The type of therapist you are – physical, occupational, speech or respiratory – only tells a fraction about the type of work you actually do. Each therapy profession is really a kaleidoscope of diversified settings. But what setting is the best fit for you?

Aside from such obvious factors as salary, benefits and proximity to your home, another primary concern is the type of setting. Be it a large hospital setting or a smaller, private facility, each has its own peculiarities that may make it a better fit for you depending upon your needs and career goals.

Michael Mulrenan, PL, OMT, FAAOMPT, is the president and co-owner of Baystate Wellness Center, an outpatient orthopedic clinic in Woburn, Mass. Within the center, he operates his own practice, Mulrenan Physical Therapy, an outpatient clinic specializing in orthopedics, spine and sports medicine and obstetrics.

His five-person staff of therapists range in age from 26 to 39, and claim anywhere from three to 15 years of professional experience in the field. The first challenge a new face joining Mulrenan's practice usually experiences is becoming acclimated with the time management and operational system there, he says.

“The private practice setting can be very fast-paced at times,” says Mulrenan. “Our busiest hours are 7:00 a.m. to 9:00 a.m. and 3:00 p.m. to 7:00 p.m., which, for a full-time employee, requires working some nights and early mornings and at least two 12-hour days. A lot of hospital settings do not have early morning or late evening hours.”

Furthermore, because of their expanded hours of operation, private practices tend to attract younger patients; those in the working population, says Mulrenan. For those who feel most comfortable working with these client populations, a private setting may be among their first choices.

In terms of specialization, says Mulrenan, the clinical responsibilities of a small-practice physical therapist are very similar to those of an MD, and can include pediatric, geriatric, orthopedic, cardiopulmonary and neurological rehabilitation settings. The type of specialty a new grad elects to pursue will dictate the type of setting in which he or she will practice: hospital, rehab center, nursing home or outpatient center.

Annie O'Connor, PT, OCS, MDT, is the corporate director of Musculoskeletal Practice at the Rehabilitation Institute of Chicago (RIC), where she manages 55 therapists at nine dedicated sites in her outpatient musculoskeletal practice alone. Throughout the organization, RIC employs 80 physical therapists, 55 occupational therapists and 25 speech language pathologists.

In addition to performing musculoskeletal rehabilitation, RIC outpatient services treats for sports injuries, chronic pain care, arthritis and women's health issues. Its inpatient arm works with patients who face the after-effects of stroke, brain injury, spinal cord injury, joint replacement and adapting to prostheses. A more specialized, intensive outpatient setting, RIC Day Rehabilitation hosts patients with more demanding needs for several hours daily.

“At RIC, there is a great variety in case load,” says O'Connor. “Professionally, we have a diagnostic role in deciding what care patients receive.”

Whichever setting a grad might choose, says Mulrenan, he or she should be certain that it offers in-house mentoring to assure that his or her skills and knowledge base are continually developed within the clinical setting.

A newcomer to this type of setting “should expect autonomy in managing his or her case load but should have experienced clinicians available to use as resources,” he says. “Clinical skills develop in a good mentoring program and a positive work environment [along with] continuing education experience.”

O'Connor concurs. “It's important to seek an environment that promotes opportunities to work with a variety of patients to diversify [your] experience,” she says. “It's also important to look for an opportunity that offers post-graduate professional development pathways for advancing [your] skills in neuromuscular and musculoskeletal practice.”

One area in which private practices cannot always compete with hospital therapy settings is employment benefits packages, which are typically more expansive in a hospital setting. Because of the size of its workforce and its educational backdrop, RIC offers flexible schedules and free continuing education classes on-site through its academy, O'Connor says.

“I have worked for the hospital for 20 years and never saw a need to look further,” she says. “They have offered job advancement and challenging patient care environments.”

In a private setting, however, the pace of the workflow and the potential for entrepreneurial experience might be other selling points to a new graduate, says Mulrenan, as well as the possibility of attaining eventual management and/or ownership positions within a private practice.

As far as personal and professional attributes are concerned, Mulrenan and O'Connor both agree in saying, aside from a functioning therapeutic knowledge base, communication skills and a personable, professional attitude are paramount qualities in a new hire.

“We look for a person with strong communication, passion and relationship abilities,” says O'Connor, ”someone who can fill a natural educator role. We like to have a mix of experienced and new grads working together.”

But regardless of how much experience a therapist has under their belt, communication is the key to unlocking professional success in any setting.

“The most important quality in a new [hire] is personality and communication skills,” says Mulrenan. “The therapists who are good at communicating and developing a strong rapport with patients tend to have better outcomes and customer satisfaction ratings.”
 
Matthew N. Skoufalos is a New Jersey-based freelancer.