Launching Your PT Career: How to Choose a Specialty
This is the third blog post in Rizing Tide’s series about launching your PT career and landing the right PT role for you. In our first two posts, we explored how to approach interviews as a new grad and what benefits to look for when evaluating job offers. In this installment, we turn to one of the biggest early career decisions PTs face: choosing a specialty and deciding whether or not to attend a residency program.
Choosing your first job as a physical therapist is a big decision—but deciding the kind of clinician you want to become is even bigger. With so many paths and specialties to choose from, including sports, orthopedics, neurology, geriatrics, oncology, and more, it can be hard to know where to start.
According to WebPT’s most recent State of Rehab Therapy report, demand for skilled clinicians continues to grow as organizations work to address staffing shortages and rising patient needs. While this demand creates opportunity for new grads, it also introduces an important question: Should you specialize early, pursue residency training, or start as a generalist and refine your path over time?
To help answer that question, we spoke with Dr. Nick Rainey, PT, DPT, OCS, FAAOMPT, owner of Rainey Pain & Performance, and Dr. Jessi Vaught, PT, DPT, NCS, physical therapy advisor at Sheltering Arms Institute. Both are board-certified PT specialists with extensive experience mentoring clinicians across settings and specialties. Read on to learn how our experts suggest thinking about specialties, settings, and residency decisions as you launch your PT career.
Where you start isn’t necessarily where you’ll land.
Many students begin PT school thinking they want to work within a specific specialty or with particular patient populations—but that interest often shifts as they move through classes and clinicals.
“I think a lot of people come into PT school with an idea of what they want to do, whether that is based on their prior experiences or the experience of a family member,” Vaught says. “And then it is fun for me to see how that changes with their exposure in clinicals or just in classes.”
After weighing a few specialties during her early career days, Vaught ultimately decided that neurologic inpatient rehab was the right fit. “I have had my NCS since 2012. Inpatient neurologic patients have often gone through the most catastrophic thing that they will experience in their lives. I love being able to help somebody through that and see the hope that life may not be exactly the same, but that it’s still possible to have joy, function, and relationships with families and friends.”
But even though she fell in love in neurologic PT, Vaught is grateful for the time she spent working on her orthopaedic skills. “Outpatient orthopaedics is the same in that you have to gain the trust of the patients,” Vaught adds. “And I think ortho is so important because it really is the basis of everything. It took me a couple of years of working with that neuro basis and realizing that I needed to go back to those orthopaedic roots. That has been very valuable for my practice.”
Even if you have a specialty in mind when you’re first starting out, it’s important to expose yourself to many different areas in the field. You never know what you’ll most connect with—or where your true strengths lie—until you do.
Rainey’s specialty path shifted over time as well. “As with a lot of PTs, at first I really wanted to focus on athletes,” Rainey says. “I was an athlete. I treated athletes. But what I do now is chronic pain, and other people at my clinic see more of our athletes. You connect with what you are good at. If you are good at something and people really value it, that is very satisfying.”
Different specialties create different daily working environments.
Your chosen work environment often matters just as much as your specialty. Vaught describes important differences between inpatient and outpatient work and where they intersect.
“There is a lot of overlap, more so than it feels initially,” she says. “It is all people. We are relationship specialists, as well as specialists in the body and its functions. Inpatient rehab tends to be more relational. You have more time with patients. We are generally seeing patients for an hour to an hour and a half a day. So you really build upon a relationship, which is a big draw for people.”
But the day-to-day reality of inpatient care can also surprise some new clinicians, says Vaught. “The uncomfortable piece is we are also spending a lot more time in the bathroom during inpatient rehab. Patients come in sicker than they would in an outpatient setting, so we do functional activities with them. Inpatient is really about how we get them up and prepared for life. Outpatient is more about helping people who are home to get out in the community, and making everything easier, better, or more functional.”
There are pros and cons to each specialty, so the trick is finding which gels best with your unique strengths and preferences and ultimately what feels most fulfilling to you.
When students and new grads ask how to find their ideal specialty or setting, Vaught says this: “Any setting is really about balance. Are you very efficient, so you could go into an outpatient orthopaedic clinic and manage the number of notes that you’ll get from seeing more patients per day? Or do you really value relationships, which might grow when you see a patient for a longer plan of care? It is about figuring out what speaks to you and what won’t burn you out or become too burdensome.”
Some PTs benefit from specializing early while others benefit from becoming a broad generalist.
As a new grad PT, should you specialize early or build a broader foundation? There is no single path, but your choice will shape how quickly you develop your skills and what kind of clinician you become.
Rainey strongly encourages early specialization.“Specialize early,” he says. “I don’t think there should be any question. Doctors do not wait. They do not get out and practice and then go into a residency. They do it right away. Right out of school, you can keep from harming people, but you are not very good. Get good at something. If you want to get good at something else later, that initial thing you got good at will help transfer into that.”
He also notes that early residency and specialty training can have a direct financial benefit. “There have been studies showing that residency and specialty early in your career actually increases your pay,” Rainey says. “Depending on which type you do, it is at least a few bucks an hour. That is easily definable, even if it is not the most important benefit.”
Vaught takes a more neutral stance and emphasizes that both paths can work. “I don’t know that there is a wrong answer here,” she says. “There is a carryover between any setting and any patient population. An important consideration is what you are getting out of your choice and how you are continuing to grow. Who are you learning from?”
Vaught also notes that some roles require more intentional learning, saying: “If you go to home health or a small clinic without a lot of other experienced clinicians around, how are you learning? You are really going to have to rely on external sources and be really intentional. I think we serve our patients by continuously learning. Whether you specialize early or go to a more general role, taking responsibility for where you gather information is the key.”
New grad PTs can always start broad and refine over time.
With so many options, new clinicians can feel overwhelmed. Rainey suggests starting with a broad specialty and refining over time.
“If you are not sure, choose one,” he suggests. “Ortho is a good broad one. If you like geriatrics, many of them have orthopaedic problems. If you like sports, many are part of ortho. Or you may want to go into something truly unique, like ultrasound imaging, nerve conduction testing, wound care, or oncologic physical therapy. Those are much more specialized with a more direct path. If you are not sure, ortho is a good fallback, and then you can sub-specialize in shoulder, low back, headaches, or TMJ.”
Sometimes though, the best course of action is to try something new and see how you feel about it. “In grad school, neuroanatomy was very overwhelming for me,” Vaught says. “I had no idea how to apply it to an actual patient. Then we got to clinicals. Seeing a patient and being able to apply what you learn out of a book really put it together for me. I love the physicality of it. I love moving my body, helping other people move their bodies, and getting them toward their goals. Every day is different.”
Remember this: choosing a specialty is less about having all the answers early-on and more about understanding where your skills, interests, and growth opportunities align as your career takes shape. And if you don’t like the path you choose, you can always switch it up and try another one!
