more isolated than most of the other islands. It offers a rural life that doesn’t have the conveniences of box stores or instant gratification through being able to get exactly what you want right when you want it, but I’ve learned to embrace that – sometimes it’s an easier life when you have to get by with what you have. I don’t know what the future holds for my relationship with Molokai (work? vacation?), but I believe it’s a place that will be a part of my life in the future. I often joke that I can’t stay in Molokai because the snow skiing is awful – I don’t think this joke ever goes over that well, but it’s the truth. I do need a healthy dose of slippery hills in my life. Skiing is my favorite mode of exercise and my favorite way to get my adrenaline fix. I don’t ever hoot and holler doing anything the way I do skiing on a great day.

We got invited back to camp in one of the valley's that Audrey Sutherland swam to in her book Paddling My Own Canoe. Unforgiving ocean, rugged land, beautiful place.

We got invited back to camp in one of the valley’s that Audrey Sutherland swam to in her book Paddling My Own Canoe (great book about getting away from it all). Unforgiving ocean, rugged land, beautiful place.

While visiting the Maine woods last week, I was reading a book by a woman,Audrey Sutherland, who had swum and paddled to many of the most remote valleys in Hawaii and later to many remote islands in Alaska. While she lived and worked on the more-busy island of Oahu where Honolulu is located, the book was mostly about her time away and the quiet and loneliness she needed to reset. I don’t necessarily crave loneliness like she did, but at times, I need the quiet for sure. When I read the book up in Maine in a quiet and peaceful place, I couldn’t help but think how connected these isolated places can be. That connection seems to be amplified as I fly from Maine to Hawaii while passing directly over my winter home in Aspen. For a small island with a population of only 8,000, I find it bizarre that I know at least 3 or 4 people on Molokai with a connection to the small town of Aspen, Colorado (also <8,000 residents).

I got to visit another one of my favorite places on this vacation. But this belongs in a different blog...

I got to visit another one of my favorite places on this vacation.

Sorry for the long blog, but I have nothing but time today – just about 3 hours until we land in Honolulu. I’ll run out of computer battery before I run out of words. I’ve taken the long way around on this story, but this is a blog about why I am a traveling Physical Therapist. I am not OK living a life built around working a job that keeps me from the places I love for all but a few days of the year. I want to constantly be surrounded by the places I love and to have easy access to the wilderness and quiet time that I am craving more and more often. The flexibility offered by the traveling-lifestyle and the opportunity to intimately discover and explore places that Kate and I love is the greatest reason to travel. I hope if you are considering traveling therapy that you too will seek out the places you really want to be. If there are great cities you want to experience, landscapes you want to explore, or beaches you want to lay on, go work there!

It has been a wonderful vacation. I saw a lot of people and places that were great to visit with. Time to get back to work this week, but I know when the work week is done, next weekend holds another adventure in the mountains and ocean right outside my door. For me, that’s what it’s all about, working where I want to live and not the other way around.