@TheOncoPT (00:19)
Hey, Onco PT and welcome back to this episode of the Onco PT podcast. In this podcast, we are now kicking off this new series on the Onco PT podcast where I’m going to be answering the question that I actually got from one of you just a couple of weeks ago. So one of the Onco PT’s who I’ve connected with out in the world reached out to me and basically asked the question, like lots of context, lots of background to it. But in essence, the question was, is it worth it?

to specialize because this is an OncoPT who’s been practicing for several years now. She is firmly in oncology physical therapy. She has lots of experience, lots of expertise in this and is kind of at the stage in her career where she’s wondering, is it worth my time? Is it worth my effort to pursue this? And I feel like this is a really well intentioned question. This is a really well thought out question. And it got me thinking so much to the point I was like,

Okay, I’m going to like I answered her in a really long, lengthy voice note. But then I said, this is really good. We need to spend some actual time talking about this on the Onco PT podcast, because this is a question that I know if one person is asking, there are so many more of you out there wondering the same thing. And I get it. It makes a ton of sense to be asking yourself this really sensical question, especially when you’re coming up against a potentially year long process of your time.

in pursuing your specialization. Now, if you did not know, just so we’re all working off of the same foundation, the same baseline here. So ABPTS is the American Board of Physical Therapy Specialties, I think is their official title. They’re the organization that oversees board specialty certification for physical therapists. There’s lots of different ones out there, lots of different sections. Of course, we’re talking about oncology because this is the Onco PT podcast.

And when you decide to pursue your oncology specialty certification, you first have to submit an application. And with that application, you have to then be accepted to then sit for the exam. So there’s like multiple steps in this process. And all in all, it takes about a year of time. So if you submit for the early bird deadline, which is usually around June 30th, July 1st, somewhere around there,

You’ll then find out probably later in the summer if your application has been accepted. And then you will then prepare for the exam, which usually takes place, again, I say usually, because sometimes from year to year, the dates change a little bit. So I just try to be broad here. The exam will then usually take place in February of March of that following year. So for example, when I pursued my specialty certification, I started the process, the application,

and whatnot in 2020, I know super fun year, super fun year to also do a big project like this. And so started that application, submitted that application in 2020, and then I sat for my exam in February of 2021. And then you will find out the results of your examination again, usually around June 30th, July 1st. So again, that’s basically a full calendar year from start to finish of when you’re submitting stuff.

to when you actually find out your results. And if we’re also thinking in logistics, that process can take a little bit more than a year, even just for the application part. So you have to write a case report as part of your application. That’s a requirement of oncology, not all the other sections have that. That is part of oncology. Your case report usually takes you some time to do. If you wanna write a really well thought out, really,

really well written case report, you have to spend some time on that. You can’t just crank that out and get a really good case report out of it in a weekend. I’ve seen attempts. It has not ended well.

So this PT who is asking this question of is specialization worth it, excuse me, is considering a lot of factors. The time factor included, the effort that she’s going to put into this process, but I think what this really boils down to, when someone asks this question, and for good reason, when someone asks the question is specialization worth it, a lot of times that underlying question comes down to money. Is specialization worth it for me?

to pursue from a financial standpoint. And maybe depending on the situation that you’re in, your work status, where you work, the institution, et cetera, maybe you’re compensated in a way for pursuing different continuing education. Maybe you are ⁓ reimbursed for different educational opportunities. Maybe you’re not. And this is behind a lot of this question of

even if my institution covers it, even if they don’t, right? Is it financially worth it for me to invest this time, this energy, this effort, and this money into this process? What is on the back end for me? Am I going to be financially compensated for this? Is my pay going to reflect my now specialty certification? You know, we’re assuming that you go through this process.

and you’ve come out on the other side successful and you’re now a board certified clinical specialist, amazing. Is it financially worth all of this effort that I am putting in? Am I going to see a return on that after this year plus long process of pursuing my specialization? And I’m gonna let you know the hard truth right at the top of this episode and we’re gonna get into it for the rest of the episode.

If you are purely looking at specialization from a financial standpoint, it is never going to make sense. Financially, across the board, it does not make financial sense for you to specialize. Now, there are exceptions to this, okay? If you’re listening to this and you’re a PT out there who’s like, my institution totally paid for me to do my specialty certification, and they also bumped my pay. Amazing. I am genuinely

so happy for you, and I’m frankly a little jealous because the vast majority of physical therapists that I have talked to over the years do not share that same experience. Unfortunately, sometimes institutions don’t value your clinical expertise when you become a board certified clinical specialist, especially in oncology, because that is like a newer thing, it’s smaller, people don’t totally know about it yet, multiple different reasons.

Some institutions just flat out don’t recognize that and don’t necessarily add anything onto your pay. And that sucks. It really does. Like there’s no delicate way to put around, like dance around it. It sucks. Now there’s some PTs who are at institutions where maybe that their clinical certification, specialty certification, excuse me, factors into like their clinical ladder. Again, potentially awesome, potentially amazing.

but I also wanna bring you a little bit of a personal experience. So I was previously at an institution that had a sort of clinical ladder. And so as I was thinking about, you I’m really interested in pursuing my clinical certification, specialty clinical certification, sorry. ⁓ You know, I am working on getting the hours and whatnot towards this. And so I was looking into the clinical ladder. And so basically how they had this clinical ladder set up.

because I was cranking stuff out, y’all. I was putting in the time and the hours to like really boost that clinical ladder. was like, I’m gonna make it, I’m gonna get it, my first year, like all these things. And then I started talking with my supervisor and other PTs in this company about like, okay, so what does it look like, you know, in the following years? Cause I’m like busting my butt getting these hours, getting these credits, et cetera. And so with that first year, I would get a pay raise for that clinical ladder level that I had achieved.

But if I did not achieve that same level of credit hours that next year, my pay would get decreased to what it was previously.

And if you’re putting in the time and effort where you are like, you know what, this is sustainable for me. Awesome. Great. Again, I genuinely love that for you. What I was doing that first couple of years of my practice becoming right out of PT school and diving right into this, it was unsustainable. And I thought it’s because I could set myself up for the long run because I demonstrated like, this is the kind of quality of work that I can deliver here. You know, I, and then I should be compensated appropriately for that.

That’s not how it always works. And then I’d like to offer you another situation here. This is another PT who I’ve talked to, another board certified clinical specialist in oncologic physical therapy working on a major, major healthcare system. So once she achieved her board certified clinical specialist, et cetera, she was put onto this clinical specialty track or whatever ⁓ her institution calls it. And what they do,

is they actually take her out of her specialty to become more of a generalist and a leadership position with PT. She’s not even totally practicing entirely in oncology, which is exactly why she went for the specialty certification.

So once she became a specialist, they took her out of that role and put her into being a generalist and like more of a managerial position.

This is the reality of clinical specialty certification. If you are looking at it purely from a financial standpoint, as I said previously, if you are looking at it purely from a financial standpoint, the numbers are never gonna add up. It is never going to make logistical sense for you to pursue your specialty certification. Maybe it does right now, it may not down the road. Maybe it doesn’t right now, and maybe it will down the road. Your situation is unique to you.

But I want to counter this. With specialization was never created to increase your salary. Specialization was never created to give you a pay raise or to help you on your clinical ladder or whatever that is at your institution. Specialization was created to change how you practice and how you show up for your patients and how you deliver excellent

level quality of oncologic physical therapy to your patients. So if you’re trying to evaluate this on money, it doesn’t make sense. But that’s not the criteria that you should be using to decide if specialization is worth it for you. I believe specialization is worth it, not for the money, but for the transformation that you get out of this process. So over the course of putting in the hours,

⁓ I’m assuming that you’re going through the hours route that you have to practice for, think, gosh, I think it’s like 2000 hours in oncology, physical therapy, and then you’re eligible to apply for it. And then you write up your case report and you submit your case report. And then once you get accepted, you’re then going to spend nine or whatever months preparing for that exam. This process of preparing to become a specialist is what accelerates

your growth, your development as an oncology physical therapist, as an oncopT. What I have seen both in myself and in the other PTs who have gone through this oncology specialty certification process is that they take what would have taken them five to 10 years on their own of piecing it together, of practicing and just trying to synthesize all this information.

They took that five to 10 years of work and effort and condensed it into a one year process.

Does this mean they know everything? No, we’re always still learning. We’re always still working on improving our knowledge. But what specialization, what pursuing specialization allows you to do is it intensively puts you into a learning mode where you are constantly reevaluating what choices am I making with my patients? What…

Test and measures, am I choosing to implement with my patients? What questions am I asking them in my subjective history to get really important information out of my interview with my patient? What are the interventions that I’m applying for this patient that are actually going to make the biggest difference? And maybe what are some interventions that I’ve been using with my patients that aren’t targeting what I think they’re targeting?

How do I know if these things that I’m doing are going to make a difference with my patients? How do I know? This was a big one for me. How do I know that my patient is maybe not progressing because of a medical issue, like an oncology issue versus something else going on? That was probably one of the biggest things for me. So example of this, I was working with a patient, ⁓ he was an older gentleman who had metastatic prostate cancer.

And we knew that he had some issues going on as far as like, know, medically complex, et cetera. And we also knew that he had cancer related fatigue that was related to his cancer, his cancer treatments. But after a while of working with him, like he was really great about coming and working really hard, like he was putting in the work, but his fatigue wasn’t significantly changing. And I mean, I was racking my brain like something isn’t…

making sense, something isn’t adding up, this should be helping him. And it was through this process of specialization, of working to learn and study this stuff in preparation for this exam that my patient care completely transformed. And in this case example, so again, I’m working with this patient, I’m implementing interventions that on paper should work. In theory, these things should have worked to improve his cancer related fatigue, it wasn’t working.

And the medical side of things wasn’t totally supporting like, it’s probably a medical or an oncology thing here. And so through this, I’m putting this together in my head. I’m like, something’s just not, something’s not making sense. Something’s not making sense. And I’m kind of second guessing myself along the way until one day I finally stopped and had this epiphany of like, I need to ask this gentleman about his sleep first and foremost. And it came out in conversation with this patient.

that he was basically couch surfing because he did not have a safe home environment that he could stay on his own. And so when I say couch surfing, that was even generous because there were times where he was sleeping on a blowup mattress and there were times he was sleeping on the floor in a sleeping bag.

Now, maybe when you’re young, not a problem. When you are older and dealing with metastatic prostate cancer and a whole slew of other issues, it is no dang surprise that this person was having such significant fatigue because his sleep quality was so poor. And I know that seems so simple, but sometimes when we’re in the thick of it, we cannot see

What is it? We can’t see the forest through the trees or whatever that saying is. It sometimes takes that intentional time and effort to be abundantly clear that I’m doing everything that I need to be doing in the situation as far as interventions, right? Like exercises, check, we’re good to go on that.

But to have that confidence to stop second guessing myself and being like, what am I doing that’s not working? Which of these exercises is not working? Or am I missing something from the oncology side of things? I finally stopped second guessing all of that to basically open my eyes up and ask the question of, ⁓ how is this thing? You know, that’s kind of outside of, think, a lot of we’re trained to ask about in PT school. And even as we start practicing,

especially those first few years, looking back on my first few years of practice, like I try to have so much compassion just because of how challenging it was. In PT school, we talked about how we’re basically drinking from a fire hydrant with all the knowledge you’re learning. I think the first few years of your practice are like drinking from a fire hydrant in a hurricane. So much, so fast, you’re trying to figure it all out. And that confidence in being able to stop second guessing yourself

and say with your whole chest of something else is happening here and I know that I can get to the bottom of this. That for me is what specialization is about. It’s not about the money. It’s about transforming how you practice and how you show up and how you deliver excellent quality cancer rehab, oncology, physical therapy for your patients. That is what specialization was built for specifically.

And so.

My answer to this PT, if you remember at the very beginning of this episode, talked, you know, this was born of a real conversation I had with a colleague. Specialization is not worth it for the money. But for me, it is 100 % worth it for the confidence, the decreased second guessing that I now have in complex cases. Y’all, we see some crazy things in cancer rehab, in oncology, physical therapy.

and having the confidence to sit with myself and say, I know what’s happening. I know what’s going on. I know what to do about this. Or to confidently say,

I know in this area, this is what could possibly be happening and this would account for this, this and this, but it doesn’t account for this over here. This warrants further investigation. This is where we need to pull in somebody else. And I can confidently say that. ⁓ I think another example of this, again, this is just kind of like as I’m going through the preparing for specialty certification, this is where things really started to click for me. So I had a patient who had a gynecologic malignancy.

And again, we were doing stuff, we were making progress, and then all of a sudden she had another body part that totally like flared up. It was pain. It was just like all these other things. And my first thought was, oh my God, this poor person’s cancer has now spread. And this is why we’re having these issues and whatnot. And I remember feeling really silly because I was like, something else is happening here. Something else is happening here.

the patient back to the referring provider. They went through imaging and found out it was a straight up old orthopedic issue that had just kind of popped up because something had happened, whatever. And I remember thinking of like, I’m glad to know for certain that this is not her cancer progressing. Like always love to be certain on that, but not having the confidence to be like, this is for sure not an oncology issue. This is definitely an orthopedic issue.

I think that’s kind of what set me on the path of I really need to get more certain, more confident in my oncology, like high level oncology information so that I can make these informed decisions in my practice with confidence and not be second guessing myself in all of this. And so all this to say, if you feel like

you are kind of in this mode of second guessing yourself, of not knowing with 100 % certainty what you’re gonna do next with your patient or what you need to bring into an evaluation with a patient who has this particular presentation, et cetera. If you feel like you’re missing things or if you have to go home every night and do a ton of research just to be prepared for the next day,

That’s what specialization is for. Specialization is to help you transform how you practice so you can practice confidently without second guessing yourself in these complex patient cases and to ultimately become the best version of OncoPT that you can possibly be. And I really, as I mentioned previously, I really appreciate how through the specialization process, it really forced me

to re-examine and re-evaluate what I do as a physical therapist. And it was challenging. It’s really hard to look at yourself through that lens and look at how you practice and the choices that you make. It can be uncomfortable at first. But as you start going through this process, as you start really spending time with what is going to work best for this patient population, what do I really need to know about

these cancer treatments for this particular, you know, cancer diagnosis, this is where things really start to click and like fall into place. If we think about kind of cancer rehab is a big old puzzle here. know, oncology, physical therapy is a big old puzzle. This is where the pieces start to fall together. So instead of trying to do all 5,000 pieces on your own, you’re able to do like chunks in a section. So clusters of pieces.

at a time instead of individual pieces. I don’t know if you’ve ever done a jigsaw puzzle. ⁓ It can take some time. And it’s sure nice when there’s puzzle pieces that are already clumped together that you can just click into place. You can just snap into place and be like, ⁓ that part of the picture is coming together really nicely. I’m gonna go spend time working on another piece of all of this.

Doesn’t that sound nice? That sounds so relieving to just be like, okay, I do know about this. I do feel better about this. So the next time that that particular patient comes in to see me or I go in to see them, I know what I’m doing and I feel really good about it. And I’m not second guessing myself. And this process of specialization isn’t just about cramming more information into your brain. It’s about learning in a

structured way about these topics so that you can not just, okay, I’m going to learn the thing because we’re not pumping and dumping through all of this. You’re learning and then you are directly applying that knowledge with your patients. So you learn the thing, right, in the academic or I guess didactic sense. You’re learning the thing and then you go and practice doing the thing. And that is what really helps solidify that knowledge into your brain so that you can improve your practice overall.

And a lot of times as we learn early on as oncology physical therapists when we’re first starting to practice, what we learn is really based on what we’re exposed to. So when I was first working, I saw a lot of patients who had breast cancer because there was a breast oncologist who was referring. I was starting to see more colorectal again because the breast oncologist basically told the rest of the team like, hey, this is working. So they started sending patients my way and I was starting to see a little bit of hemorrhage.

But that was kind of it. I did see some prostate. That was kind of it. And so when it came to like other diagnoses, gynecologic for example, I did not see very many of those. Wasn’t very confident on those.

So if you rely only on that exposure, those random cases, it’s really hard to get a very comprehensive view and understanding of how to best practice oncology physical therapy. Now, if you’re fine and you just wanna work with patients who have prostate cancer, cool, love that for you. I would like to be able to treat any patient who walks through my door. And I imagine that you are probably similar in that you want to be able to show up and deliver

best quality care to any patient who happens to walk through your door or who you walk through their door, for example. And through specialization, we go from this random exposure to a very intentional, comprehensive understanding of oncology physical therapy. And this is where that confidence comes from. You have less hesitation. You’ve got less second guessing of yourself and overall better patient care for your patients.

And it’s not because you know everything. As I said earlier in this episode, this isn’t about knowing everything. It’s about understanding how to think through what’s in front of you.

so that even when you do have a patient who has a random diagnosis you have never seen before, or who’s going through a new treatment that you were like, I have never heard of this before, that happens to me still, it’s gonna keep happening to me because that’s the cool thing about oncology, we are always learning stuff. But being able to have a structured way of thinking through those complex cases, even if you don’t know everything,

It’s a game changer. It’s an absolute game changer to be able to say, I may not know everything. I absolutely know what to do to get started. And I feel confident in that. And I’m not second guessing myself every step of the way. That is what makes specialization worth it to me. And that’s what I think a lot of PTs value about the specialization process. If you’re looking at specialization purely for a pay raise,

you’re probably going to be disappointed. But if you are considering specialization to improve how you practice and how you approach working with your oncology patients, it is 100 % worth it every single time, in my opinion.

So I really want you to, when you’re considering specialization, look at it through the appropriate lens. If you’re looking through it from that money lens, it doesn’t make sense. If you’re looking through it, looking through the lens of, this going to change how I practice for the better? That’s how you need to be evaluating specialization.

Now, if you’re trying to figure out if specialization is actually worth it and what this path really looks like, I go over this and more in a free webinar that I will link in the show notes and in your podcast player. In this webinar, I walk through what changes in your practice, what to expect as you go through specialization, and ultimately how to approach specialization without wasting years of your time.

or frankly your money in all of this. So again, I have linked that in today’s show notes as well as your podcast player. I sincerely hope that I get to see you over there in this webinar. But until next time, this is Elise with the Onco PT. And remember, you are exactly the physical therapist that your patients with cancer need. So let’s get to work.