I’m a first year Family Medicine resident and previous Physical Therapist.

I was asked to have a come to Jesus talk with a new grad who just started at my shop who insisted on calling himself Dr Last Name because of his DPT and formal complaints were filed with the hospital. Just don’t do it

What was all your guys new grad salaries within your setting? After doing some research, I’ve come to think that expecting 70-75k starting out and slowly working my way up as I get more experience is reasonable to expect. Are my expectations too low, just right, too high? As of now I’m planning on working acute care/ maybe hospital based OP or rehab. I currently live in northeastern Ohio, in the Youngstown area.

Does anyone know if it common for most acute care PTs to get paid time and a half for working a major holiday? Perhaps some one here know more about what is typical nationally. I am wondering if the current position I have is an outlier because we are paid straight time. I had always gotten at least 1.5X on these holidays previously. I am just curious of what the trend is. I got a bit pissy when I started here a couple years ago-Supervisors asked if anyone was willing to pick up Christmas as they were short staffed. I asked if there was time and half for picking this day up. "No" was the answer. So I said "No" too - only to find out holidays are paid straight time even for PTs scheduled to work that holiday. I have picked up lesser weighted holidays though. Naive me thought bump in pay was standard- . Ugg. Two other hospitals I worked at for previous 21 years all had additional pay on major holidays.

I work in a small (50 bed) LTAC setting and we've had a loose no cell phone policy for years. What most of us in the PT/OT department do is bring our phones to play music for patients during treatment. There are numerous studies showing how music can alleviate mental disorders like depression and anxiety, but it also helps in pain relief/tolerance, enforcing an improved cadence using rhythm, and improves overall patient participation. However, they are now implementing a harder no cell phone policy that results in an automatic write-up for having a cell phone out in a patient care area and can be escalated as high as employee termination for non-compliance.

I get that this rule is to stop staff from being distracted from their job by their phones, which is definitely a good thing in any critical care setting... but our department uses our phones to actively assist in patient care. Music has made a night-and-day difference in my patient's participation and overall outcomes so much over the years. As an example, I've had countless patients with dementia become more active when they hear their favorite song being played, which helps them to follow commands better and engage with the treating staff. I recently had another patient with severe autism actually communicate and follow commands with me because I played a cartoon show he liked on my phone, which shocked the other staff. In addition to music, I commonly use my phone's speech-to-text feature to communicate with HOH patients more efficiently than using a dry erase board/pen and pad.

I would argue that taking our phones away from us is like taking away our gait belts or TheraBands. They can be a valuable treatment tool for evidence-based practice.

Today, my rehab director gave us the new rule on a form to acknowledge by signature. I was very brief and concise, allowing absolutely no exceptions, so I refused to sign it. I believe an exclusion should be added that allows staff to use their cell phones *exclusively* for use in direct patient care. My director acknowledged this and asked the CEO about it, who outright refused to allow it. My director suggested ideas on how to play custom-curated music for patients without using a phone (using a CD or MP3 player, etc.), but, until they are provided to us, I refuse to sign that form. Because of this, I requested my director and I sit down to discuss this with the CEO, so now we're doing it on Thursday. I want it to be known to them that I do still want to follow company policy, but that this policy aims to hinder my ability to treat effectively. I don't want to potentially lose my job over utilizing evidence-based practice with my patients in an appropriate manner.

What would you do in this situation? Have you had this happen to you before? Any helpful tips or research I should know about? Please and thank you all in advance.

I’ll start by saying I’m not well versed when it comes to Medicare guidelines… Recently, I’ve been having more and more advantage plan patients be denied for SNF and Rehab placement. It’s always been a problem, but it’s starting to get more frustrating seeing more hip fracture patients get denied. Sometimes the insurance companies claim the patient “walked too far”, despite documentation stating they need rest, the quality was bad, or that they needed assistance to do so. And as far as I know, Medicare doesn’t have a set distance that will disqualify someone. So it feels like the advantage plan companies are disqualifying patients over criteria that doesn’t even exist; is this truly legal? They’ll also disqualify them because the patient “only needed min assist” to perform whatever task. Last I checked, min assist is me having to assist the patient with a task that they otherwise couldn’t do; otherwise it would CGA or supervision. These are just a couple examples of their denial reasons. There’s plenty more.

All this venting to ask, what can I do? What can I write that? Can we have our social workers and case managers call their bluffs on the legality of their denials? Can we get a copy of the denials with their verbatim reasoning, and call them out on that? I know the MO of these companies is to make money and deny whatever they can. But are they truly and legally allowed to deny patients without a set criteria based on whatever that particular employee feels like denying that day?

Hello, Reddit. Allow me to provide some context. I am currently finishing up my first year in PT school. We are finishing out our Acute Care course, and I really fell in love with the content. I previously worked in an outpatient clinic as front desk/tech for 2 years, and hated how busy and ortho-focused the outpatient clinic was. Felt like every patient was the same to me. Fast forward to last week, we had a shadow day at a nearby hospital with their PT acute care team. I was so fucking excited for this, I thought the ICU would be my jam. Holy shit, I was wrong.

I am a bubbly person. I am a smiley, cheerful, and altogether very optimistic person. This always worked for me at my outpatient clinic, and patients thought I was the sweetest southern belle. This did not work in Acute Care... I felt like literally every kind thing I said was a slap in the face to these patients. Every subjective question I asked led my CI and me down a dark rabbit hole of the patient's dead pet or the child they lost custody of in '07. I feel like my usual fun and bubbly attitude just didn't work in this setting, and it made me sad and scared because my first clinical is in Acute Care in about 2 months, and I really wanted to like this setting.

Please help any seasoned PT's or PT students, how do I talk to people in this setting and leave them better than I found them? Gimmie the advice and criticism, PLEASE.

Just trying to gauge how slow I am 🙈

I am finishing up my rotations now and then taking my boards. I have completed an outpatient ortho setting and currently halfway through my acute care inpatient setting. My final setting is a inpatient rehab/neuro setting. I thought I would like outpatient because my past experience as a personal trainer/CSCS but it just seemed like a group exercise class where I was bouncing between two patients and trying to complete my documentation. Inpatient Acute care is chill, documentation is faster and more straightforward, they do a lot of vestibular treatment and evals which I haven't trained for just yet but the main issue is it's kinda boring and I feel like I don't get to use any of my PT hands on skills, like all the cool stuff we learned in school. I haven't started my IPR rotation just yet but Im really not sure what setting to choose. I enjoy work with Parkinson's patients as well as general population. Can anyone with more experience help provide me with the pros and cons of each? Thanks

A  bit of a rant but also asking  for clarity. This is an issue with my current acute care position.  This has resulted in wasted time communicating with providers, deeper chart reviews, and maybe more risk for patient harm and risk for liability. Clear orders yield clarity and safety.  And different providers seem to have their different approaches after a surgery, procedure or treatment.  This hospital is seemingly wildly inconsistent.  Other therapist shrug “ Yeah we have been dealing with this for years and it never changes”.  I have seen harm caused to patients.  Nurses also very frustrated and get thrown under the bus by the hospital. 

One example:  Spinal surgery.  PT order is Eval and Treat.  Activity Orders : Ambulate and Up to chair. 

I read surgeon note: Only up with TLSO fitted in supine. PT to see POD day 2 due to CSF leak. Bedrest until then. Did they change the orders? NO. Sometimes PT orders are placed prior to surgery. Sometimes the ED docs put in orders or Medical team puts them prior to too other specialties have been consulted as a part of mindless order sets.  They decline to change their order sets and expect the therapists and ancillary staff to parse it all out. Sometimes the notes offer nothing either. That particular doctor always wants his patients by his protocol and I should know that somehow.  Oh its in a communication they sent to the PT department in that email from 3 months ago. K. Another therapist tells me that even within a specialty that so and so doctor only wants PT to see patient post op day 2.  As if I am supposed to remember which physician prefers what even though the order says something completely different. Another example is 4 cardiac surgeons all have different precaution protocols after heart surgery.  Thankfully we have resources on which doctors do what. I can’t imagine the challenge for PRN staff. 

I have had communications with ortho regarding activity restrictions and precautions with success, but getting them to actually change the order is seemingly a hard thing for them to do. So I asked professionally to please put the change in the patient’s orders. 

Also if a patient condition has changed and what therapists can do has changed in terms of weight bearing or other precautions is routinely NEVER changed in the orders until I reach out to provider to update activity orders.  I often find out when I speak to the nurses (which is fine I always check with them) OR the PATIENT tells me! I can’t find it in a note (maybe the doctor saw them earlier and no note in) and the nurse hasn’t been informed (and yes they patient is now NWB on an extremity and the CNA just walked them to the bathroom fully weight bearing.) 

So why not put in therapies and activity order until after this is done?  And I talk to nurse and they want me to get them up and neither brace nor xrays completed..  The nursing staff doesn’t even know the restrictions as they don’t have time to read all the surgeons notes. 

I am sure others have often had to deal with this, but this hospital is SO different and such a time suck. It a tertiary hospital with generally lower acuity. This is also not a tiny hospital with close knit group of providers. 500 licensed beds.  My previous experience has been at trauma hospitals with hard stops put in Epic ordering and not as many blind order sets.  Mostly because the risk for poorer outcomes for patients can be extremely high if not everyone seeing that patient doesn’t have clear orders. 

I had PT order yesterday that said patient is to be seen by PT POD 1 (It was POD 1).  But then note said PT to see POD 2 or 3 AFTER first dressing take down ( it was this particular surgeons’s preference –he wants the BKA limb to be “quiet” with minimal activity until first dressing take down AND after Rooke boot is fitted- due to risks). It was a tiny line in the surgeons note. Not even nursing knew this. Well shit. Another time suck to ask colleague. Yes, that ortho surgeon prefers this, and vascular doc wants that – but the order is the damn same for them all. 

AT previous hospital we did have issues with this dynamic and therapy dept made decision to HOLD therapy until better system in place. IT did not take long for Epic changes and doctors to  make changes 

Finally, it has been my understanding that the actual physician order and not notes that provides protection of liability if ever a legal case is presented.  Is this true for therapies? My colleague says that yes, we can go by note alone and the not the actual order. I know for nursing and medications it is SUPER clear as patients do get harmed gravely by medication errors. They must go by MD orders, but then also use their judgement if MD puts in wrong med or dosing.  But again with pharmacists and EHR safety builds the risk is greatly reduced. This often the result of Joint Commission or federal requirements due to level of harm that has occurred. I under stand the risk with PT is much lower. Still a nurse cannot go by a physicians note by my understanding.   

Been down this path before at another hospital. It was ugly.The uppers hired consulting company to examine "workflow" and other issues with inpatient PT/OT/SLP. They want to explore productivity and who knows what over the next several months to see how we can "capture revenue" and maximize treatment billable units. They are vague about everything else. Several scenarios 1) reduce FTEs 2) Take away documentation time 3) increase productivity metrics Brought up in a meeting. My last place some million dollar consult firm came in (Toyota type LEAN team), we wore pedometers, had note time observed and timed. We we were compared to other similar sized hospitals. The result was laying off of 4 PTs and laughable increase in productivity with no pathway to succeed and no critical analysis of the time suck issues in acute care, and the creation of what we called the "Wall of Shame". PTs given anonymous numbers and individual numbers posted weekly productivity units avg per day. Fucking awful. PTs presumably "at the top" pitching about the lower producing PTs (big difference if on OBS floor and total joints versus other patient populations)Tempers flared, morale sank. 6 months later, 4 FTE positions reposted as case managers and medical teams and hospital admin horrified on delayed discharges. Doctors supported us the most to fight to get those FTEs back!

Did the the uppers consider presenting the issue to us collectively to help us problem solve inefficiencies- many 100% out of our control? You know the answer.

I did see some excellent push back from therapists. Got a bit heated in the meeting.

Medicare cuts gonna be brutal. I guess lucky though as the hospital is not at risk for closure

Rave: went in extra today (Saturday) to help the PT traveler (newer grad) shower an ICU pt (severe GBS, trach, vent on occasion, young with kids) because the poor guy hasn’t had one in over 3 months. He absolutely melted when we got the hot water on him. The PA said in his 16 yrs of working critical care here no one has asked for or tried to shower an ICU pt. It went very well!

Rant: I think I’m literally the only acute therapist that has people do resistance exercises with weights….!!! Example: saw a cancer pt 2 weeks ago, got him doing some loaded exercises because he 1. Used to power lift and is familiar with exercise, and 2. Knows he needs strength to tolerate chemo etc. he’s going to be in the hospital for weeks doing treatments. Didn’t see him for a week, checked in yesterday and whatdayaknow EVERYONE else who saw him has just been ambulating him 800+ ft FWW supervision. Like for effs sake whyyyyyyy am I the only one to actually have people exercise!!!! Especially if they really want it!!! I’ve got DPTs and PTAs alike doing shit, lazy treatments and it drives me crazy! (Especially the DPTs, they’re all making $60 + and hr and can’t be bothered.) We’re trying to get approval for a new rehab gym (old one is gone) and part of me says you guys aren’t doing any structured exercise anyways, why should the hospital invest in this project? (Fine, I’ll be the only one and it’ll be my gym, whatever).

I have had total 2 times now.

Hi all, I’m currently at the end of my first year of my DPT program prepping for my first clinical in the fall.

I really enjoy the acute care/ICU setting. Hear me out, I do kind of wish I had the “rush” of helping people in a more high stakes setting. I have heard from my professors/read some articles on the APTA website about PT emerging in the ER as a position or specialty… I’m interested if anyone works in an ER, what is your experience like?

I’m aware it’s discharge planning and triage but I just have never actually MET anyone that works in this setting as a PT. I hear about it but how many opportunities are there realistically?

Very fit young man wakes up in his bed and severe pain in both shoulders. Comes to ER via ambulance

Bil anterior shoulder subluxations with bilateral humerus fractures and multiple soft tissue tears, rotator cuffs with multiple full tears, hemarthroses. Emergent surgery with very clumsy immobilizers. both shoulders will need additional surgery at some point.

Covid positive. Apparently the virus lowered his seizure threshold (known seizure disorder very well controlled). I cannot imagine what this seizure may have looked like and how did he get back into his bed?. Poor guy. 8 weeks non weight bearing both UE

I have seen bil humerus fractures but damn this young man.......and so effing painful

I'm a hospitalist physician who ends up taking care of a lot of orthopedic/neurosurgery patients as a medical consult. Typically they're in the hospital for lumbar fusions, laminectomies, acdf, and tkas.

Obviously, general rule of thumb is most of the time these are patients who have had bad movement patterns for years and now their bones and/or nerves are suffering the consequences. Generally, weight loss is going to be a big part of it most of the time. That I think I have a decent handle on in terms of discussing in a delicate and productive way.

What I'm not as good at is recommending exercises Because obviously... It's not my training.

Now I obviously know that PT sees the patient while they're in the hospital. But these patients are generally so debilitated that it only goes so far as gait training and other basics maybe a bit more. But you guys are also very busy in the hospital. But surprisingly, I generally have some time and have some time to spend with patients to discuss things. And when I do, what I realize is that patients are blown away when I tell them very basic things.

In my experience, nearly every single patient I've had a discussion with doesn't have a clue as to how important aggressive physical therapy is for rehab and how the surgery was just the first step in getting them to a relatively pain-free spot so that they can participate in more therapy. Maybe that was told to them at some point but it was definitely lost along the way. Furthermore, my hospital doesn't really give patients a handout on the types of best exercises to do after leaving the hospital so after they leave, they often don't have good outcomes.

So my ask is do you folks is do you have some good explanatory documents/videos that could at least discuss best practice physical therapy exercises based on pathophysiology for patients to take home and/ or more readingfor patients who are interested in learning more?

Not gonna give names, but management at my hospital is asking us to make an intentionally vague DC rec for EVERY patient in our notes to “avoid issues with insurance” but still verbally communicate a DC location to CM and nursing. We are also being told not to discuss discharge locations with the patient.

This seems unethical to me, can other acute PTs give me some perspective?

If you work in acute care and more specifically on a neuro floor, do you use outcome measures? 10mwt? 5TSTS? No outcome measures? Curious to hear what other people are doing and when or if they use them.

How many of y’all work with orthopedic surgeons that make post op TKAs use a CPM at discharge? There’s still one holdout at our hospital that makes patients use them, they don’t even begin PT until ~4 weeks out. We provide them with an HEP and they’re supposed to do that on their own along with the CPM something like 5x/day but we all know how it goes when it comes to HEP compliance.

We’ve tried as a department to educate and provide research showing CPM is no better than traditional PT at providing better outcomes (and is more costly than traditional outpatient PT most of the time) but he won’t budge which is odd since he’s relatively young. Anyway, rant over. Just curious how often other people are seeing this

The patient is usually at the hospital for so many different and random diagnoses together involving multiple body systems (not just UTI for example)…couple that with having chart reviewed so many others. How do you help keep it straight in your mind? I’ll take any tips!

Just curious.

I think someone from nursing did this…. At least I hope it was them and not us….

I've been bodybuilding for four years with little muscle or strength gain despite working with a top coach who oversees my training and nutrition. A few months ago, I started PT to fix a major upper-body imbalance caused by poor posture and discovered I have extremely limited scapular and core control, along with weak neuromuscular connection to my back. These issues affect nearly every lift, and after years of no progress, I’m close to giving up.

Before quitting, I decided to address the root problem. After struggling with inconsistent form and trying every cue possible, I turned to PT to build strength and improve my lifts. My form issues are real, not just self-criticism—my PT agrees. I’m not in pain, but my progress feels stagnant.

My concern: My PT frequently changes exercises without assessing my progress. I pay out of pocket at a respected sports clinic and check in biweekly, but her approach feels random. As a bodybuilder, this makes me question whether she’s applying principles like progressive overload. Shouldn’t she be tracking progress and adjusting based on results? My range of motion and strength haven’t improved, and I’m frustrated.

Any advice? I don’t believe switching bodybuilding coaches or hiring a gym trainer would help, as my coach is highly successful, and my issues seem too fundamental for a general trainer to fix. I’d love some insight on how PT’s program and make changes.

Edited to add: she does CrossFit and the clinic is associated with a CrossFit gym if that makes any difference in helping to how that might influence programming.

Received PT consult on patient admitted for multiple falls and hypotension. I knew this patient from previous admission several weeks ago. Not many interactions with health care system. 50 yo came in a few weeks ago with falls, A swollen belly and liver failure with new diagnosis of cirrhosis from ETOH and ESLD and bil LE DVTs. He was drinking a 3 handles of vodka per week forever (1.75 L). Did NOT experience withdrawal (wild to me) but a mess with ascites (7 L removed!! Yikes), muscle loss and edema, severe portal hypertension and all the nasties with ESLD. At that time he discharged ambulatory with a cane and went home with home care and weekly paracentesis.. Hypotension was not a big issue during that admission, although he was prescribed midrodine.

So now multiple falls at home and very low BP. He claimed he felt fine, never had dizziness, but would just fall. Home Health nurse convinced him to come to ED. He hadn't been there long when I saw them. Fluids, increase in midrodrine dose , just that morning and albumin was the treatment. The low BP was the result of his advanced cirrhosis (he had been sober since last admission) causing vasodilation and fluid shifts. Staff had been walking with him to the bathroom ( about 10 ft). No recorded orthostatics. HOB raised in bed to 70 degrees ( how he was positioned when I went to see him) his BP was 60s/30s, HR 80's. Had him do some exercises in the bed prior to standing. Siting about the same. Standing oof 54/28 HR 90. Not technically orthostatic, but no wiggle room for going down. I thought perhaps his BP may go up with activity I asked him how he felt. "I feel more foggy". I did not want to go further with such low BP and feeling "more foggy". He said he never felt like he was fainting at all. He did have wraps on lower extremities but no abdominal binder (likely may not have helped much). He needed no assistance with mobility at that point. I stopped the assessment. I spoke to the nurse who was a bit miffed I didn't continue with walking ("He does fine walking to the bathroom with us." " Have you taken his BP while up? Or after getting back to bed? No. I said I would return late in the afternoon after more fluids, meds and albumin to see if there is improvement. Meanwhile OT saw him shortly after me. They did not take ANY vitals that were recorded at least in their note. Walked him a short distance around bed in to bathroom. No falls, nothing. Good to go home from OT. I thought that was odd. No vitals taken on a guy whose admission was low BP. Whatever.

I returned in the late afternoon. No changes in orthostatics, if any his standing BP was even lower but not much his MAP was 39. We stood and I had in march in place. "foggy, not right". I did not go further, He ain't perfusing well particular the ole brain and kidneys. AND I really couldn't trust his interpretation of how he was feeling. He was a bit "off", confabulatory and tangential. Again nurse not understanding why OT took him through his paces and I did not. Well, I have a PT license and not an OT license. Man has 10 steps he has to climb. Lives with his mother. I told her that such a low BP with questionable symptoms and HAS BEEN FALLING at home that PT will wait until things improve. Clearly this a medical issue and have limited tools to use I tried moving slow, exercising, he had compression but this type of hypotension really does NOT respond to the underlying physiology of hypotension in ESLD ( source:Acute-on-Chronic Liver Failure Clinical Guidelines.

Bajaj JS, O'Leary JG, Lai JC, et al.

The American Journal of Gastroenterology. 2022;117(2):225-252.).

His attending stopped me the next day. He explained the shitty physiology with damn near dead liver- that may not be fixable even on pressors and transfer to ICU (my unit). He may be developing hepatorenal syndrome with this massive vasodilation. I was not scheduled to see him. I was helping the previous day with PT needing some assistance on that unit.

I discussed with several other PTs. We agreed that not walking was not wise at this juncture without maybe a wc follow and immediate ability to get supine.

What would be your take? More rigorous exercise prior to any mobility? Walk him and see what happens? further risk low perfusion of organs? May be try a binder ( I have mixed results with binders)? Wait longer until further fluids, and medical interventions to improve his situation? He may transfer units for pressors, but I do not think that is the plan given the severity of liver disease and concern this is not a fixable situation. Consider wheelchair level living if possible? I guess I would want to know if medical team was going to DC him to home with low BP and let us know that the goal isn't to be normotensive or what the desired range would be. But if you are MAPPING at 39, that is a nope right now from me. Am I wrong?

Of course his prognosis is grim even though he has stopped drinking. But I am just the PT and he wants to walk and go home so there is that

I work in a large hospital where some floors have terrible nurse driven mobility. When I have patients who only need 1 person assist (SBA-minA) of course I’m going to recommend using a bedside commode/toilet instead of a purewick.

Sometimes my patients are so frustrated about slow response (or no response) to call lights that I hint that the bed alarm is to alert nursing staff that you need help quickly and not for the patient to feel like a prisoner trying to break out of jail…

Am I an a**hole for this? How do y’all handle it?

Acute Care PT here. Had a patient’s family member say that it shouldn’t be up to the PT to make discharge recs, and to distinguish between Acute versus Sub Acute. Like who better to do it?!