Should you do a residency/fellowship right out of school, or practice a little first?

Having previously completed a sports physical therapy fellowship, I’m asked a lot not only about the experience, but also when the best time is to do a residency/fellowship.  Should you do it right after PT school or should you practice for a few years first then do one?  The timing is always a tough question to answer, for a number of reasons.  The question has come up a lot recently, so I figured it was time just to share my take on it with my colleagues in the PT world.  Agree or disagree, it’s just one guy’s take.

Before we dig deeper into this, there are a few things that make each person’s decision unique.  One, are you able to do one at this time in your life? To illustrate, do you have a home to sell or kids to move out of schools for a year, or are you single with no commitments and either living at home with your folks or just renting a place? Obviously, that changes things.  Secondly, does your current financial situation enable you to do so?  Sure, most of us are in mounds of debt after PT school, but are you able to swing it for one more year? At least you’ll be making some money, but not nearly what you would be making if you went to work.  On the contrary, if you waited, can you afford the pay cut that is likely to occur?  Do you plan on buying a house that you may have to sell if you wait?  Those things need to be considered.  Last, are you able to completely immerse yourself in the experience? Again, at the time, I had no mortgage, wasn’t married, and was living at home with my folks.  I was happy to work some looonnnngg days on the fellowship because I wanted to get every last morsel out of it.  DO NOT do a residency/fellowship if you plan on working 8 hour days. Don’t waste your bloody time.  By the time it’s over, you should be spent because you didn’t waste a minute.  It has to be the right time of life for you.  There’s nothing worse than pursuing a passion, but knowing at the same time that a little baby at home desperately wants your attention too.  As a proud dad now, it would kill me to have to decide between a learning opportunity or seeing my kids that are waiting for me at home.  It’s a tough call!  Essentially, this decision comes down to personal values and what’s most important to you.  Now that we got that out of the way, here’s why I say wait if you can…
Because Mr. Davies said so.  I had the privilege of doing a rotation with Dr. George Davies, an absolute lion in the field of sports physical therapy.  Seriously, he’s probably the father of the dang profession.  Mr. Davies is a true professional and is both a clinician and a researcher.  The guy has forgot more than I could ever possibly know and I was tremendously blessed to have learned from him (students, if you don’t know him, you should and need to).  Well, he told me many years ago when I asked about doing one that you should practice for at least a year and then do one because you’ll have seen some things, developed some biases, gotten “comfortable” treating things, developed some confidence, etc.  Now do the residency or fellowship to “fine tune.”  Well, when he spoke, I listened.  I waited three years actually before I did one.  I’m so glad I did because he was right – I was able to “live my questions” for that year every day.  I went away with a specific purpose and objectives.  I wasn’t trying to figure out how to treat basic stuff anymore. I knew what I struggled with, knew where I was successful, and knew what I was uneasy about.
It’s true.  You’ll get more out of it.  So you just graduated, passed your boards.  But now there’s no CI to go over every case with you.  Now that patient with patellofemoral pain or subacromial impingement is all your own.  So now what? Sure, you can “muscle through it,” but not all are the same.  You have to do a treatment plan beginning to end now, not in fractured pieces like on your clinicals.  You need to develop a rhythm, an approach that fits you.  You need some confidence.  You need to develop some biases, maybe drink a little of the Kool-Aid of some “guru” and then realize after application that it’s total crap.  In that time, if you’re really trying to get better as a clinician, you’ll screw up and make mistakes and hopefully scratch your head just about every day.  Perfect. Now go do your residency/fellowship and sharpen those skills and learn from lots of experienced clinicians.
You’ll have set yourself apart from the millions of people that apply.  These things are really popular now. Lots of people are competing for a few spots.  Now, let’s say you wait.  You’ll have stuff to share in an interview about some struggles and successes you’ve experienced.  You’ll have a clearer picture about why you want to do the residency/fellowship too.  You’ll be a little more seasoned, a little more mature.  Plus, they’re likely to know that you really want this because there’s likely to be a big pay cut.  That’s not everyone’s cup of tea so to speak.  You will set yourself apart by having some experience.
Hope this helps. Just my opinion from my experience as a past fellow.  I’m sure many others that did it right away would dispute this, but that’s OK.  Maybe this resonates with you, maybe it doesn’t.  Just thought it may help from someone that did one and is still in the trenches treating patients every day.
Here’s a link for credentialed residency/fellowship programs.

Tags: Physical Therapy, physical therapy fellowship, physical therapy residency