Rural OP PT advice for new graduates

[u/Loud_Awareness1835]

I’ve been given an amazing job offer at a rural clinic. It will be me and one other PTA once I am trained up. I know in rural PT there is a wider variety of patients that come through the door, so what are some of your recommendations of need-to-knows for rural PT/conditions. Climate is humid, hot.

For example: I know I’ll have to re-learn pediatric evaluation because I’ll be the only DPT in the area

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[u/GlassProfessional424]

Lean how to treat BPPV. It's easy and new research suggests that roughly 10% of the elderly have it. You won't always see nystagmus unless you buy the $10-15,000 infrared glasses but there are only 2 ears, it almost never occurs in the anterior canal so you have only four potential places for the debris to be hiding. Even then, >90 of the cases are in the posterior canal. The history (only triggered by head movements, rolling over in bed, looking up/ down, supine <>sit) will help you for it in/ out 90 % of the time accurately.

[u/Loud_Awareness1835 → u/GlassProfessional424]

Thankfully I took a vestibular rehab course, and currently see it 5/6x per week, so I’m well versed in this, thanks for the input!

[u/alyssameh]

I work in a rural setting as well. I second the other comment, do NOT feel bad about turning someone away if you feel like their care would suffer. My front desk will ask if I treat xyz, if I’m not comfortable I’ll have them tell the patient that I don’t have experience but there’s other clinics and if they also say no then come back here and I’ll try my best!

You’ll probably see a lot of back pain. Probably a lot of chronic pain. You might deal with a lot more socio-economic barriers to treatment

[u/Sugar_on_the_rumpus]

I also work in a rural area and when I started out I felt like I needed to know everything. With time I've learned it's ok to turn away patients that I'm not going to be able to treat adequately, like peds. Personally, I feel like I'd be doing a disservice to the patient by trying to fake my way through it.

[u/llamadrama217]

I'm at a rural hospital based clinic in the south. We see anything and everything. My patients are usually not just straight forward whatever they were referred for. They always have a long list of comorbidities. We had a simple TKA sent over. The referral didn't mention that he also had a stroke during surgery on his surgical side.

A lot of my patients are noncompliant with their meds and don't have great health literacy. They ignore so many symptoms of other things so you need to ask a lot of questions during your treatment. I've caught undiagnosed a-fib in several patients referred for balance issues. Checking vitals is also important. We send out patients all the time with unstable BP or blood sugar. Infected wounds they didn't mention to their PCP.

You have to be creative in rural areas. You don't always have the best equipment. Your patients can't always afford proper shoes, adaptive equipment, etc. And they can't always get into the position to do a lot of the exercises you want them to do. But I've learned so much working at this clinic and I've seen and treated things I never would have been able to treat if I were at a regular Ortho clinic in a city. It's a great experience. Don't be afraid to tell a patient you don't know how to treat something. And reach out to PT friends for help with things you're less familiar with.

[u/Sharinganedo]

Depending on the area, sometimes a big thing to consider is a decreased health literacy in some rural communities. I worked in an OP clinic like that and when someone would say, "Oh yeah, I had this happen the other day, but I figured it wasn't anything important." and then you have to follow up with, "Well, with you telling me thing, I think we need to end today's session actually because you need to go see a doctor. That is something that we would like you to really get looked at first because it could be an indicator of something very serious going on."

[u/fastxkill50]

Cancel / no show rate is substantially higher as well. Clinic I tech at averages 35-40% Very impoverished area as well.