8 Nontraditional PT Settings to Explore

Many physical therapists go through school with the goal of working in a specific physical therapy setting. Some can’t wait to join an inpatient rehab facility; others are excited to work in outpatient orthopedics. Then there are the PTs who love the idea of home health, pediatrics, or skilled nursing facility (SNF) rehab. But, the dreaming tends to end there—because as PT students, most of us assume that we’ll be working in one of the aforementioned environments.

That’s why we decided to write this article: PTs have tons of unconventional—and largely unknown—settings where we can treat patients. So, if you’re interested in working outside of a traditional setting—but you’re not quite ready to leave patient care—then you’ll love learning about these seven non-traditional PT settings.

1. Adult Day Care

Adult day care is a setting many people don’t know about. These facilities offer companionship, supervision, and assistance to seniors—and a break for their caregivers—during daytime hours. Many adult day care facilities offer physical and occupational therapy services. They often operate on an as-needed basis, which allows clients to be dropped off for a single day or for ongoing care. While Medicare doesn’t typically cover adult day care services (except in the PACE model, which I’ll discuss later), clients can sometimes receive federal or state assistance. 

Pros

• Easier on the body: PTs typically perform less manual therapy and fewer dependent transfers in this setting, making it a great fit for therapists who need a break from physically taxing settings.
• Great schedule: The hours tend to be flexible and lend themselves to a good work-life balance.
• Documentation: Paperwork is often less burdensome compared to other settings.

Cons

• Pay: Adult day care jobs aren’t the highest paying around.
• Lack of hours: Full-time, benefited positions can be tough to land, but it’s not impossible.
• Little growth: There isn’t always a clear career path in this setting. 

An Example

Malika Rasheed, PT, has been in practice for more than 20 years, and she’s worked in nearly every setting, including owning her own outpatient ortho clinic. She eventually sold her clinic to be more present with her aging mother and joined the staff at Montgomery Adult Day Care in Rockville, MD. The facility is open six days a week, between 8:00 AM and 2:00 PM. This part-time schedule allows Rasheed to visit her mom daily, and she’s able to set her own schedule. “I still had a passion to treat patients, just not 17 a day,” she explains. Not only does Rasheed find that that her work-life balance has improved immensely in this setting, but she also enjoys working with the patients themselves. “This population is genuinely grateful, eager to learn and so appreciative of your time with them,” she says. “At the end of a work day, I leave having finished all my notes and walk out reminding myself what these patients have taught me...to smile wider, laugh harder, and hug longer.”

2. Corporate/Employer-Based

Another unusual setting for PTs is working onsite at a corporation. For example, there are PTs onsite at the Google and Apple campuses and other large corporate sites. These roles can be great for therapists who enjoy a steady schedule and are looking for a healthy work-life balance. 

Pros

• Predictability: Corporate sites tend to offer consistent schedules and patient populations.
• Lower pressure: Corporate environments tend to be less productivity-driven than other settings.
• Focus on patient care: You typically won’t be asked to perform additional marketing duties.

Cons

• Monotony: If you crave variety, these settings can feel a little boring at times. 
• Fewer non-clinical opportunities: Compared to more traditional outpatient facilities, corporate sites don’t always allow as many chances to develop non-clinical skills.
• Lower compliance rates: Patients can sometimes take the care for granted and be less compliant with their therapy.

An Example

Matt Huey, PT, MPT, Dip MDT, works for Premise Health as an onsite therapist at a courier delivery company headquartered in Irving, TX. He sees a caseload presenting with primarily orthopedic issues, and he has been very happy in his role at this facility. “They want quality care, not high numbers,” he explains, noting that his center doesn’t hound him to cram tons of patients into his schedule or treat in any particular way. He also points out that, because many of the company’s employees know each other, there’s a strong focus on providing private, discreet, one-on-one care. “You don’t have a gym full of people,” he adds. For therapists who thrive in focused, calm environments—rather than busy and chaotic clinics—this type of setting could be the perfect fit.

3. Mobile Outpatient

Mobile outpatient therapy is a relatively new practice model that has been gaining popularity over the last few years. It’s sort of like a hybrid between home health and outpatient therapy, because therapists bill under Medicare Part B (or private insurance), but they provide services in patients’ homes. This can be a really great fit for therapists who are independent and love relaxed schedules, but wish to work with an active, somewhat independent population.

Pros

• Flexible hours: Therapists can often set their own schedules (provided this works for the patients).
• Autonomous work: Therapists have the luxury of independence in these roles, with little to no workplace politics or drama.
• Patient-centered: Interventions can be very functional and focused on patients’ unique home setups.

Cons

• Isolation: Driving around all day can be lonely, especially if you’re used to bouncing ideas off of coworkers.
• Documentation: Finding time and space to chart to Medicare’s standards can be tough, as seniors don’t always have consistent Internet access.
• Hidden costs: Therapists often cover their own travel expenses to move between patients, which can cut into profit.

Examples

Jim Prussack, PT, MPT, MMT, is the president of In-Home Therapy Services in San Diego, CA. He created the company in 2006 when he saw that many older Medicare patients had trouble traveling to PT clinics for their outpatient care. He wound up creating a niche mobile outpatient service that was so successful, he has since started training other therapists across the country to help them set up their own mobile outpatient practices. He shares: “There is a need for more therapists doing this type of work. Patients benefit from it. Therapists love it. It is a win-win for everyone.”

Across the country in Philadelphia, PA, Sam Kelokates, PT, DPT, GCS, has enjoyed working in the mobile outpatient model with FOX Rehabilitation for several years. “What I love the best is restoring independence and helping my patients return to community activities,” he says. “In the home, I'm able to build a strong relationship with my patients and caregivers. I'm better able to identify the barriers they have to safely aging in place.”

4. Animal-Related Rehab

You love working with patients, but if you sometimes wish you could work with animals instead of humans, then this might just be the setting for you. We’re seeing more and more physical therapists incorporate animals into their careers these days. In some cases, therapists use animals as therapeutic aids (e.g., therapy pets and hippotherapy), but other PTs are starting to treat the animals themselves. Dogs and horses are the most commonly treated animal patients, but some therapists are working with cats—and even rabbits!

Pros

• Variety: Working with animals can be a refreshing change for bored therapists. You’ll see all types of patients, including sporting dogs/athletes (e.g., agility, flyball, dock diving), companion animals, rescue/shelter animals, and working dogs (e.g., K9 and search and rescue). You can even work with horses if you get the right education!
• Growth opportunity: This is an emerging niche with many opportunities for ambitious PTs, especially those who want to advocate for our seat at the professional table.
• No insurance hassles: These roles tend to be fee-for-service/cash-pay businesses. When insurance is involved, the client still pays for services upfront; it’s then the client’s responsibility to collect payment from the insurance company.

Cons

• Cost: The cost of continuing education to gain competency can range from about $7,000-$10,000, and jobs don’t always pay well (depending on where you live).
• Lack of awareness: Because this is such a new practice area, many members of the public and the veterinary community have no idea how valuable it is. Furthermore, some veterinarians maintain a hierarchical collaboration model, rather than an interprofessional collaboration model.
• Legislation/regulation limitations: Depending on the specific laws and regulations in your state, you might be dealing with quite a few restrictions on the type of care you can provide. For example, therapists can only work on veterinarian office premises in many states. 

An Example

Karen Atlas, PT, MPT, CCRT, is the founder and director of animal rehabilitation at Atlas Rehabilitation for Canines, a Santa Barbara-based canine rehab practice that offers comprehensive physical rehabilitation to pups with mobility impairments. “It is such a joy to be able to use my gifts, education, specialized skills, and experience to help improve the quality of life for animals,” she says. Atlas feels very fortunate to have her career and love for animals align so perfectly. “Transforming the lives of our furry friends has profound effects on not only the animals themselves, but for all those who love them,” she says, noting that providing rehab to animals is a powerful and rewarding experience every single day.

5. Military Contractor

Many therapists assume that you need to join the military in order to work as a military PT, but plenty of civilian therapists work as military contractors. Whether you’re in the military or you’re a civilian contractor, you’ll find that you have a much wider scope of practice in this setting. It’s a bit like working as a primary care provider, as you can see patients with full direct access—and you can easily refer out to other providers, order imaging when indicated, and even order labs and certain medications (e.g., NSAIDs and muscle relaxers). The best part is that you can do all of this without going through the patient’s physician. 

Pros

• A sense of freedom: Therapists enjoy much more independence, as they are able to treat using clinical judgment and evidence-based practices without having to bill a certain way.
• No financial or productivity pressure: Nobody will be breathing down your neck for you to meet productivity quotas or use outdated modalities.
• Great culture and work-life balance: You’ll get federal holidays off, and you’ll work in a well-funded clinic—which helps foster a low-stress, stable environment.

Cons

• Rank politics: Higher-ranking service members often have more say in clinic operations simply because of their rank—and this can lead to lower-ranking members feeling scared to speak up.
• Time crunches: Active duty members sometimes need to be ready for fitness tests, which can lead to work piling up at clinics.
• Contractors lack stability: If you’re working as a civilian contractor, there’s little opportunity for career growth and your contract can end at any time.

An Example

Joe Camoratto, PT, DPT, was a civilian contractor for three years. While he currently works with MedTravelers, he spent his time with the military contracting under GiaCare, Inc. Camoratto really enjoyed his military work, and he highly recommends that others explore this unique setting. “It can be very rewarding,” he explains. “You have the ability to work with people serving our country from all over the world, and speaking from experience, it can be very good for preventing burnout.” If you’re sick of the shady practices typical in many “mill” clinics, you might want to explore this wonderful alternative to traditional outpatient ortho. Plus, military PTs can work in inpatient settings as well as outpatient settings, so there are tons of ways to make this type of role work for you.

6. Early Intervention

If you love small children and crave variety, you might enjoy working in early intervention. Most people think of OTs working in this setting, but PTs have tons of opportunities as well. It’s a fulfilling practice niche that allows you to address patients’ needs before they miss “milestones.” It’s also a great way to make contacts in the non-clinical world, as you’ll spend a lot of time researching and recommending adaptive equipment such as orthotics/braces, wheelchairs, activity chairs, and standers.

Pros

• Fulfilling, enjoyable work: You get to help little ones get moving and spend your day playing with babies.
• You won’t get bored: You’ll work with a wide variety of kids in many different settings, so no two days are the same.
• Networking: Because you’ll work in numerous settings, you’ll have a unique opportunity to network with all sorts of folks, including those who work for DME companies.

Cons

• Cancellations: Little ones with low immunity often need to cancel appointments—which, depending on your compensation structure, can cut into your paycheck.
• Paperwork: You’ll usually have your hands full with children, so point-of-service documentation is tough in this role.
• Wear and tear on your car: As with any mobile role, you’ll be on the road quite a bit, and this can put miles on your car and run up your gas expenses.

An Example

Whitney Castle, PT, DPT, is a physical therapist at TalkBack Pediatric Therapy, Inc in the Tri-Cities region of Tennessee. She works with children from birth through eight years old, and she sees them in their homes, in day care centers, and in outpatient settings. She helps these kids improve gross motor skills for rolling, walking, crawling, walking, running, jumping, strengthening, and balance. She also treats diagnoses like plagiocephaly and torticollis. Castle loves her work, saying the best part is the look on everyone’s faces when babies and kids start crawling or walking for the first time. She shares: ”I get to play all day so it never seems like work!”

7. Prison

If you love treating patients, but feel frustrated by bureaucracy and hectic schedules, you might want to explore working in a prison! Prison PTs typically see a wide variety of diagnoses, including gunshot wounds, chronic low back pain, and other conditions that often wind up being treated with prescription meds. Considering the current opioid crisis, working in a prison enables PTs barrier-free access to some of the patients who need our help the most—without the red tape that often keeps patients from seeking our help.

Pros

• Flexibility: You can usually make your own schedule, and you have quite a bit of freedom in your daily activities.
• Collaboration: Unlike some settings, PTs typically have immediate access to other providers, nursing staff, and security staff, making this a very collaborative environment.
• No billing: You can spend all your time treating patients, rather than trying to fight insurance companies for more visits.

Cons

• Niche population: This is a very niche setting—and not everyone is comfortable working with an incarcerated population.
• Lack of equipment: PTs must think outside the box, as inmates might not have access to free weights—and the facility may prohibit dispensing resistive bands.
• Limited job opportunities: These roles only come up every so often, and they’re only available at correctional facilities, so they’re not as plentiful as other jobs.

An Example

Mike Koscielak, PT, DPT, works as a physical therapist at the Wisconsin Department of Corrections. He enjoys variety and flexibility in his day-to-day responsibilities, and he likes knowing that he can make a real difference for a population that many people forget about. “Prison PTs are positioned at the front line of treating people with drug addictions trying to manage their pain,” he explains. Koscielak feels grateful to work in a setting where he is often the first person to do an in-depth assessment of a patient’s condition—and where he has access to a great team that can quickly update him on any status changes. He shares: “I see the main difference between working in prison and my previous jobs is that I have some secure doors and barbed wire fences to walk through to get to my office, and after that it’s SOAP notes and steamboats like everywhere else!”

8. PACE programs

An acronym for Program of All Inclusive Care, PACE is designed to serve seniors by using an interdisciplinary approach. The end goal of these programs is for older adults to remain safe and independent in their own homes. The programs provide a variety of core services, including:

• primary care,
• therapy,
• social work,
• adult day care,
• dietary support,
• home care services, and
• transportation.

PACE is funded by Medicare and/or Medicaid (depending on the state). When a patient joins the program, it becomes his or her sole source for services—but the patient can leave PACE at any time. Physical therapists in the PACE model promote health and wellness in the way of performing annual assessments, providing fall-prevention education, and organizing opportunities for physical activity (including group and individual exercises). PACE PTs also consult on DME needs and discharge planning as needed. 

Pros: 

• No insurance headaches: In this model, you have the freedom to provide whatever the patient needs, because you are playing the role of provider and insurance. Billing is based not on visits or minutes, but on patients’ needs. 
• Creativity: Because the PACE program operates in so many settings, you can truly flex your rehab muscles. Most treatment takes place in gyms located inside of adult day care facilities or in patients’ homes. Organized community outings and aquatic therapy are other ways to provide care in the PACE model.
• Opportunity: PACE programs are not yet established in all 50 states, but there are new programs opening up frequently.

Cons:

• Communication challenges: You could wind up working alongside professionals who don’t always consider the functional or therapeutic implications of certain scenarios; this means you might need to advocate for your patients’ needs with respect to their PT plans of care.
• Stagnation: Because you will spend long spells treating the same patients, it can lead to feelings of boredom.
• Feelings of guilt: Due to the all-encompassing nature of the work at PACE, providers may start to feel responsible for patients’ overall safety in the home and community.

An Example

Kaitlin Dodi-Monk, PT, DPT, GCS, CEEAA, works for a PACE program in Virginia. She has enjoyed working in a non-traditional care model and finds the work to be interesting and fulfilling—not to mention a nice break from the traditional PT clinic. Her favorite part of the model is having the autonomy to truly address to patients’ needs. “In this model, you have the freedom to provide whatever the patient needs, because you are not only the provider, but the insurance as well,” she explains. The PACE model is great for collaborative types would like to work with seniors in creative new ways—without stepping away from patient care entirely.

In addition to exploring these non-traditional clinical settings, more and more PTs are opting to leverage their professional knowledge and experience in non-clinical roles. From working in utilization management to serving as clinical liaisons, plenty of therapists use their healthcare backgrounds on the daily—without directly treating patients. What are some other non-traditional or alternative physical therapy settings you’ve considered? We’d love to hear from you in the comments!