I've just finished speaking with a group of final year physiotherapy students about working in private practice. It was a Friday afternoon and you could feel the amount of brain power that was being used in the group. Consumed with final year coursework deadlines along with trying to get into the right head space to figure out whats happening next, I could feel the energy, although positive and keen to learning, weaning.
I still remember to this day the feeling I had when I found out I got onto my physiotherapy course. I couldn’t believe I was accepted in as I had met so many great folk on the day of the interview with far more confidence and knowledge than me it seemed. Once the initial buzz died down I thought Aberdeen… that's near Edinburgh right, and January will be a nice month to start a new life in Scotland!!!!…. Ah wasn’t I in for a great learning curve... and that I did. Runners/’trainers' do not keep your feet dry in the snow… and no matter which direction you're cycling in to get to lectures and part time jobs, there's very often a head wind!!
When you get to the final stretch of your course, you start to think about the next step and I was itching to get going. I got more and more hooked by the day in physiotherapy and actually took the North East on by doing lots of sea swimming with the Aberdeen Surf Lifesaving. If you're going to do it, you may as well jump in with both feet! Coming towards the end of our course I often heard clinical educators joke about how you think you have made huge steps with your learning in University but wait till you start in the real world, in the field and head on with a full list… then, they assured me, I would actually start learning.
As the final months progress, it is a tough challenge to manage mixed emotions of achievement, confidence with where you are at, and feeling like you're about to jump into the unknown and would you be prepared enough? Would you remember all that you had learned, and would you be a part of a team where you would be able to get the opportunity for maximum soakage of knowledge when you qualify?
Before I qualified I had applied for some jobs in a variety of settings including NHS (National Health Service) as well as some private practice positions. We were often advised to start as a Band 5 (Basic Grade Physiotherapist in the NHS) and then you would get lots of experience in different physiotherapy settings. However, a few months before qualification, the jobs situation reached an all time low. Jobs were hard to come by and we hadn’t even qualified yet!
When I look back now, I realise the silver lining in this scenario for an eager, soon-to-be graduate was that it pushes you to think outside the box, to work even harder than you thought you had it in you, and to embrace any opportunity as it came up. It made me more enthusiastic about physiotherapy than ever and when my first job did get started I embraced each aspect and was constantly looking for learning opportunities and I learned more than I ever thought was possible.
Many a graduation student knows the feeling of accomplishment and happiness with being able to be a Chartered Physiotherapist after a long hard slog, mixed like a cocktail with "what am I going to do now and have i picked the right path?" It can be really tough trying to navigate and manage the mindset of getting to the end of your physiotherapy course, leaving friends and moving on potentially, compared with preparing for an interview and even choosing where to apply to.
You have to think further ahead and ask questions about whether you feel you will be going on the path you think you will still love a year, 2 years or even 3 years down the line, because in physiotherapy, what you do in the first few years shapes where you progress to after that. I have qualified with people who were top of the class in outpatient physiotherapy as a student and after their first job, disliked it so much never went back to it, and I have friends who qualified not knowing what they would do but finding their niche early on and are now still passionate about it to this day. It's not simply a case of whether you want to work in a hospital or work with sports injuries. You need to look deeper into your goals, what your style of learning is, and match them with the environment or departments you may be relying on to help further your career.
1. Check out Your Clinical Leads!
The need for physiotherapy is greater than ever as we are stretched for time with patients. Often we don't get the opportunities for ‘hands on’ with patients and in many outpatient Health Service positions you might only ever triage a patient over the phone, or see them once before discharge. This can make it even more scary to be able to give advice to patients on what they should be doing to get better and how long that make take, as the proportion of patients you get to journey with throughout their issue has reduced considerably.
One of the biggest challenges (apart from connecting with your patients) that I see new grads and students have in a private practice setting is knowing likely healing times of issues, as well as the difference in hands-on assessments. Why? Let's face it, over the course of most placements (up to 6 weeks) you may never see the same patient twice in our current Health Service outpatient setting. Think about it… "follow this rehab program Mrs Smith and I’ve read in studies that you will most probably get better!" When the time comes to sit in front of a patient and honestly try to answer and address their concerns, worries and questions, your confidence can take a hit as you genuinely have never been there before!
Having a good supportive team that gives you regularly 1-1 and team training (and yes even in private practice it's needed. At Alba Physiotherapy we close our clinic for up to 2 hours every week AND you have 1-1 time) to be able to support you as well as make sure you're going in the right direction AND that you're getting maximum soakage to become the best therapist you can be.
I've had many a student and newly qualified graduate breathe a sigh of relief that they made it through the full initial assessment to only take a sharp intake of breath when they wonder what do we do with them next! What if they come back worse, better or… even worse… no different! Many musculoskeletal outpatient placement opportunities now will mean you often see patients once or twice throughout, due to time constraints and staffing. In order to be able to provide a comprehensive plan of care to patients, you must have the opportunity to work with therapists and clinical leads that navigate and journey with patients on a daily basis. To be able to confidently and comprehensively address patients concerns as they go through what is often stages of behavioural change to correct a habit and get better essentially, being part of a team that works in that way is essential.
It is often hard for patients to feel confident in a therapist who uses the words "might", and "maybe you will", "probably," and "most people should get better at that stage I think" etc. We ethically give our clinical judgement, but this can be challenging to give if you haven’t actually HAD the opportunity to experience the journey of patient care.
It may surprise many that I'm not talking about specific physiotherapy treatment courses and what book you should be buying and making notes in the columns right now but throughout my career and working life, this one is the corner stone. I've worked in places with fantastic clinicians where the culture was stressful, non supportive and lead to disjointed team work . AND, I’ve also been blessed to work with fantastic clinicians who created a fantastic culture… the main difference between the two… one where you learn rapidly with both personal and professional development, but with the other, a lot of your energy goes towards all the negative stuff.
The great thing about physiotherapy is that we are practical people, keen to make a difference and improve peoples quality of life, and we love to learn. What is important however is that we don’t sacrifice the person i.e. you, for the system. It leads to burnout, dissatisfaction that you can’t input the way you would like and it kills the spark we have. That spark drives creativity to find ways to help patients navigate through their pain and difficulties, it drives us forward to want to research more to improve our clinical reasoning, it drives our thinking process to brainstorm ways to improve service provision and it also gives us the ability to be ourselves in work and to do what we do well - work and support each other as a team through the good days and the not so good days and that's where exceptional patient care provision is really seen. So, find a culture that fits your way of working, thinking and embraces YOU for YOU as part of their team.
The final aspect I encourage all new graduates (and even oldies like myself) to continually work on is communication… I often find the word communication is used as a given as we work with people every day... surely we must be great at communicating right?... Not only do we have people in pain, they are anxious, fearful and unsure in front of us. They are using the emotional part of their brain which is normal. We - as we are not going through it - are using the logical part! So, explaining logically to someone who is thinking emotionally is like oil and water.
Vital to this, is understanding and connecting with the patient's true concerns, with empathy. Let me give you an example. We presume as physios (in a lot of cases), the patient's first problem that we write down on their problem list and treatment plan is pain… and yes, technically, it is. Throughout my entire career, the biggest and first lesson I've learned was that people put up with pain for weeks, months and even years and many people actually don’t even come to get treated who are in pain!
The people who come to us come because the pain triggered something e.g. fear of the loss of independence... it stopped them from playing on the floor with their grand kids... pain meant they couldn’t finish a round of golf and hence left them feeling isolated from their friends and the list goes on. Getting to know the root cause of people's issues, i.e. the "why", is, i would argue one of the most important things in order to truly connect with patients. If you can start this process, you will then be able to design a plan of care which will work and will be truly tailored to the person sitting in front of you.
In our clinic we have a 3 point focus… Person first, patient second, problem third… high level physiotherapy treatment is a given, but getting to know the patient's true challenges is where we make the most headway with getting to the root cause of issues and making sure all our treatments are specifically tailored to the person who is in front of us. When you are choosing a job to apply for, make sure you will have ample time to get truly get to know your patients' real issues and how they intertwine with their ‘physiotherapy’ ones. If being a part of a team that delivers exemplary patient care is your passion and vision then ask the questions to find out if you will have the tools you need to develop your skills in the role. This will be time - time with your patients, and time with your clinical leads to chat through your cases AND time with the admin team who a lot of the time, are in the front line with helping your patients and can provide valuable insight.
So they are my top 3 pointers for new graduates to think about when contemplating where to apply to. Even as you approach your qualification date, excitement is looming and you're starting to see double as you fill out job applications, take some time to really think about where you're applying. Do they have the right mentorship program to suit the type of physio you truly want to be? What is their culture like for growth and learning? You may not be sure of which type of physiotherapy or patient group you would like to progress in, or you may not even know if you might want to specialise at some point, but find a culture that values growth and learning both on a personal and professional level and you will enjoy each day and grow to be a great clinician.