Orthopedic Residency Q&A for Physical Therapists

These were some questions/answers I had put together with the help of my peeps from my Instagram story 11/10/2020 regarding my experience with an orthopedic residency. So thank you to those who contributed questions.


How long did it take?

Two years.


How much time out of work did it take?

It is hard to put a true number to this! However, there were several weekend courses that were spread over the course of two years. There were 6 600-level NAIOMT courses and three additional lectures, pharmacology (in-person), imaging, and research (online). Plus studying for the CMPT (certified manual physical therapist) certification and OCS (orthopedic certified specialist) exams. But this was manageable with working 40-hours per week.


What was the most valuable part?

MENTORSHIP. I had an amazing key mentor that followed me from the beginning to the end of the residency and he helped me grow as a clinician. The first year was recognizing and performing manual techniques and special tests. The second year was about putting the puzzle pieces together and building clinical patterns. I valued my key mentor immensely and included experience with other PTs as well.

Legendary PTs shadowed me working with patients and vice versa. Each experience, I walked out with something new.


Which residency did you do?

The one I completed was offered through my employer, Therapeutic Associates Inc. It was an orthopedic residency with a focus on manual therapy with a structured curriculum surrounding NAIOMT (North American Institute of Manual Therapy).


How much did it cost?

The cost was dependent on how much course work I already had completed. Over the course of two years, I had my paycheck deducted ~$142 every two weeks which ends up being $14,768 over the course of two years.


Was it worth it considering the financial strain?

Yes, 100%. Although it cost, $14k, the mentorship and method of accelerating my clinical skills and pattern recognition are priceless. I strive to be the best physical therapist I can be for patients and starting early in my career was invaluable. The plan was for my company to pay it back to me over two years of working with the company post-completion however, I was laid off from COVID-19 and didn’t return. I don’t regret the investment in my career.


Are residency programs standardized/accredited?

Yes. Residency programs are held up to a standard by the APTA and become accredited. There are minimum requirements for the curriculum and are dependent on the type of residency (ie. sports, manual, neuro, etc.).


Do you have to do a residency in order to sit for the OCS?

No. There are two options: (1) complete an APTA-accredited residency within the last 10 years or (2) “Applicants must submit evidence of 2,000 hours of direct patient care as a licensed United States physical therapist (temporary license excluded) in the specialty area within the last ten (10) years, 25% (500) of which must have occurred within the last three (3) years.” per the American Board of Physical Therapy Specialists website.


When should I apply?

When you are ready and when you plan to start. Depending on the program, there are different start dates throughout the year. I personally liked working for 1-year before applying to develop my own style and gain experience. There were many peers that were in my cohort that just graduated PT school less than 6 months before the start of the residency program. In my opinion, if you were to start one, I’d recommend starting within the first three years of working as a PT.


Did your work offer an in-house residency?

Yes! They did which made obtaining hours and collaborating with colleagues within the company/residency very easy. 


Residency or certification?

You can get certifications without a residency. For example, I earned the Certified Manual Physical Therapist (CMPT) within the residency but that certification is not exclusive to residents. I performed an orthopedic residency so I can’t speak much towards a sports residency. 


Are you able to be as thorough as you were in residency as you are in your daily practice?

Yes, 100%. If anything, more thorough. On days of mentorship, we filled out clinical reasoning forms for each patient to lay out subjective, objective measures, interventions tried so far, and our assessment of how the patient has progressed (expected or not expected). This practice is helpful and carries over to my daily practice and makes me more efficient and effective as a PT!


I hope you found these answers helpful in weighing the decision of whether to pursue a residency program. I highly recommend it. If you have more questions, feel free to send me a question on the Contact page or DM me on Instagram!

Money Mindset Books for Beginners

Are you ready to start feeling in control of what the heck is going on with your money? If so, keep reading because I provide a list of the beginner books I started with and why they helped me.

I truly wish I would have started this sooner… I wasn’t turned on to books about money until my final year of PT school. One of my CIs assigned me to read Rich Dad Poor Dad by Robert Kiyosaki. This book simplifies the basics about balancing your income to your expenses and your assets vs your liabilities. It was a great and easy book to read through to get your toes wet. It wasn’t until I read this book that I realized how little I knew about money and the concept of investing.

I’m under a mountain of student loans and I want to be able to set myself up for success for retirement and get ahold of my money now so I don’t feel guilty for my “fun” expenses/purchases. I hope these are helpful to you.


I’ll share a few other books I’ve read over the past 4 years that I recommend reading through. I’ll provide a brief synopsis about each book and why I liked each one. These will be listed in no particular order.


  • Rich Dad Poor Dad by Robert KiyosakiThis book simplifies the concepts of money and terminology
    • It primes the mind for the idea of investing and how to start saving for a retirement fund and why start sooner rather than later
    • I liked this book because… It was easy to read. The concepts are introduced very well so that even a beginner (like me) could follow along.
  • Money, Master the Game by Tony Robbins
    • Review concepts of HOW to make the most of your money with the use of compounding interest and how to make the best out of your retirement plans
    • The basics about taxes
    • How to divide your income into different “buckets” for different purposes
    • Ray Dalio’s All Seasons Portfolio Breakdown
      • Ray Dalio is a financial guru (who I hadn’t heard about until this book)
    • Wealth, not just financial but also emotional wealth
    • I liked this book because… it gave actionable steps and goals to target for setting up my retirement fund
  • Cash Flow Quadrant by Robert Kiyosaki
    • People are categorized into 4 different financial groups: the employee, self-employed, business owner, and investor
    • This is a great continuation of the Rich Dad Poor dad book that builds on the concepts of how to generally save and then this book goes into when you become a worker OR how you can make your money work for you
    • Money mindset concepts like: “live within or below your means so you can expand your means,” “business and investing are not risky, but being under-educated is.”
    • I liked this book because… it helped me understand where I’m at financially and where I want to go.
  • Profit First by Michael Michalowicz
    • If you’re a business owner or plan to be one, this book is a great resource on how to learn how to pay yourself first
    • Application of Parkinson’s law: you work with what you have, if you give yourself excess, you’ll end up using it
    • Strategies to destroy your debt
    • I liked this book because… I plan to be a clinic director someday and want to be able to apply financial savviness to my work and personal life. It gave a clear outline of how to allocate money in a business. 


Each time I read through a book, I take notes and save them for later to reference. The links above are affiliate links through amazon and I do receive a commission if you purchase from them. I would greatly appreciate your support if you bought through the links provided, but there is absolutely no pressure to buy at all. I just want to share the books that have helped me feel a little bit more in control of my financial status.

Outpatient Ortho vs. Outpatient Ortho

I practice physical therapy in an outpatient orthopedics clinic. It’s been almost two weeks working at a new one and I’ve found many differences. Differences that make me feel like I have to change the way I practice. Here are some of the differences and what/how I’ve changed.

Working with a chiropractor. Patients are being treated by a chiropractor within the same session of me treating them. Thrusting through the spine multiple times may be overtreating and will not be beneficial for the patient. I am a manual therapist and have trained with thrust manipulations (grade V’s). But not all of the patients see a chiropractor so, I can still use them for patients that don’t see the chiropractor. But when we do share patients, I need to be clear in my communication when speaking with her to let her know the areas I worked on and what my target is for my treatment intervention.

Modalities. This clinic is heavy on the use of ultrasound which I used to use 1x or less in a month at the clinic I worked at before. In DPT school, we did learn that ultrasound has its place for tissue remodeling (pulsed setting) and deep tissue heating (continuous). However, I prefer to use active methods to warm tissues. Coming into an already existing patient load, I’ve dabbled with taking ultrasound away but some patients request for it to be brought back in. Part of my style of treatment is shared decision making which is including the patient in their treatment plan. So for those who still want ultrasound, I add it back in.

Manual Therapy. I am a Certified Manual Physical Therapist (CMPT) and have earned this certification through the North American Institute of Manual Therapy (NAIOMT). I consider myself a skilled manual therapist but this clinic uses a ton of STM (pettrisage and effleurage). My hands and fingers were dead tired after doing this for one patient!! So I’ve also dabbled with changing the amount of this treatment with some patients and have shown them other methods or self-mobilization techniques so that they become less reliant on passive treatment with studies that show only temporary relief.

Wellness visits. After a patient has completed functional goals and pain is resolved, the patients are encouraged to keep up with “wellness visits” and come monthly for check-ins. I used to discharge patients and have them come back if something is wrong but the model here is that patients may not come back until the pain has progressed and it’s harder to turn around. In theory, having monthly check-ins will reduce this from happening. Being there for only two weeks, I haven’t encountered this discussion yet.

It has been challenging to change my style and method of how I want to treat patients but, after a lot of reflection… I realize I need to change my mindset to also look at the similarities between both. I have realized the end goal is still the same. Help the patients out of their pain, get them moving better, and guide them to achieve their goals.

Clinical Rotations Series – Part 1 of 4

At WesternU, we had 4 clinical rotations in total. One two-weeker first year, one 12-weeker second year, and two 12-weekers at then end of third year. I’ve created a series to share my key takeaways from each experience and share tips on ways you can take advantage of yours.

Year 1 – Inpatient Rehab – Acute/ICU – 2 weeks

This was my first rotation and I was crazy nervous. I reviewed vital norms and had a cheat sheet in my pocket to refer to. My CI was very sweet and popular with the nurses. She mostly let me observe the first week and carry her DMEs around. In the second week, we started to go through the checklist of skills that my school had provided me. She passed me with flying colors however I wanted to get more hands-on skills.

Clearly I was over-eager and she could sense it.

She offered me to observe a surgery. What?? I can do that?? She scheduled a day for me to observe a Total Knee Arthroplasty (TKA) and a Total Hip Arthroplasty (THA). Being in the operating room was so interesting. I watched the staff layout the prosthetics, post x-rays and then wheel the patient in. There was one member of the staff that stood with me, in the beginning, to explain what was going on. I stood off to the side and watched from afar. The table was already crowded with the essential staff. Both surgeries were back to back and in the morning. So then by the end of the second procedure, I reported back to my CI. We had lunch and then later that SAME DAY, we got the patient with the THA out of bed, post-op day 0.

If you have an inpatient rotation, I strongly recommend you to ask to observe a surgery. If I were to choose between the two, I’d recommend the TKA because the surgeon flexes the knee and so much more is exposed.

I’m grateful to have such an amazing experience for my first rotation and an amazing CI to give me the opportunities I didn’t know I had the option for. Check out my YouTube video on how to better prepare for your rotations.

How To Build Trust With A Patient

Communication Tips for PTs

“It is recommended that every health professional establishes a therapeutic relationship with a client-centered approach with empathy, unconditional regard and genuineness.”

A key mentor of mine referred me to read “Chapter 3: Communication and the Therapeutic Relationship” from Maitland Vertebral Manipulation Management of Neuromusculoskeletal Disorders.


This is important to all clinicians because the relationship and tone set from the initial evaluation carries throughout the rest of the patients’ care. I have highlighted the areas that stood out most to me and will elaborate on my own personal reflection/experiences of each of these points. Some of these, I had discussed in my YouTube video prior to reading this chapter.


Goals should be created with instead of for the patient. During the subjective, goals should be determined based on current functional limitations. Discussing the parameters (time, level, or pain) should be established collaboratively with the patient. Goals should also be discussed between treatment sessions to ensure there’s progress towards the end goal instead of only at the initial evaluation and progress notes. 


Communication should be given at the patients’ level of thinking. Speaking in medical terminology may reduce the patients’ engagement. The use of metaphors or analogies have been helpful for me to describe a PT diagnosis. Be aware that patients may feel embarrassed to ask you to clarify something if the topic has already brushed over. Ensure there’s time taken to give patients time to ask questions before the end of the session. 


Clarify meanings versus assuming. Although we, as PTs, have a symptom list readily available, the patients often do not and have a hard time describing it. Ensure that you fully understand what it is they’re trying to say by asking specific clarifying questions rather than assuming.


“Hearing is passive, listening is active” 


Should pain be a topic of discussion? Some patients fixate on pain and measure their progress only by pain. So it is a choice for the clinician how to present this as a question and how often to discuss this topic. As a new grad, I used to ask patients their pain level at every session. I realize the number was slow to change. When I started asking about functional progress, I started to realize a faster change and fortunately, the patient would too. 


Letting the patient have a say in the decision on the intervention. I implement this technique after establishing a few sessions and if I’ve used different treatments, I will share with the patient my “agenda” for the day. I’ll list my plan for interventions and purposefully leave one out and then ask the patient if there’s something they’d like to incorporate. Sometimes they ask for the intervention I leave out, sometimes they go along with my plan. It empowers them to make decisions within their care or be able to voice if they’d rather change the direction.


Attention needs to be given not only in what is said but how it is said. Emphasis on keywords can be very impactful on a person. If you emphasize “abnormal,” the individual may fixate on that. Or, the tone in how a sentence is given can be interpreted differently between individuals. Also be mindful of body language because there’s a lot to be said with how your body is positioned, what your hands are doing, down to even the wrinkle between your eyebrows. 


Ensure the patient knows what and why tests/interventions are performed. I will never forget the one time I was being mentored and taking a patient through an exercise. My mentor asked my patient, “do you know why you’re doing that exercise?” The patient responded, “because Pauline told me to.” My eyes got so big and I felt so embarrassed. This was a big learning moment for me because I know why I gave the patient that exercise, but it’s equally important the patient does too. If the patient knows how that exercise is going to help him/her, the more likely he/she will do it as part of their home exercise program.


This chapter provides other insightful and researched evidence for the art of communication. This write up is to share my perspective and experiences on what I found to be key points. Please refer to the reading for more details. 


Considerations for Orthopedic Residency Program

After PT school, I spent two more years in an orthopedic residency program. Why? Because I want to give my patients the best PT service I am capable of an the residency was an avenue to achieve that. It is like an accelerated route into becoming a stronger clinician because you get to learn from other PTs and have a structured course work in a specialty of my interest.


150+ hours of mentoring by a skilled and experienced clinician. Mentoring entailed shadowing treatment sessions and evaluations with immediate feedback. The quality and relationship established with the mentor is a large part of the value you’ll gain from a residency program. Communicate early with your mentor your preference for learning.

Structured curriculum. I was pursuing my Certification of Manual Therapy and the coursework aligned with the residency program. This gave me funding, a timeline, and a commitment to completion of the certification.

Networking. Meeting other PTs in different locations and clinics added fun to the experience.

Cost is always a factor but consider it an investment in your career. I am more confident in myself as a PT after completion of the program.


Additional Considerations

Cost. See if your company will financially support you with some sort of tuition advancement program. Most likely it will be in exchange for your commitment to the company for a certain period of time. In my case, my paycheck was deducted for two years and I’d be paid back each paycheck for 2 years if I stayed with the company.

When should you start. When you’re ready! I started one year after graduation after I developed my own style for treatment/evaluations. I attended the Level 1 courses through NAIOMT and the residency I chose carried onto Level 2 courses. So it flowed well for me. It’s valuable to work for a company for some time before asking for such a large benefit. Show them your worth and dedication. Also this is a time for you to ensure this is a place you can see yourself working long-term.

8 Things To Look For In A Job

I have accepted a new job at a different company. The pressure of being laid off led me to search for other opportunities. Within the first two weeks, I had applied for 15 jobs. Jobs of all different settings. I applied for skilled nursing facilities and home health which were intended to be temporary.

When I wasn’t getting responses from them, I started to apply for outpatient orthopedic settings and was offered an interview. Upon reflection of the things I value in my career, I realized this company could offer me more.

Here’s a list of items I value in my place of work:

  • Competitive salary: because 𝗜 𝗸𝗻𝗼𝘄 𝗺𝘆 𝘄𝗼𝗿𝘁𝗵 and I work 𝗱𝗮𝗺𝗻 𝗵𝗮𝗿𝗱.
  • Schedule: work-life harmony. How much work/stress is being brought home? Can I stay productive M-F so I can enjoy my weekends?
  • Continuing education: I need a company to support my thirst for learning. Opportunity, financially, and moral support.
  • Friends with co-workers: We spend so much time at work! I want to be able 𝘁𝗼 𝗲𝗻𝗷𝗼𝘆 𝘁𝗵𝗲 𝗰𝗼𝗺𝗽𝗮𝗻𝘆 𝗜’𝗺 𝘄𝗶𝘁𝗵 and be happy/laugh with them.
  • Commute: within reason but otherwise have some great podcasts to listen to.
  • Room for growth: Are the people around me motivating me to be better? Will I be able to become a Clinic Director?
  • Mentorship: [Can you tell I want to keep learning?] I want to have a role model to look up to and give me methods to become a better PT. I’m the type to need a pat on the back sprinkled in with constructive criticism.
  • Networking: Am I meeting 𝗶𝗻𝘀𝗽𝗶𝗿𝗶𝗻𝗴 𝗶𝗻𝗱𝗶𝘃𝗶𝗱𝘂𝗮𝗹𝘀?

Since COVID-19 has patient volumes still low, we haven’t set an official start date yet. I am anxious to see how I fit into the new place.

How COVID-19 Has Affected Me

I was laid off a little over two weeks ago. COVID-19 hit our clinic so hard that our schedules dwindled down to 5-7 visits per day when we were steadily seeing 12-14 patients per day. I understand where my director was coming from and knew that he had to do it to keep the clinic running.

However, it leaves me with a MOUNTAIN of PRIVATE student loan debt, a home mortgage, and NO income. Having a private student loan means that I don’t get the interest waived and I don’t get to postpone my payments like if I had federal loans. So I still have to somehow come up with monthly payments.

I’ve been beyond stressed and trying to keep busy. I am now in a weird transition looking for work in a time when hiring for PTs is at an all-time low.

I wanted to share my journey with you because it’s real and I think a lot of other people are going through this as well. I want to let you know that what you’re feeling is valid and that YOU ARE NOT ALONE.

I’m going to share what I’ve been doing to stay productive and what it’s been like to look for work again.

My husband encourages me by reminding me that this may be a blessing in disguise, so for now, I’m working on embracing this idea and taking it one day at a time.