PA vs. PT

[ChaseBlakeley]

Anyone here a former Physical Therapist or considered PT as a career?

Data seems to be inconsistent as far as salary goes, and long term growth differences (for example, running your own practice) is nebulous to me.

Any insight would be appreciated.

[camoman1234]

Would not do it, the debt to income ratio is huge. I have a friend doing a DPT/MBA combined program, he told me he was going to be ~150K in debt and making ~$86,850 https://www.bls.gov/oes/current/oes291123.htm. I personally would not touch DPT for that reason alone. I had several PTs in my class and a few OTs, they all work in ortho. 

[scott079]

Debt to income ratio is awful. Never meet a PT that did not enjoy their job but there is no way higher ed can justify a 2-1 debt to income ratio. The damage to your ability to buy a house, have a kid, go on vaca is massive. running a practice makes you a business owner, manager and provider, please be sure you want to be all three. Its a great field that helps people but I just don't understand why it requires a graduate degree.

[SirScottric]

I was an OT before going back to PA school. I worked side by side with dozens of PT whom many are still very good friends of mine. I share the sentiment as stated by the posters above. A big factor for me going back to school was having a master's in OT and making $60,000 after 4 years of experience. I live in Michigan and the PT's starting salary at my hospital system in metro-Detroit are roughly $75,000-$80,000 after taking on $150,000 of student debt from their programs (not including their undergraduate student debt). Some of the new grads I worked with had a collective student debt of $200,000-$250,000. Every new grad PT I worked with is banking on the 10 year loan forgiveness program for working for a non-profit hospital because there is no possible way they could afford a mortgage in metro-Detroit and pay off their student loans. I know a number of PT's who are in their 40's and still paying off their student loans at least 10-15 years later. Overall, I definitely made the right decision for myself by switching from OT to PA. Many of the older OT colleagues I work with say if they were 10 or 20 years younger, they would most definitely do the same thing I did. OT and PT are good careers and can be very rewarding/satisfying. If you really have a passion for PT, go for it. But, if you are concerned with making more money in your career, therapy is NOT the way to go.

[ChaseBlakeley]

Wow, eye-opening. Thanks for the warning signs, that ratio for PT's seems beyond absurd.

 

I might ask this somewhere else, but as a follow-up to the debt issue, do y'all have any creative stories of offsetting debt during pre-pa and PA school itself, including but not limited to jobs or possibly clinical work that was also salaried?

[NikkiPA20]

I’m also an OT that will be starting PA school this fall. I’ll offer a different perspective in that salary vs debt was not really a concern for me. I work in home health so I’m at the high end of the income curve. In home care where I live, you can easily make $90-100k. However, I am making the change because I know I don’t want to do home care for the rest of my life but enjoy the income range. Any other setting in OT for me will be at least a $20k pay cut with more hours and probably holiday/wkend hours. I will add that I received my degree when a masters was all that was required, OT and PT now require a doctorate degree. I know of a PT that owns his own business and appears to enjoy but..........he’s older and has owned his business for 20 yrs. It’s a lot of work in the beginning with reward that comes MUCH later. 

Bonus for me is that my salary has allowed me to save a lot for PA school. Not to mention my PCE and prerequisites were easy because of my background. 

[JD2012]

I work as a PT Aide the sentiments are the same. Too much debt for the end salary. Some of them even mentioned they would do PA or even CRNA if they were to do it again.

[boli]

Eh, I disagree with the above.

My wife is a PT. The income to debt ratio is not great, but in our case, not THAT horrible. Could be one of those kids who majored in feminist dance theory at a private undergrad and now works at starbucks ;). My wife took approx120k in loans (undergrad and PT school included) and makes north of 70k as a hospital based therapist. We qualify for IBR so the loans aren't THAT onerous... She works 40 a week (MAYBE 42-43 if things are crazy at the hospital). Never takes call, never takes her work home. She absolutely loves what she does, and the specialty in which she works (she didn't like outpatient ortho for the record). Through work she gets great benefits, the opportunity for continuing education, and many other perks. Gets roughly a 4% raise annually. Plus, as hospital based, she qualifies for public service loan forgiveness after 10 years. 

In my experience, PT has one of the higher job satisfaction ratings (anecdotally) in the medical field. I think if you're going into the medical field with salary:debt ratio at the forefront of your decision you're setting yourself up to burn out. Follow your interests and passions and the money will work itself out. 

[kko0403]

I was enrolled in an accelerated DPT program before I decided to leave and begin the process to apply to PA school. My former PT classmates will be graduating this summer and I'm honestly very happy with my decision to leave. I've spent the past few years getting paid HCE hours rather than completing the 3 years of graduate school. 

Additionally, I have shadowed some PAs who have told me that they also considered applying to PT schools at one time. Many stated that they felt PT was a more limiting career. It's more specific, you cannot prescribe meds, and you cannot work in as many specialties. Salaries are also lower than PAs and I personally don't think the PT field needs to require a doctorate (most programs are now 3 year DPT programs). 

[ChaseBlakeley]

Maybe this forum is biased, but based on anecdote alone, these posts are generally pro-PA more than pro-PT based on their own experiences and talking to others in the field.

I think the emphasis on learning medicine and prescribing medicine as a PA as going to ultimately drive me in that direction. As an aside, all the experience I have had as a client of PT's has been generally positive in the short term, but never healed any of my underlying issues, which is where I think medicine could have entered in the picture and gives me a personal motivation to pursue this path.

 

Thank you all for your feedback

[Guest PAhopeful85]

I've been a PTA for the past 4 years and am a pre-PA student. I've talked to many PT's and OT's and I would say roughly 90% of them literally tell me they wish they did PA school or nursing. The PT's with doctorates (DPTs), get frustrated when they are literally told who to eval, who to pick up on caseload, and for how long by some office employee making 14/hr. What's the point of a higher degree when you're bossed around by everybody else?

In the nursing  home setting the PT's I know make roughly 85,000/yr on paper, but patients refuse or get sick and your hours drop. I like to joke that PT is the opposite of "work smart, not harder". What do you want to do when the director makes you eval a stroke patient that is a long term resident at the nursing home and in the past 7 years has had therapy every year for a hundred days with no improvement? Guess what, you're going to pick them up and do it all over again (definition of insanity btw).

The evals are cookie cutter and you get pressured to pick the same people up over and over and over again despite knowing that they will never improve (like severe hamstring contractures on someone alert and oriented x 0 who has been bed bound for ten years which will only improve with surgical intervention). They also have to lie during their evals about how much patient's actually can do or private insurance will discharge them. So if they can walk 300 feet on day one, the PT will document that they walked 30 ft so we can justify keeping them on caseload by showing improvement. What's the point of the doctorate again if you just end up making stuff up on evals? 

In the home health setting as a PTA I seriously have a bone to pick with these supervising PT's. They will pick up anybody for tx and then it's all on me to deal with the stress. Don't pick up a patient that literally tells you they don't want to do HH therapy. I have maybe seen 4 patients in two years actually improve as a result of therapy and I would guess those patient's probably would have improved regardless of our intervention. And when I ask patient's what the supervising PT did with them they almost always say "they walked in, said I'm signing you up for therapy and the assistant will see you next week and they left". So, they don't even do any actual work and just make up stuff on the eval that sounds good. 

The positives of PT is how laid back it is. If a problem happens you can always call a nurse or doctor and pass it off. I for one am pursuing PA because I want to feel important and not just sit on the sidelines like others.

 

 

[brandonhughey]

In 2016, I was committed to a DPT program before switching to PA. Tuition alone was 100k. 3yrs of living lets say is 30-50k. 130k-150k debt for a starting salary of 65-70k. Not the best financial move. 

[OrthoPT2PA]

. - My background is I am a PT with 2 years of experience. My first job out of school was directing an outpatient sports clinic in NC. My base was $68,000 with a raise to $72,000 at 6 months and made another $3,000 in bonus. I also taught at a local collage at night for an extra $8,000 for the year. I also worked 1/2 days on Sunday PRN for about $5,000. Total: $88,000 I was also part of a loan repayment program of $23,000 for the year so that puts me at $111,000 

- I have since moved to CA to work in a sports clinic (staff PT) with a base of $80K and about $3K in bonus. (no longer part of the loan repayment program as I paid them off).

- The thing you have to ask yourself is this. What do YOU want.

PA

- Pros:

You will make more for sure as a PA. Most PTs out of school make about 62-65K within a few years you will be about 80K and max out about 90K. (these numbers are for ortho if you work in home health you can make between 120-150K but you will work for it and they are not sports patients.

- A PA is thought of to be more of a "medical" provider. PT's are a blend of a personal trainer and a medical provider. Some dig that and other people don't.

Cons:

- Some will say lack of autonomy. As you MAY be in close contact with the MD.

 

PT:

Pro:

- More time: This is huge I see about 16 patients per day and get about 30 min per patient and get to BS about their day and they weekend and I work on their shoulder for a bit and change their exercises if needed

- Fun: Being a PT is really fun, you see the patient maybe 2x per week for a couple weeks and really get to know them.

Cons:

- Pay: you hit a ceiling pretty quick of about 85-90K. 

The aspect you are talking about is OWNING your own practice. This is NOT the same as being a PT often the clinic owners  have a very different view on patient care as they are worried about the bottom line more then a staff PT. Also It s VERY VERY tough to own your own clinic you need a strong referral source from the docs to keep your tables full. At some point you would become a business owner and not a PT.

 

- I chose to go back to PA school because I like to learn and want to live in an area of the country where I can use the extra money a PA will earn. (I hope to make 130-150 as an ortho PA).

[NikkiPA20]

Good points from poster above.....every single position has pros and cons. It’s all about what factors are most important to you and what you can live with yourself doing. There are several degrees that now (IMO) require more schooling than necessary but that’s not a reason to dismiss that career as an option. I still believe therapy as a whole is a great field, with plenty of work options. 

[Solulu]

I’m a PT who works with PAs in an inpatient setting and has several friends who are PAs. So I have first hand experience with how both fields work.

PT and PA are very different fields. PAs practice medicine under the supervision (either directly or indirectly) of a physician. PTs practice gross movement science/kinesiology and use that to help people with disease or dysfunction return to or maintain a functional lifestyle (e.g., walking to the bathroom, putting on a jacket, lifting a suitcase, return to work or sport, etc.). We don’t use exercise/movement for fitness like personal trainers or just walk patients in the hospital hallway for no purpose, this is a major misconception that belittles the profession. Skilled PT rehab includes addressing muscle imbalances, coordination and balance, managing spasticity and hypotonicity, treating joint abnormalities, determining what assistive device to use if needed, fatigue management, casting and splinting for contractures, using body weight support for gait, neuroplasticity development, etc.

First off I’m surprised by all the negative comments about the role of PT here. PT is super important in the field of health care and absolutely necessary. It’s important for people to maintain and build gross motor function in order to prevent deterioration, proper coordination of movements, and safety. For example, a good PT program can help prevent falls in the elderly and neuro patients. Frequent falls are a major deterioration to health and many elderly will die within one year if there is a significant injury.

I majored in public health and knew I wanted to be a clinician. I looked into PA, PT, and pharmacy and ultimately decided PT was the best fit for me because I love being active and wanted to learn more about the movement side of health care. After talking with some PAs and learning more about the scope of practice of PA, I also realized autonomy is very important to me. 

As a PT, I do my own evaluation, determine the physical impairments, and type of treatment the patient will get without any physician co-signing to approve my plan of care. Yes, we rely on physicians for referral in outpatient but most scripts will say “low back pain eval and treat,” “ankle sprain,” or “stress incontience” and nothing else. Some physicians might give of a list of modalities or types of therex to do, but I don’t have to abide by it and I ultimately do whatever therex will benefit the patient the most. The only time we have to abide by physician orders is movement precautions, WB status, and post-op therex protocols, and even the therex protocols are more of a guideline. We also have a lot of autonomy in the acute hospital where we must determine if a patient is physically stable and safe to discharged and recommend what setting they should be discharged to (e.g., rehab, home health, etc.)

In contrast, even though most PAs work without direct supervision, a PA will always need oversight from a physician in some way or another. You’ll also never be the ultimate expert in the field in comparison to the specialty trained physician (yes, I know they’re are bad physicians and amazing PAs), but in general the work experience of a seasoned PA will never replace the extra schooling and residency of a physician. Heck, PTs know more about MSK than PAs and PCPs due to our more specialized schooling, which is why we were granted the rights to direct access in outpatient orthopedics several years ago.

As I said, I ultimately chose PT because autonomy is important to me. Keep in mind autonomy isn’t just “being the boss.” This also includes more career growth opportunities such as non-clinical jobs in management/administration, research, and health policy in the respective field. 

Like other health fields, there are so many settings and specialities you can work in PT and not just orthopedics and sports. PTs have a vital role in inpatient, SNF, neuro, cardiopulmonary rehab, wound/burn care, women’s health, pediatrics, oncology, and even emergency medicine when we are paged to treat benign MSK issues. Being a good PT also requires a lot of critical thinking, superb knowledge of anatomy and biomechanics, and deductive reasoning. For example, people with hemophilia are prone to contractures due to hemarthrosis and need to be splinted properly and limit closed chain activities at times. Or the fact that people with Parkinson’s Disease have difficulty with procedural learning due to basal ganglia deficits and need special audio and visual cues for improved gait mechanics.

Lastly, I agree the salary vs. debt ratio isn’t the best for PT, but there are opportunities to address that such as working PRN, career advancement, and loan forgiveness programs. PA does have a higher income ceiling, but FWIW the average PA salary is only about $10-15k more than the average PT salary according to BLS (something like $86k vs. $104k.) PT is also only one more year of schooling than PA (3 years vs. 2 years, with some PA schools becoming 3 years and requiring 1000+ hours of clinical exposure prior to application). So I wouldn’t chose PA solely on the fact of “less schooling/time and money.” In fact, my PT school total tuition is only about $10k more at $88k than some private PA schools like Georgetown and Columbia programs which is about $76k total. However, that is if you’re lucky to get accepted at a state or lower cost private PT school, and I know not everyone has that option. My point is that the lower cost PT programs rival the higher cost PA programs when it comes to total tuition costs and that it’s not true that PT school is always a lot more money than PA school.

Sorry for the long post, there was way too much fabricated and inaccurate information about the PT field on this thread and I wanted to provide my insight. Both are good fields, but like I said it comes down to what you enjoy more, medicine or movement science. I absolutely love PT and to me there is nothing more rewarding than helping a person return or maintain to function even if it’s small (e.g., patient with SCI walking in parallel bars, maintaining remaining muscle integrity in the arms for an ALS patient, or seeing a patient with a RTC be able to put on their jacket for the first time in months). However, some people might prefer the medical side of disease and dysfunction. Therefore, PA would probably be a better fit.

Edited July 17, 2018 by Solulu

[Prepaguy23]

I work with PT's daily as a physical therapy aide. Many are 5-6 even 7 years out of school and can not even own their own house because they are 200k+ in debt making 70k a year. The tuition to salary ratio is just not there. I do think that PT's should make more money but with the PTA career, thats a smaller financial route than doing PT. 

 

Don't get me wrong, they all love their job and I believe PT is one of the most important aspects of healthcare, but being 35 years old still paying 2500 a month on student loans in my opinion is ridiculous. 

Edited July 17, 2018 by Prepaguy23

[Solulu]

1 hour ago, Prepaguy23 said:

I work with PT's daily as a physical therapy aide. Many are 5-6 even 7 years out of school and can not even own their own house because they are 200k+ in debt making 70k a year. The tuition to salary ratio is just not there. I do think that PT's should make more money but with the PTA career, thats a smaller financial route than doing PT. 

 

Don't get me wrong, they all love their job and I believe PT is one of the most important aspects of healthcare, but being 35 years old still paying 2500 a month on student loans in my opinion is ridiculous. 

Your points are valid. I assume you work in oupatient orthopedics, which is the lowest paid setting in PT and albeit the most desired and popular. However, inpatient and home health make a lot more so if you want a higher base salary you have to be flexible with what settings to work in, which many PTs aren’t and some I even know that would take a $30k less salary to do outpatient ortho than to ever step foot in a hospital.

The only way to make six figures in the outpatient setting other than owning a practice is becoming a clinical supervisor/manager in a big chain company, or work in a high demand outpatient field like hand therapy or women’s health, but that’s not for everybody.

Inpatient, SNF, home health can easily make $100k+ with experience, but again not for everybody. It’s unfair the discrepancy in pay. For someone with a low outpatient salary and $200k in debt I would probably do income based repayment and pick up PRN hours which can pay off the monthly loan. 

However, as I stated in my previous post, the cheaper PT schools are on par tuition than the more expensive PA schools. Despite PAs having a higher income ceiling, the average salary is only $10-15k higher for PA compared to PT according to BLS. So I wouldn’t chose PA over PT solely based on income and debt. The marginally higher PA salary didn’t justify me to chose it over PT. I also had no desire to go into the higher paid PA fields like surgery or dermatology, and I was willing to work in higher paid PT fields like inpatient and perhaps home health in the future, so it’s all relative. Also, from my understanding primary care PA sometimes don’t pay well and can be more on par with the average PT salary than higher paid specialty PA salaries. Actually my friend who is an FM PA is making less out of school than her sister who is a pediatric PT out of school.

PTA is a good option, but limited scope of practice in that they can’t do evaluations, discharge, determine prognosis, change a plan of care without approval from the PT, perform certain joint mobilizations, etc. This can be frustrating if you highly value autonomy. Nevertheless, it’s a good career especially with the income to debt ratio considered.

All healthcare fields are ridden with school debt. Seems like the only fields that aren’t are the two year certifications like PTA, radiology tech, ultrasound tech, etc. or the super high paying physician specialities like surgery and radiology that can probably pay it off in 3-4 years after residency if they lived within their means.

 

Edited July 17, 2018 by Solulu

[AdamPAC]

If your heart is ultimately in being a PT, and not a PA, maybe talk to an Army recruiter about Baylor's DPT program. As a current PA-student, being paid by the Army to attend school to come out the other side with my degree, and without debt for several more years of service to my country was as lucky a straw as I could've drawn. The Army/Baylor PT route is different from mine, because they will take you as a civilian with a Bachelor's degree as long as you are accepted and meet the Army's standards, obviously. If you're interested, you could talk to a recruiter. That's one way of avoiding debt. Also, I hear that not many people know of them, but the Department of Veterans Affairs does offer scholarships at least for PA and OT school. I would imagine they do for PT school as well. As I understood when I applied a while ago (Low GPA, and did not win one for PA school), this was a full-tuition scholarship in exchange for a commitment to practice for the VA for I think 2-3 years after completing school. There may have been a stipend too, but I can't remember. They post these scholarships when they open them up for applications under the Federal Job Board, USAJobs.gov. I found it by searching something on that board, like "Physician Assistant Veterans Affairs", or something like that. Anyway, I recommend you explore ALL the options for the career that truly interests you first before writing it off. 

As an aside, if you do talk to an Army recruiter beware if they try to lure you into enlistment with promises that you could go to the Army's PA school someday. I see a lot of posts on this forum, and elsewhere from people in that situation, and there is no guaranteed shot at the Army's PA school if you enlist.

[pursuitofPA]

Wow, I just found  this thread. Im an OTR and I start PA school next month. I am very excited about the opportunities ahead in medicine. Its good to know there are other therapists on this journey as well!

[Guest PAhopeful85]

On 12/26/2018 at 7:28 PM, pursuitofPA said:

Wow, I just found  this thread. Im an OTR and I start PA school next month. I am very excited about the opportunities ahead in medicine. Its good to know there are other therapists on this journey as well!

Congratulations!! I’m a PTA and start PA school in August!

[pursuitofPA]

11 hours ago, PAhopeful85 said:

Congratulations!! I’m a PTA and start PA school in August!

Congrats to you as well!

[DPT88]

On 4/10/2018 at 8:55 AM, scott079 said:

Debt to income ratio is awful. Never meet a PT that did not enjoy their job but there is no way higher ed can justify a 2-1 debt to income ratio. The damage to your ability to buy a house, have a kid, go on vaca is massive. running a practice makes you a business owner, manager and provider, please be sure you want to be all three. Its a great field that helps people but I just don't understand why it requires a graduate degree.

A graduate degree is necessary as physical therapist are moving into primary care orthopedics. The US military and several other countries have PT's working with fully autonomy - ordering imaging prescribing medications, etc - due to the fact that therapist are superior to all medical professionals and second to orthopedic surgeons in evaluating musculoskeletal pathology. This is the direction of the APTA and will be the case with time. Diagnostic imaging, orthopedic evaluations, manual therapy (joint manipulation)  are not easy areas to learn in little time, therefore requiring advanced training. PT's are now being employed in the ER to perform ortho evals thereby decreasing unnecessary imaging contributing to cost savings. 

[DPT88]

On 4/10/2018 at 8:55 AM, scott079 said:

Debt to income ratio is awful. Never meet a PT that did not enjoy their job but there is no way higher ed can justify a 2-1 debt to income ratio. The damage to your ability to buy a house, have a kid, go on vaca is massive. running a practice makes you a business owner, manager and provider, please be sure you want to be all three. Its a great field that helps people but I just don't understand why it requires a graduate degree.

Debt: income may not be the best, however there are several income based repayment plans to help students pay back loans at a more feasible rate. You can do extremely well as a PT private practice owner. Just as you had commented, you need to bring your business acumen and really be motivated to run a practice. You can always be employed, make 75k/yr starting, and pick up a couple extra hours on the weekend to make another 7- 12k a year. We all know that the majority of midlevel practitioners work more than 40hrs/week. I would like to see the data on the hours worked vs salary compared with PT. I think that would mix things up a little bit. 

[DPT88]

On 4/10/2018 at 1:03 PM, SirScottric said:

I was an OT before going back to PA school. I worked side by side with dozens of PT whom many are still very good friends of mine. I share the sentiment as stated by the posters above. A big factor for me going back to school was having a master's in OT and making $60,000 after 4 years of experience. I live in Michigan and the PT's starting salary at my hospital system in metro-Detroit are roughly $75,000-$80,000 after taking on $150,000 of student debt from their programs (not including their undergraduate student debt). Some of the new grads I worked with had a collective student debt of $200,000-$250,000. Every new grad PT I worked with is banking on the 10 year loan forgiveness program for working for a non-profit hospital because there is no possible way they could afford a mortgage in metro-Detroit and pay off their student loans. I know a number of PT's who are in their 40's and still paying off their student loans at least 10-15 years later. Overall, I definitely made the right decision for myself by switching from OT to PA. Many of the older OT colleagues I work with say if they were 10 or 20 years younger, they would most definitely do the same thing I did. OT and PT are good careers and can be very rewarding/satisfying. If you really have a passion for PT, go for it. But, if you are concerned with making more money in your career, therapy is NOT the way to go.

Income based repayment is the way to go. I dont see how making 10k more a year is going to make that much of a difference in paying the high cost of loans for all graduate school healthcare professions. More aspiring students need to consider where their passion lies in healthcare. If you want to get involved in medicine, really find various organ systems interesting, and are okay with working with physicians as your career, then go the PA route. If being a musculoskeletal/movement specialist utilizing dry needling and joint manipulation is of interest to you, then go the DPT route. Reimbursement continues to change in PT along with cash based practice taking off. Supply and demand also needs to be of consideration for both professions. I know there is more concern of a surplus with PA's and NP's with years to come when compared to DPT. 

[EMEDPA]

Good points above. I would add that someone interested in orthopedics could consider an ortho PA residency, which might include many of the same skills learned. As a PA you can write RXs, as a PT you can own a practice without a sponsoring physician. There are advantages to both paths. There are a lot of PAs out there who are former athletic trainers or exercise physiologists who end up going into ortho or physical medicine and rehab.