“Do you miss being a physical therapist?” It’s a question I’m frequently asked, and my response is always the same. That little voice in my head starts taking on a slightly exasperated tone. Last time I checked, I am still licensed as a physical therapist in a couple of states and still consider myself a PT, working in a subspecialty of a subspecialty. I have also come to realize that some people think that if you specialize too much, you are not really in a subspecialty of a subspecialty, but have rather wandered into a different field entirely. However, that is a debate for another day.
Most of the time, what the person asking the question really means is, “Since you practice surgical neurophysiology, do you miss doing typical PT work?” The answer to this question is not straightforward, so I will preface it by providing a bit more information about my background.
I graduated from Creighton University with a Doctor of Physical Therapy degree in 2001. One of the last classes I took was in clinical electrophysiology.
For those of you who are not familiar, clinical electrophysiologists are the practitioners that place very long needles into patients’ muscles to see what kind of electrical activity is taking place in the middle of the muscle. If that isn’t creepy enough, they also place metal prongs on the patient’s skin and shock the nerves to see how fast electrical impulses are conducted. Naturally, being the “physical terrorist” (a name coined for me during my clinical practice), I thought that was what I wanted to do for the rest of my life.
As a physical therapist, I was fortunate enough to have many diverse practice experiences that brought me many deep friendships, intellectual stimulation, and clinical satisfaction. Over the years, I was able to work in varied practice settings where I had the opportunity to enter a variety of PT subspecialties. It was challenging, fulfilling, and fun to help a heart transplant patient walk the day after their surgery. The respiratory therapist would be on one side, “bagging” the patients to help them breathe. A nurse would be on the other side, pulling the IV pole along. Myriad lines and tubes would be everywhere, keeping the patient alive.
I’ve had the pleasure of being there for people when strokes, traumatic spinal cord injuries, and major traumatic accidents changed their lives in an instant. I’ve taught people how to sit in, transfer to, and operate their wheelchairs, but one of the most rewarding things for me was teaching them how to walk again.
The most moving experience that I ever encountered occurred when a former patient invited me to dine with him and his family at a golf course country club. When I walked in to join him, he immediately stood up at our table, and I’ll remember that moment for eternity. In a loud, emotional voice that garnered the attention of all of his friends and acquaintances, he introduced me by name and declared, “This is my physical therapist; he is the one that taught me how to walk again!”
So, how does someone who received so much personal satisfaction as a PT wind up working as a surgical neurophysiologist in an operating room? Many people don’t realize what a physical toll being an acute care or rehabilitation PT has on your body. On more than one occasion, people would lose their balance while walking or go limp while I helped them move from a bed to a chair. I caught and carried a few too many others, and I detached the biceps tendons on both my arms within three weeks of each other. It was the wake-up call that I needed to get serious about following my passion for clinical electrophysiology.
Following my PT school graduation, I became acquainted with Dr. Richard Nielsen, a legend in the physical therapy field, who also does clinical electrophysiology. Dr. Nielsen went on to found and became the President of Rocky Mountain University of Health Professions. Even before the University came into existence, I shadowed Dr. Nielsen and took several of his clinical electrophysiology classes.
At that time, he hadn’t yet rolled out the residency program that I would later use as my gateway into clinical electrophysiology. However, while I was recovering from the bicep surgery that would change my professional trajectory, serendipity struck. Nanette Sturgill, manager of the Intraoperative Neurophysiological Monitoring (IONM) program at Primary Children’s Hospital, reached out to Dr. Nielsen to see if he knew of anyone who could run the program. He connected us, and I was able to begin learning pediatric surgical neurophysiology.
My new position at Primary Children’s Hospital was like a dream come true. Half of the time, I was able to work in the OR with some amazing surgeons like Dr. John Smith, who is considered one of the top 20 pediatric orthopedic surgeons in the US. I spent the other half of my time in the clinic, working with babies who were under a year old. It was perfect for me as my patients didn’t weigh very much, and my shoulders weren’t strained as I raised them. As time went on, my surgical responsibilities increased until I was working full-time in the OR.
I worked in myriad leadership roles for seven years until I happened upon my true dream job at Neuro Alert, where we work with surgeons to test and monitor patients’ nervous systems during complex surgeries. We speak for patients who can’t speak for themselves and ensure they leave the operating room safely. I was thankful for the path I had been on before, but I’m eternally grateful for the outcome. My time at Neuro Alert has brought me an amazing sense of fulfillment and incredible opportunities.
My first role was to oversee the surgical neurophysiology services and, since then, my duties have continued to expand. I am currently Neuro Alert’s Director of Clinical Program Development, and on a day-to-day basis, I still put my traditional PT clinical skills to use. I evaluate patients preoperatively and postoperatively. Before surgery, I get a clinical picture of what to expect during the surgery. After surgery, I check for any changes that may have happened to the nervous system during the procedure.
The answer to the original overarching question is: No, I don’t really miss being a physical therapist because I still think of myself as being one, albeit a little incognito. Do I miss the personal satisfaction of using my skills to help people recover from injuries? Sometimes. However, there is a different but powerful satisfaction that comes from protecting patients in the OR. Working in IONM, I get to be there for patients when they need it most (when they are under anesthesia and can’t speak for themselves). Without me or someone like me working with the surgeon and surgical team, there would have been many more catastrophic outcomes. And knowing my role in preventing those catastrophes brings tremendous joy to my heart.
My advice for PTs looking for a new challenge would be to learn about IONM and shadow a few cases to see if it is a good fit for you. Currently, it is much easier for a physical therapist to enter the field of surgical neurophysiology. There are excellent education programs like Center for Electroneurodiagnostics (CEN), which offers hands-on training in the OR. These initiatives provide opportunities that didn’t exist even just a few years ago. For PTs that don’t want to give up on their traditional clinical practice, remember, it doesn’t have to be an all or none proposition. PTs have the option of working part-time in the clinic and part-time in the OR.
However, this advice is not just limited to PTs.The IONM field has an unusual mix of clinicians from across the medical spectrum. Neurologists and other MDs from many specialties, audiologists, chiropractors, and many other degreed individuals in healthcare have come together to provide the rich foundation that we see in the field today. If you find yourself needing a new change of challenge, please feel free to reach out to me. I would love to share the meaning I’ve found in IONM, and discuss the amazing opportunities that are open to anyone who has an interest.
Director of Clinical Program Development