Experiences of a New Grad - Part 1/3: Views on Treating Patients, Clinic Culture, Unique Challenges, and COVID-19
By: Sukhbir Manku, BSc, MScPT, Physiotherapy Resident

Welcome to Experiences of a New Grad!

It’s the end of summer and during “normal” times, a new cohort of physiotherapy students would be bursting through the seams as they graduate from their respective programs and officially begin their post-graduation career in physiotherapy.

Unfortunately, the COVID-19 pandemic has plunged society into a boiling pot of uncertainty about what lies beyond the horizon, especially for new physiotherapy grads. Furthermore, the PCE delays and lack of transparency, communication, and empathy by CAPR and various regulatory colleges of physiotherapy, have added another complex element to the new grad experience. 

Students will be graduating a little bit later than usual, but what’s in store?

EXPERIENCES OF PT RESIDENTS: 2020-??? 

Last year, the PT class of 2020 entered the working world of physiotherapy amidst the 2nd wave of COVID-19 as PT residents. It’s been almost a full year since they’ve graduated… So what’s the New Grad experience actually been like for PT residents?

5 University of Toronto PT residents were interviewed about the challenges they’ve faced in the clinic, building a caseload, continuing education course recommendations, the impact of the PCE delays, and much more. 

If you’re a PT student, PT resident, registered PT, or a clinic owner, be sure to read this 3 part blog series to gain valuable insight into what life as a PT resident has been in these trying times! 

How many weeks of placement did you have in your current setting and did you feel prepared to assess and treat patients after graduating?

Placements are an excellent opportunity to get a taste of physiotherapy in practice - an opportunity to practice subjective and objective assessments, develop critical thinking skills, apply treatment frameworks, and learn from all sorts of clinicians. But sometimes, it feels like placements are the appetizers in a three-course meal when students need the main course. 

Interviewees primarily worked in private practice. Some had 0 weeks of private practice experience and others had 12 weeks, yet perspectives and experiences were similar. PT residents, in general, felt that 12 weeks were not nearly comprehensive enough as this did not allow for long-term treatment planning for common complaints like chronic pain. 

PT residents initially did NOT feel aptly prepared to assess and treat patients but that was okay! As one PT resident put it...

“Part of being a new grad is the moment of uncertainty - being able to provide something valuable is important, we don’t need to have all the answers right away!” 

Another PT resident spoke of their imposter syndrome and confidence.

“We have this because we’re imposters in the field initially, we need to learn from practice as competence breeds confidence. How do you deliver a diagnosis with conviction when you don’t really know what’s going on? How do you make the patient trust you when you don’t trust yourself?“ 

However, PT residents across the interviews mentioned how they greatly evolved with practice and support from other clinicians, the road was just rocky and growing comfortable with uncertainty was essential for their growth as clinicians. 

As a new grad, what were you looking for in a clinic after you graduated? 

We’ve all heard of those stories about clinic cultures defined by quantity of care vs. quality of care and “mentors” that chastise clinicians for developing plans of care shorter than 8 weeks, irrelevant of patient presentation. If we want new grads to avoid this nightmare scenario, what should they be looking for? 

PT residents shared some valuable insight into what they were looking for in a clinic, what they currently have, and what they’d change if they could pull out the Ocarina of Time and go back in time.

In general, PT residents were specifically looking for full-time positions, mentorship, equipment and space for exercise, and a supportive and fun work environment; classic factors when considering a job in PT. However, the fine details regarding these factors is where the treasure lies.

Mentorship

Mentorship is always a key factor in selecting a clinic but mentorship can present itself in many different ways. Many PT residents preferred a model where they initially received formal 1-on-1 and group mentorship, “as opposed to trying to find time in someone else’s schedule.” Some residents preferred this formal mentorship would eventually taper off to “casual conversations with the team” whereas others preferred to have both structured AND unstructured mentorship throughout.

It’s quite clear, finding a mentorship model that fits your needs as a new grad is important and equally, it is important for clinics to have models that can meet the specific needs of their PTs.

Treatment Model of Practice

Interestingly, all PT residents mentioned the importance of finding a clinic that implements a treatment model in practice, not just motto. As one PT resident aptly put it,

“I wasn’t looking for a business to treatment model, I was looking for a treatment model which drove a business model. In my last placement, the clinic I was working at, I saw 20-25 people a day. I personally can’t give quality care like that, especially when treatment time isn't adequate. Biggest thing I was looking for was big treatment times - ethical practice without being reprimanded for business-driven practices. Do what’s best for the patient.”

Salary & Compensation

One important topic of conversation was salary and compensation models. One PT resident mentioned...

“I had less of a focus on compensation models and in hindsight, I may have preferred discussing potential salary models in the beginning due to a slower caseload.”

Other PT residents were fortunate enough to receive a salary when they initially started in the clinic and eventually transitioned to a pay for service model when it was financially beneficial for the PT resident.

What are some of the challenges you’ve faced as a new grad?

From student to clinician, there’s a multitude of challenges as we step into the real world of clinical practice. Not all ulnar nerve entrapments can be diagnosed by smacking Guyon's tunnel! PT residents faced many challenges, many of which new grads will face… and conquer.

Financial Security

Financial security was a challenge faced by many residents, especially with the mountain of student debt and high cost of living in Ontario. 

“As an independent contractor, you feel inclined to take any assessment or patient that comes despite your comfort level or experience because that could be the difference for paying rent or not. This was the struggle for the first 4 months.”

Imposter Syndrome

Imposter syndrome is a real thing and as new grads (and seasoned veterans!), it’s a challenge to face and overcome. 

“We learned a lot of special tests, but what do we use? We never really learned about statistics and clusters and likelihood ratios during assessment. Like, am I just using a PIVM for the sake of a PIVM? It’s a challenge to critically appraise why you’re doing what you’re doing. Is what we learned relevant? How do we challenge ourselves without being nihilistic about who we are as a profession?"

Charting

This won’t be a surprise… Charting was brought up!

“In school, we learn ideal ways of charting which are quite involved. It’s hard to implement this school taught way with appropriate time management with safe work-life balance.” Some PT residents are rightfully afraid of burnout - “especially due to charting outside of work hours.” 

Additional Challenges

Here are some additional challenges that were mentioned.

“Treatment planning. No idea how long some conditions would take to resolve and what a 6-8 week plan looks like.”

“There was no soft tissue release practice in school, we just talked about it.”

“Cancellations are frustrating… Initially, I took it personally but I now know I shouldn’t.”

The quote below is something that absolutely needs to be shared, even though it's tough to hear. There’s a difference between what we perceive the profession to be and what it sometimes ends up being.

“Every single person I’ve spoken to has felt some sort of displeasure with the beginning of their career (private practice). All of it comes down to more business than what you’ve wanted. Numbers driven by the business - feeling like you’re going through the motions or giving people the treatment you don’t think they need. Full Treatment planning inexperience was challenging. People being bored with it or discouraged from the business side of things, clientele NOT wanting exercise is frustrating.”

How has COVID-19 impacted your practice, if at all?

COVID-19 has been a challenge for the entire healthcare system and of course, physiotherapy is included in this. For many PT residents and practicing clinicians, there was a reduction in assessments and follow-ups every lockdown and not everyone wanted virtual sessions.

One PT resident mentioned that “The first 3 months there was a lot of financial insecurity and I was incredibly stressed” and another noted that “the first 3 months were really quiet, not a lot of money. I have a fairly low overhead so I was able to live and pay bills.” 

With that said, there were some positives to take away from this experience - there was some value in the slow pace and the large influx of virtual courses increased accessibility.

“Forcing a slow pace was nice as a new grad, I was better prepared for when it started to get busy. It’s definitely been slower and I kind’ve liked that. 10-15 minute gaps between patients in the private world is nice.” 

To paraphrase another PT resident, online courses allow for increased accessibility as they don’t cut down on clinical hours. Practical in-person components were included in courses so students got the relevant hands-on training as well.

What's Next?

Entering the world of physiotherapy can be daunting. There’s so much to learn and it’s easy to get overwhelmed with uncertainty! If you’re interested in orthopedics, check out our Orthopedics Entry to Practice course track to help you get started on your journey to develop your clinical skills. 

Click here to read part 2 of the Experiences of a New Grad blog!