The Importance of Being a Generalist

As a first year PT student, I hear a LOT of complaints (okay, and I  make a lot of them too) about the state of physical therapy education.  It seems, on the whole, that a lot of students would rather have specialized education: the ability to focus on a field of your choice. “Like medical education”, they say.  I’ll admit that I am sometimes one of these people.  I know that I want to specialize in sports injury rehabilitation, especially with the endurance sport community and with female athletes.  In no way does that mean I think the other disciplines are unimportant, it’s just….that’s what gets me fired up!


Here’s the thing, though.  There’s nothing wrong with creating a specialized career.  In fact, I think it’s in many ways a good thing for our profession and I think we should ultimately move in that direction.  But PT school, as it currently stands, is not the place for specialization, and here’s why.

1.To specialize while still in school would not be “like medical education”.  The way we’re already doing things is actually a pretty solid mirror image! You don’t specialize in medical school – you take courses and do rotations in pretty much ALL the specialties. It’s not until you match with your residency that you pick a specialty.  Same thing in PT school, except that for us, residencies are not required.  If you know you want to specialize, start planning for your residency!

2.You need to pass the NPTE.  Yep.  Can’t have a specialty practice without a license, amiright?  I’ve actually found this unavoidable truth to be super helpful in keeping me focused and engaged in classes that aren’t my favorite.  Every time I find myself trying to memorize muscles of the tongue (yeah…I still don’t know why this is relevant to PT, not gonna lie…), or trying to identify acute care lines and leads (they all look the same!!), instead of thinking “ugh, this isn’t useful to me, this isn’t what I want to do”, I try to think of it as early reviewing for the NPTE.  The more I engage now, the less work I’ll have to do to pass that test later. 

3.You don’t reeaaallly get to pick your patients, most of the time.  If you work for a sports team or in a D1 training room…..actually nevermind, I was going to say “you can stop reading”, but it turns out imma need you to hang with me for a bit.  Suppose you work in a D1 training room, and one of your athletes comes to you with some weird tingling and numbness. Or chest pain.  Just because you work with high level patients does NOT mean you can forget about differential diagnoses. Think about it; athletes are every bit as susceptible to conditions like Multiple Sclerosis and hemmorrhagic stroke as anyone else. How many times have YOU felt some numbness or tingling right after a neuro practice management lecture and thought “OMG WHAT IF I HAVE ______(insert random medical condition here)?”.  Right? It could happen.   And while risk of things like stroke and heart problems can be lower, depending on the type of athlete you work with, they can certainly still occur.  It’s rare, but not impossible, and you need to be ready for it.  If you are going to be the FIRST provider your patient sees (direct access, guys…), then you need to be able to spot the basic red flags, and know when to refer.


Less rare: you don’t get to pick your patients. A lot of us want to do the sexy cash-based private practice thing (I’m right there with you), and while you can tailor it to a certain population, you really can’t control who walks through the door. If you advertise yourself as a sports expert, and a stroke patient comes to your clinic….you’re probably not going to turn them away (straight up, if you do…you’re making our whole profession look like douchebags).  You NEED to know how to treat them! One of my professors at Duke gave us a lecture about this earlier in the summer;  in his words, “You will all be DOCTORS of Physical Therapy.  If a complex patient, or a patient outside your specialty, walks into your clinic, and you don’t know how to treat them, that’s UNACCEPTABLE”. And I completely agree.

For example: I’m currently getting physical therapy after a labral tear repair surgery.  The place I go is really cool – it’s half rehab, half strength and conditioning.  It’s based in a gym, so while I’m doing my bosu step-ups, there’s likely a bunch of dudes right behind me doing push presses and turkish getups. My PTs are both strength and conditioning professionals and are both athletes themselves.  They work with a lot of athletes, for sure, but they also see worker’s comp, total hips, elderly patients – I mean,  I myself am the most boring patient in the world right now (I can do some really aggressive quad sets though…) but they’re treating me! You can work in a place that doesn’t even have “physical therapy” in it’s name, a place that’s mostly barbell-based, and STILL see patients outside your specialty.  You MUST be ready to do a good job with them.

When you choose a career in physical therapy, you shouldn’t really care what level of performance your patients start at.  You should care what level of performance they’re at when you discharge them.  Pro tip. 


4. And lastly, Mastery.   I know, I can’t help myself, three articles was not enough! To be a truly good therapist, you need to go both deep into your specialty, and WIDE into all the specialties.  As Robert Greene says- true ingenuity is simply learning all you can about multiple disciplines, and combining them in new and different ways. An in-depth knowledge of the neurologic system will add depth to your athletic performance programming (seriously, pay attention when your professor talks about neural plasticity.  It occurs in healthy brains too).  A solid grasp of strength and conditioning principles will help your MS and Parkinson’s patients live a higher-quality life.


Bottom line: You can worry about specialization when you’ve graduated.  That, I believe, is the value of residency training. During your short three years of physical therapy school, really engage in your coursework- this is your time to get really good at treating ANYONE who walks through your door, and more importantly, taking your role as a primary care practicioner. If you want a direct-access, cash based, clinic, then triage and differential diagnosis is something you’re going to be doing with most every first time patient!



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