Should you do a Physical Therapy Residency?
This question has been circulating the interwebs in recent weeks and I have also been asked this question from a few from quite a few former students in the past few weeks. Some asking with pure curiosity, others with a negative rhetoric and a profound “are you crazy”, and some with a positive tone (usually former residents or those participating in a residency program in some way shape or form).
I have a unique perspective on this question because I was a resident in a 1-year cardiopulmonary residency at the VA Ann Arbor and then was a mentor in that cardiopulmonary residency for about 4 years. I have definitely seen the ins and outs of this type of program. Also, to be fully transparent, I now mentor clinicians who want to sit for their cardiopulmonary specialty exam, instead of doing a residency. So I suppose I have bias on both sides of this coin. will give you the pros and cons from my perspective and I’ll give it to you straight.
So the quick answer to the question: Should you do a physical therapy residency? Is: It depends!
I know most people hate that answer, but hear me out. What does it depend on? It 100% depends on you.
Start with a few questions:
What is your why?
What are you trying to accomplish with a residency?
Is it about the letters behind your name?
Is it to make more money?
Is it for mentorship?
Is it to level up your hands-on skills and advance your practice?
Is this the area of practice you want to specialize in? Are you passionate about this population?
This may sound like an obvious one, but I hear it often. Usually after the completion of a residency or specialty exam. “Do I even want to practice in this area?”
This is especially true for the new grad. Are you sure you want to do this?
What are your expectations post-residency?
Like I said, it depends on you. Your "why" matters and I recommend starting there. Hint: This will also help you on your residency interview.
I’ll also add some tidbits on new grad vs seasoned therapist along the way.
Pros:
Expedites the Specialty Process
In order to sit for your specialty exam you have 2 options. (this may have to be a separate Blog post)
Option A: Experience. 2000 hours in a specific specialty. The Cardiac & Pulmonary Specialty also requires a research project or more recently a case study, essentially proving your expertise.
Option B: Residency from an ABPTS-certified residency program. Typically 1 year in length.
Mentorship
This was one of the major reasons why I wanted to do a residency. I wanted hands-on mentorship. I wanted to be engulfed in the learning process.
As a new grad, I was thrown in like many others have described or experienced. I learned by doing, by making mistakes and by eventually leading. In 4 years’ time, I was running a successful program within my institution, I was a “clinical specialist” on my unit, I was a go-to person for many and I helped implement and train a nursing mobility program. But I felt like I hit a wall on growth and I wanted to understand more, I wanted to break down the why, have better rationale and be able to articulate that rationale.
It is super important to understand what mentorship means. You will have someone guiding you and teaching you, but you will be critiqued and challenged. You are a student again. Everything from how you ask questions, to your note writing, to your literal hands-on skills and everything in between. I personally wanted this. I craved this. I was in search of this. I believe this is an advantage for the new grad or novice PT. You are still in that student mode and may be keen to constructive feedback. Seasoned PTs, get back in that saddle and leave the ego at the door.
Expedited Experience
This is a 1-year robust program. Meaning for 1 year you will be engulfed in whatever specialty you are working in. You will likely have a wide variety of experiences within this specialty. For example, in my residency program, I had access to cardiopulmonary patients in the ICU, acute care setting (regular floors), skilled nursing, and outpatient programs. I ran both outpatient cardiac and pulmonary rehab programs. As a mentor, I assisted in implementing a home-based cardiac rehab telehealth program, which my residents then assisted in running. All of which was possible in one day for an entire year.
When my residency did not have access to a certain experience, then opportunities were created to observe in other facilities. I.e. cardiopulmonary pediatric patients, LVADs, ECMO, etc.
Opportunities to teach in multiple settings: DPT programs, State Conferences and Patient education sessions. It is a skill to be able to teach information to different audiences (patients, students, colleagues).
The point: You will have more opportunities in this one year than you likely would have in maybe 5 years’ time without the residency
Networking
You become a part of a network. You will may make connections with other providers, possibly patients, faculty, etc. Doors may open that would not have opened without this experience. It may lead you to your dream job. Again, it depends.
I was able to become a mentor in my residency. I essentially had a 1-year interview. Both myself and the employer knew exactly what they were getting. And although sometimes hard, this was my dream job, with relatively good pay.
I was able to get a tenure-track position in faculty due to my specialties and teaching experience within the residency without needing a post-doctoral degree. (note: decrease in pay with this job)
A friend/ colleague/ mentee of mine did a sports residency; that experience and the connections that were made during that residency led her to an amazing opportunity in the NFL.
Practicing at the top of your License
Full scope of practice and nothing less.
Typically in a residency you learn your entire scope of practice (specific to that specialty). And I honestly can say this was my favorite piece.
I learned how to suction, auscultate, perform airway clearance techniques, use an ambu bag as a breathing tool, mobilize patients on vents, learn how to manage LVADs, how to manage wounds and wound vacs, create PT MICU rounds, etc etc etc
Ownership! The residency gave me ownership over my skills, techniques, leadership, teaching, note writing and even the simple things like wearing my damn stethoscope.
Thinking about what you are wanting to get out of a residency is step #1.
If higher pay is the primary reason for considering residency, I’m going to say this is likely not the route you should take. But sometimes improvement in pay is possible based on opportunities that present itself post-residency and specific institutions that you may work for.
Cons of a Residency:
Money/Cost
First piece about money revolves around the residency itself. Will you be paying tuition or will you be paid a salary? Both are possible.
If being paid a salary, you can expect ballpark figures to be around 75% of entry-level salary. Typically you will get health benefits, but no retirement plan.
For reference I made ~$45,000 during my residency. So essentially I took a 50k pay cut to do a residency, plus moving fees, rent, etc. Was this a good financial decision? ABSOLUTELY NOT! Would I do it again? Probably. Because it is what I was looking for at that time and money was not the #1 reason why I chose to do this.
But this is a real issue right?? That’s a BIG hit. It took about 2 years to truly recover from that 1 year. Can you take that hit financially? Do you want to take that hit financially? Do you have other sources of income? Do you have savings or a side hustle?
I do think in theory this is can be an easier move for a new grad. Does it still suck financially? Yes, but maybe less of a hit? I know, that can be debatable, especially with the amount of student loans you may have acquired. It would essentially be starting at 45k instead of 60k, which may be more palatable than going backward in pay.
And lastly, yes, I spoke about money. I honestly wish more people would. It helps in decision-making and lots more, including equity.
Money/Salary
Will you make more money post-residency? Maybe. Sometimes. It depends.
It’s not always and I’m sorry to say that is the truth.
It totally depends on where you land your next job.
Some jobs pay only based on time experience. (So, maybe not)
Some jobs honor specialties as a different step-level on their pay ladder. (So, maybe yes)
You may land a high-profile job. (So, maybe yes)
The Move
I think this a big decision and can be the biggest barrier outside of cost. Are you able to pick up your life and move across the country? Do you want to pick up your life and move across the country?
What’s the plan post-residency?
Are you leaving a job you like? Will that job be waiting for you post-residency?
Do you own a home/condo/apt? Do you rent? When is your lease up? Will you be able to rent out your current place for a year? Will have to find a new place when you return?
Do you have a family? Is your spouse/significant other willing to leave for 1 year? Do you have kids? Are they in school?
Most specialties at this point have a few residencies across the country which may increase the probability that the residency that you want is in your state. But likely, you can expect to move.
PS that also comes with a cost.
1-Year Commitment
For real this is a 1-year commitment. Do not make any big plans for this year, I.e. weddings, buying a home, etc.
It is one year of being fully engulfed in PT day in and day out, ask my wife we may do a podcast about this.
Soooo, like I said, it totally depends! It depends on you and how you answered the above questions. And how you felt about the pros and cons. There are lots of factors to weigh here. Again if increasing your financial status is your primary motivation, I’m going to say stop, this is not the right path. And that is unfortunate but true. Is there possibility to make more money, yes, but it is not an automatic result.
At this point you may be wondering if there are other options to get to specialty, the answer is yes.
Check out my podcast: Talking All Things Cardiopulm, Episode 16: 3 Roads to Specialty Practice
Wear the damn stethoscope!
Disclaimer: I am an Amazon affiliate.
