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Physical Therapists

Nature of the Work
Working Conditions
Training, Other Qualifications, and Advancement
Employment
Job Outlook
Earnings
Related Occupations
Sources of Additional Information

Significant Points

Employment is expected to increase much faster than the average, as growth in the number of individuals with disabilities or limited functioning spurs demand for therapy services.
Job opportunities should be particularly good in acute hospital, rehabilitation, and orthopedic settings.
After graduating from an accredited physical therapist educational program, therapists must pass a licensure exam before they can practice.
Nearly 6 out of 10 physical therapists work in hospitals or in offices of physical therapists.


Nature of the Work [About this section] Back to Top

Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. They restore, maintain, and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low-back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.

Therapists examine patients’ medical histories and then test and measure the patients’ strength, range of motion, balance and coordination, posture, muscle performance, respiration, and motor function. They also determine patients’ ability to be independent and reintegrate into the community or workplace after injury or illness. Next, physical therapists develop plans describing a treatment strategy, its purpose, and its anticipated outcome. Physical therapist assistants, under the direction and supervision of a physical therapist, may be involved in implementing treatment plans with patients. Physical therapist aides perform routine support tasks, as directed by the therapist. (Physical therapist assistants and aides are discussed elsewhere in the Handbook.)

Treatment often includes exercise for patients who have been immobilized and lack flexibility, strength, or endurance. Physical therapists encourage patients to use their own muscles to increase their flexibility and range of motion before finally advancing to other exercises that improve strength, balance, coordination, and endurance. The goal is to improve how an individual functions at work and at home.

Physical therapists also use electrical stimulation, hot packs or cold compresses, and ultrasound to relieve pain and reduce swelling. They may use traction or deep-tissue massage to relieve pain. Therapists also teach patients to use assistive and adaptive devices, such as crutches, prostheses, and wheelchairs. They also may show patients exercises to do at home to expedite their recovery.

As treatment continues, physical therapists document the patient’s progress, conduct periodic examinations, and modify treatments when necessary. Besides tracking the patient’s progress, such documentation identifies areas requiring more or less attention.

Physical therapists often consult and practice with a variety of other professionals, such as physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language pathologists, and audiologists.

Some physical therapists treat a wide range of ailments; others specialize in areas such as pediatrics, geriatrics, orthopedics, sports medicine, neurology, and cardiopulmonary physical therapy.



Working Conditions

Physical therapists practice in hospitals, clinics, and private offices that have specially equipped facilities, or they treat patients in hospital rooms, homes, or schools.

In 2004, most full-time physical therapists worked a 40-hour week; some worked evenings and weekends to fit their patients’ schedules. About 1 in 4 physical therapists worked part time. The job can be physically demanding because therapists often have to stoop, kneel, crouch, lift, and stand for long periods. In addition, physical therapists move heavy equipment and lift patients or help them turn, stand, or walk.



Training, Other Qualifications, and Advancement

All States require physical therapists to pass a licensure exam before they can practice, after graduating from an accredited physical therapist educational program.

According to the American Physical Therapy Association, there were 205 accredited physical therapist programs in 2004. Of the accredited programs, 94 offered master’s degrees, and 111 offered doctoral degrees. All physical therapist programs seeking accreditation are required to offer degrees at the master’s degree level and above, in accordance with the Commission on Accreditation in Physical Therapy Education.

Physical therapist programs start with basic science courses such as biology, chemistry, and physics and then introduce specialized courses, including biomechanics, neuroanatomy, human growth and development, manifestations of disease, examination techniques, and therapeutic procedures. Besides getting classroom and laboratory instruction, students receive supervised clinical experience. Among the courses that are useful when one applies to a physical therapist educational program are anatomy, biology, chemistry, social science, mathematics, and physics. Before granting admission, many professional education programs require experience as a volunteer in a physical therapy department of a hospital or clinic. For high school students, volunteering with the school athletic trainer is a good way to gain experience.

Physical therapists should have strong interpersonal skills in order to be able to educate patients about their physical therapy treatments. Physical therapists also should be compassionate and possess a desire to help patients. Similar traits are needed to interact with the patient’s family.

Physical therapists are expected to continue their professional development by participating in continuing education courses and workshops. In fact, a number of States require continuing education as a condition of maintaining licensure.

Employment

Physical therapists held about 155,000 jobs in 2004. The number of jobs is greater than the number of practicing physical therapists, because some physical therapists hold two or more jobs. For example, some may work in a private practice, but also work part time in another health care facility.

Nearly 6 out of 10 physical therapists worked in hospitals or in offices of physical therapists. Other jobs were in home health care services, nursing care facilities, outpatient care centers, and offices of physicians.

Some physical therapists were self-employed in private practices, seeing individual patients and contracting to provide services in hospitals, rehabilitation centers, nursing care facilities, home health care agencies, adult day care programs, and schools. Physical therapists also teach in academic institutions and conduct research.

Job Outlook

Employment of physical therapists is expected to grow much faster than the average for all occupations through 2014. The impact of proposed Federal legislation imposing limits on reimbursement for therapy services may adversely affect the short-term job outlook for physical therapists. However, over the long run, the demand for physical therapists should continue to rise as growth in the number of individuals with disabilities or limited function spurs demand for therapy services. Job opportunities should be particularly good in acute hospital, rehabilitation, and orthopedic settings, because the elderly receive the most treatment in these settings. The growing elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. Also, the baby-boom generation is entering the prime age for heart attacks and strokes, increasing the demand for cardiac and physical rehabilitation. Further, young people will need physical therapy as technological advances save the lives of a larger proportion of newborns with severe birth defects.

Future medical developments also should permit a higher percentage of trauma victims to survive, creating additional demand for rehabilitative care. In addition, growth may result from advances in medical technology that could permit the treatment of more disabling conditions.

Widespread interest in health promotion also should increase demand for physical therapy services. A growing number of employers are using physical therapists to evaluate worksites, develop exercise programs, and teach safe work habits to employees in the hope of reducing injuries in the workplace.

Earnings

Median annual earnings of physical therapists were $60,180 in May 2004. The middle 50 percent earned between $50,330 and $71,760. The lowest 10 percent earned less than $42,010, and the highest 10 percent earned more than $88,580. Median annual earnings in the industries employing the largest numbers of physical therapists in May 2004 were:

Home health care services $64,650
Nursing care facilities 61,720
Offices of physicians 61,270
General medical and surgical hospitals 60,350
Offices of other health practitioners 60,130

Significant Points

-The largest health care occupation, with more than 2 million jobs.
-One of the 10 occupations projected to have the largest numbers of new jobs.
-Job opportunities are expected to be very good.
-Earnings are above average, particularly for advanced practice nurses, who have additional education or training.

Nature of the Work

Registered nurses (RNs) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress; assist physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation. RNs also develop and manage nursing care plans; instruct patients and their families in proper care; and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it is usually the work setting that determines their daily job duties.

Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They also may supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one area, such as surgery, maternity, pediatrics, emergency room, intensive care, or treatment of cancer patients. Some may rotate among departments.

Office nurses care for outpatients in physicians' offices, clinics, surgicenters, and emergency medical centers. They prepare patients for and assist with examinations, administer injections and medications, dress wounds and incisions, assist with minor surgery, and maintain records. Some also perform routine laboratory and office work.

Nursing home nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease. Although they often spend much of their time on administrative and supervisory tasks, RNs also assess residents' health condition, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform difficult procedures such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitation units for patients with strokes and head-injuries.

Home health nurses provide periodic services to patients at home. After assessing patients' home environments, they care for and instruct patients and their families. Home health nurses care for a broad range of patients, such as those recovering from illnesses and accidents, cancer, and childbirth. They must be able to work independently, and may supervise home health aides.

Public health nurses work in government and private agencies and clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities. They also work as partners with communities to plan and implement programs. Public health nurses instruct individuals, families, and other groups regarding health issues, disease prevention, nutrition, and childcare. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community leaders, teachers, parents, and physicians in community health education.

Occupational health or industrial nurses provide nursing care at worksites to employees, customers, and others with minor injuries and illnesses. They provide emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, assist with health examinations and inoculations, and assess work environments to identify potential health or safety problems.

Head nurses or nurse supervisors direct nursing activities. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to ensure the proper delivery of care. They also may see that records are maintained and equipment and supplies are ordered.

At the advanced level, nurse practitioners provide basic primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse practitioners also can prescribe medications(but certification and licensing requirements vary by State. Other advanced practice nurses include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives. Advanced practice nurses must meet higher educational and clinical practice requirements beyond the basic nursing education and licensing required of all RNs.

Working Conditions


Most nurses work in well-lighted, comfortable healthcare facilities. Home health and public health nurses travel to patients' homes, schools, community centers, and other sites. Nurses may spend considerable time walking and standing. They need emotional stability to cope with human suffering, emergencies, and other stresses. Patients in hospitals and nursing homes require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on-call(available to work on short notice. Office, occupational health, and public health nurses are more likely to work regular business hours. Almost 1 in 10 RNs held more than one job in 2000.

Nursing has its hazards, especially in hospitals, nursing homes, and clinics where nurses may care for individuals with infectious diseases. Nurses must observe rigid guidelines to guard against disease and other dangers, such as those posed by radiation, chemicals used for sterilization of instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases.

Employment


As the largest healthcare occupation, registered nurses held about 2.2 million jobs in 2000. About 3 out of 5 jobs were in hospitals, in inpatient and outpatient departments. Others were mostly in offices and clinics of physicians and other health practitioners, home healthcare agencies, nursing homes, temporary help agencies, schools, and government agencies. The remainder worked in residential care facilities, social service agencies, religious organizations, research facilities, management and public relations firms, insurance agencies, and private households. About 1 out of 4 RNs worked part time.



Training, Other Qualifications, and Advancement

In all States and the District of Columbia, students must graduate from an approved nursing program and pass a national licensing examination to obtain a nursing license. Nurses may be licensed in more than one State, either by examination, by endorsement of a license issued by another State, or through a multi-State licensing agreement. All States require periodic license renewal, which may involve continuing education.

There are three major educational paths to registered nursing: associate degree in nursing (A.D.N.), bachelor of science degree in nursing (B.S.N.), and diploma. A.D.N. programs, offered by community and junior colleges, take about 2 to 3 years. About half of the 1,700 RN programs in 2000 were at the A.D.N. level. B.S.N. programs, offered by colleges and universities, take 4 or 5 years. More than one-third of all programs in 2000 offered degrees at the bachelor's level. Diploma programs, administered in hospitals, last 2 to 3 years. Only a small number of programs offer diploma-level degrees. Generally, licensed graduates of any of the three program types qualify for entry-level positions as staff nurses.

Many A.D.N. and diploma-educated nurses later enter bachelor's programs to prepare for a broader scope of nursing practice. They can often find a staff nurse position and then take advantage of tuition reimbursement programs to work toward a B.S.N.

Individuals considering nursing should carefully weigh the pros and cons of enrolling in a B.S.N. program because, if they do so, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with bachelor's or advanced degrees. A bachelor's degree is often necessary for administrative positions, and it is a prerequisite for admission to graduate nursing programs in research, consulting, teaching, or a clinical specialization.

Nursing education includes classroom instruction and supervised clinical experience in hospitals and other health facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing homes, public health departments, home health agencies, and ambulatory clinics.

Nurses should be caring and sympathetic. They must be able to accept responsibility, direct or supervise others, follow orders precisely, and determine when consultation is required.

Experience and good performance can lead to promotion to more responsible positions. Nurses can advance, in management, to assistant head nurse or head nurse. From there, they can advance to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs preparing executive-level nurses usually last 1 to 2 years.

Within patient care, nurses can advance to clinical nurse specialist, nurse practitioner, certified nurse-midwife, or certified registered nurse anesthetist. These positions require 1 or 2 years of graduate education, leading to a master's degree or, in some instances, to a certificate.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home health, and chronic care services. Healthcare corporations employ nurses for health planning and development, marketing, and quality assurance. Other nurses work as college and university faculty or do research.

Job Outlook


Job opportunites for RNs are expected to be very good. Employment of registered nurses is expected to for all occupations through 2010, and because the occupation is very large, many new jobs will result. Thousands of job openings also will result from the need to replace experienced nurses who leave the occupation, especially as the median age of the registered nurse population continues to rise.

Some States report current and projected shortages of RNs, primarily due to an aging RN workforce and recent declines in nursing school enrollments. Imbalances between the supply of and demand for qualified workers should spur efforts to attract and retain qualified RNs. For example, employers may restructure workloads, improve compensation and working conditions, and subsidize training or continuing education.

Faster than average growth will be driven by technological advances in patient care, which permit a greater number of medical problems to be treated, and an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.

Employment in hospitals, the largest sector, is expected to grow more slowly than in other healthcare sectors. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to increase much. Patients are being discharged earlier and more procedures are being done on an outpatient basis, both in and outside hospitals. However, rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy.

Employment in home healthcare is expected to grow rapidly. This is in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.

Employment in nursing homes is expected to grow faster than average due to increases in the number of elderly, many of whom require long-term care. In addition, the financial pressure on hospitals to discharge patients as soon as possible should produce more nursing home admissions. Growth in units that provide specialized long-term rehabilitation for stroke and head injury patients or that treat Alzheimer's victims also will increase employment.

An increasing proportion of sophisticated procedures, which once were performed only in hospitals, are being performed in physicians' offices and clinics, including ambulatory surgicenters and emergency medical centers. Accordingly, employment is expected to grow faster than average in these places as healthcare in general expands.

In evolving integrated health care networks, nurses may rotate among employment settings. Because jobs in traditional hospital nursing positions are no longer the only option, RNs will need to be flexible. Opportunities should be excellent, particularly for nurses with advanced education and training.

Earnings


Median annual earnings of registered nurses were $44,840 in 2000. The middle 50 percent earned between $37,870 and $54,000. The lowest 10 percent earned less than $31,890, and the highest 10 percent earned more than $64,360. Median annual earnings in the industries employing the largest numbers of registered nurses in 2000 were as follows:



Personnel supply services $46,860
Hospitals 45,780
Home health care services 43,640
Offices and clinics of medical doctors 43,480
Nursing and personal care facilities 41,330

Many employers offer flexible work schedules, childcare, educational benefits, and bonuses.

Information on this page courtesy of the Occupational Outlook Handbook

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