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Episode 5: Becoming a Physical Therapist


Nate Reynolds 0:00

Welcome back to the second part of the interview with Ethan Caulkins. On this episode, we're going to talk about his transition from being a strength coach to being a physical therapy student, Ethan, I'll let you kind of tell us more about your story and kind of why you transition from, you know, the strength and conditioning fields to a PT,

Ethan Calkins 0:19

I was doing strength and conditioning at Susquehanna Valley High School, and you know, coming across a lot of situations where I was working with injured athletes, and I was frequently, you know, reaching out to the physical therapists that work for you HS, I believe I reached out to you a few times about baseball players and other athletes like that, just trying to learn more information about you know, how can I best get this athlete back to the field. And, you know, working with our athletic trainer that was there at the time, you know, we kind of tag teamed the effort of trying to rehab these athletes, but I never felt comfortable truly knowing what I was doing as far as like rehab goes. And, you know, I had always had a strong strong interest in physical therapy. For me, it was one of those goals that I always wanted to go back to physical therapy school, but I love strength and conditioning, like I love, you know, working with the athletes having control over what I was doing on a daily basis, basically being in control of every situation, in the weight room. And at some point, I came to realize that, you know, I wanted more, I wanted to go back and attain that doctorate in physical therapy, and take what I learned with strength and conditioning, and apply that to working as a physical therapist.

Nate Reynolds 1:49

Yeah, I think one of the things that we often forget is that it's a, it's a continuum, with strength and conditioning and physical therapy, you know, you have rehab, then you have wellness, in the fitness, you know, it's kind of like a, like an art, a lot of the strength and conditioning principles apply to physical therapy. And I think that's where sometimes we missed the mark, as physical therapists is that, you know, we're very good at overloading patients, and we don't challenge them or give them enough stimulus. So they meet that therapeutic threshold. And so I think your background as a strength and conditioning coach is only going to help you as a physical therapist, because you can see how to properly strengthen, strengthen someone and progress them appropriately. And so I think that's going to be a huge benefit in your career.

Ethan Calkins 2:34

Yeah, I definitely agree. It's difficult for me when I look at physical therapy clinics that that can claim that they rehab athletes back to their playing ability, but they only have up to 20 pound kettlebell in their facility. And they get a patient in there with an ACL tear, and expect to be able to do a nine month rehab session with just that much weight, I feel like it's an issue because like you said, there's not going to be the chance to properly load that athlete to get them. So if they're ready to step back on the field, when they're done with their rehabilitation. So that's something that I look forward to, hopefully, with this new wave of strength and conditioning and physical therapy, I'm seeing more and more of facilities being able to provide that full spectrum of care to athletes.

Nate Reynolds 3:30

Yeah, I think the the simple way to put it is our goal as a physical therapist is to get the patient is in pain, and then load them up, get them as strong and resilient as possible. So they don't come back to us. If we're only getting out of pain. We're only solving, you know, one part of the problem. And so then my next question for you is, where do you think your background has helped you in PT school so far?

Ethan Calkins 3:52

As far as my background goes, I would say that a lot of the hands on skills, a lot of the skills that I had in one of my classes, so far, examination intervention, where I had to basically go through mock patient situations, getting whether it's, you know, an inpatient setting, getting a patient out of the hospital bed, or we're talking about an outpatient setting, you know, a lot of times you're using assistive devices, you're cueing different things. And I feel like one of my biggest strengths is, you know, that coaching aspect, the cueing walking with a walker or sitting into a chair, you know, really this is we're learning the foundational pieces of information now, but I can still see that carryover from the coaching aspect to the physical therapy aspect. And like, in my opinion, a physical therapist is a coach at the end of the day, like, Yes, just because your patient might not be an athlete doesn't mean that you can't still coach them up and, you know, get them to do The movement properly. And I feel like the better coaching that you do, the better physical therapists that you can be. Do you feel like your coaching has gotten better? Since getting your CrossFit certification?

Nate Reynolds 5:12

Yeah, I think the more that I've dived into the CrossFit community, and really trying to understand that world has improved my ability to analyze movement, you know, I think I can only speak for where I went to school, you know, we learn a lot of theory, you know, we don't get that hands on experience that you had. But it really is depend on your clinical experience. You know, I felt like there wasn't a class where you're just like looking at a squat pattern or listen, looking at a lunge and giving different cues and, and if that doesn't work, try this or try this tactile cue. I feel like that was kind of missing in the curriculum. And I don't think that's just Donnybrook, I think that's across the board, you know, there's so much knowledge that you need to know to be a physical therapist, because it's not just, you're not just learning to be an outpatient physical therapist, in PT school, you're learning to be a general physical therapist, you know, you're learning because you can become like a neuro physical, physical therapist, you can be in acute care, you can be, you know, working in cardiac rehab, there's working in a sniff Yeah, there's just so much variety that you can do, which is one of the perks of being a physical therapist is that if you get burned out, you can go to another part of the field. But I honestly think that, you know, that was one part of schooling that, you know, we didn't have as much understanding on, you know, how to coach, the other part of that could be is, I didn't have that experience coming out of college, you know, I went straight into PT school. So, you know, I felt like I was kind of behind some of my, my peers, because they had just actual experience, and they could pick up things much quicker than I could. So I didn't think it was until after our first clinical experience, where things kind of got caught back up, where everyone was kind of on a, like an even playing field, because it's even just like the simple queuing that you're talking about, where like you're picking up faster than your peers, you know, it's just like, so much just experience in, in understanding how to coach or understand people, the end of the day, like our job is basically it's customer service, teaching people how to move better, teaching them why what we're doing is important, and convincing them what physical therapy can do for their quality of life.

Ethan Calkins 7:22

Yeah, and I really think that that's where PTs and you know, other health professionals can look back to strength and conditioning and, you know, even personal trainers to an extent where it's like, there's so much to learn, you know, going back and forth. To me, it seemed like, just because a PT has a doctorate or a master's level, if they're older, they're seen as like this hierarchy of knowledge. And they know more than a strength and conditioning coach, whereas like, a PT has so much to learn from strength coaches, like it's a, it's a two way street where, you know, information should be passed back and forth between the two. And I feel like, you know, the communication between the two disciplines use much more, or working with athletes and just patients in general. Yeah, and

Nate Reynolds 8:10

I agree, I think a good example is a strength coach that works in like a group setting, they can see a movement fall, and they can correct it in like two words, right? They're like, Alright, do this and that, and then, you know, the movement quality improves, whereas, you know, with physical therapy, like we're, I think we overthink it, and you're like, you know, you get right over next to that person, you put their hand on their back, you know, and you're giving them tactile cues. And you're like, this is why we're doing this this way. And we overcomplicate things. And so sometimes, you know, I think you can learn from a strength coach, and I, you know, that's what I learned when I got my level one is like, you know, you can get people to do what you want them to do, one to two, like short verbal cues, and they're moving better. And it's simple, and they're accomplishing what you want. And, and I think that just kind of goes to show that, you know, sometimes, you know, it's not the athlete or the patient that is failing, like, sometimes the PT, or the strength coach, sometimes is failing because they, they're just not comfortable or confident and the cues they give to it to get them moving like they should.

Ethan Calkins 9:11

Yeah, to go off, overcompensation point of it, like I early on when I was working in the high school setting, I was working with middle schoolers as well. And you know, working with a seventh or eighth grade athlete, a lot of times they don't have the proprioception, the body awareness to be able to do certain movements. So on top of you trying to get them to squat and not have a knee valgus or get them to hinge correctly with you know, proper mechanics. You know, if you're trying to overcomplicate things and explain here's what it should look like this, this, this and this, you know, if you're giving them much more simple cues, they're going to respond much better to that anyway because you know, the the amount of information coming into their nervous system You know, it's an overload, honestly. So just keeping things simple, from that aspect makes a huge difference in the effectiveness as a coach. Yeah, I

Nate Reynolds 10:09

think a good example of that is squatting, like, you know, just saying, like down, not sit back people for years have been saying, like, oh, like, sit back into your squat. And, you know, the first thing they do is they hip hinge and they don't let their news travel a little bit forward. Because we've been kind of ingrained that the knees traveling or the toes is bad. And so like, I feel like an example like that, like you're you're working with, like a young kid, he's just telling, like, sit down while you squat, you know, they're gonna do it, like they send to a chair and their knees are gonna go over their toes, and their hips are gonna go back and they, you know, the hips and knees are gonna break at the same time. And it's gonna be more natural,

Ethan Calkins 10:45

right? Oh, and right, and we talked about the, you know, that knee valgus, sometimes throwing like a band around their knees, giving them that external stimulus will help with those certain situations. And, and that's where I feel like social media is great as far as just getting ideas like different things, because not every cue is going to work with every athlete. So, you know, finding, finding different ways getting creative with cueing different athletes, or patients or whatever it is that you're doing, is always a benefit as a coach or a physical therapist. Yeah,

Nate Reynolds 11:21

I agree with that. So my next question is being in PT, now I kind of understand the whole world of PT, the pros and the cons. Now that you're coming out of the strength and conditioning world, or you've been there for two and a half, three years, you know, what would you say are some of the pros and cons of being a strength and conditioning coach, because obviously, you know, you left to pursue being a PT, but I'm sure there was some things that you liked. And there's some things that you didn't like. So what were some of those?

Ethan Calkins 11:51

Definitely, I think the pros, you know, working with athletes, that's the population that I feel comfortable working with. Generally, I had worked in, you know, shadowed in some previous PT clinics, and, you know, working with just general outpatient clinics, you know, you're working with the general population, a lot of times, the thing that I struggled with was the level of motivation to want to get better to want to achieve goals to want to get out of pain, I just didn't see it. So it's like staying there as a college student shadowing, you know, it didn't motivate me to want to be in that situation like it was almost kind of drag you down. Whereas as soon as I got into the strength and conditioning arena, those athletes, they want to get better they want to perform, they want to see themselves get stronger. So working with that population was definitely a pro. They're easily motivated, getting to see an athlete achieve their goals is awesome to see, like I said, I worked with anywhere from seventh graders to seniors in high school. And then I worked with some clubs, sports teams, adding them to the university and you know, getting somebody who they walk in day one lab see them and they look like Bambi walk in you know, and unsteady on their legs. And then, you know, take charge and really be accountable towards following a program being successful and just figuring out how to use their body and being successful out on the field. And that's a that's a really cool thing to see. See them hit goals, squat weight that they never thought they could squat, bench press, deadlift, anything like that. Really cool to see.

Nate Reynolds 13:34

Yeah, I think that's one thing that's pretty cool is when you can see being there for three years, right? Like, you can see a person that's a freshman, and then by the time they're junior senior, now, they're the ones that are the captain or the top player on the team. And they're actually, you know, before they were a role player, now they're now they're the the ace, let's say on the baseball team, or they're going on to, they want to go out and play in college, and now they've got that scholarship, or they're gonna play in college. And it's kind of cool to be part of that. You know, I was just messaging last night with one of my former patients mom back in Binghamton. She actually found you know, the energy health page. And, you know, I was kind of surprised by that. So I messaged your house like, hey, yeah, like, I really enjoyed working there sound like he was great. You know, he was a baseball player had numbness tingling, heavy arm turned out to be, you know, coming from his neck and his elbow. And, you know, I worked with him and got him back throwing Well, I just found out his mom told me that, like, he's gonna go play on you got a scholarship to go play in Juco being part of that journey is cool, you know,

Ethan Calkins 14:36

Fulfilling for sure.

Nate Reynolds 14:37

Yeah, it's fulfilling any, you don't always get the happy ending that you want. And so just to like, know, that you made a difference is is pretty awesome. And I think being a strength coach, like you probably see that more often than not, whereas in the physical therapy realm, you know, we get people out of pain, but you know, they don't have their later on in life. And so they don't have those goals. They don't have as many goals. They can help accomplish. You know,

Ethan Calkins 15:01

as far as some of the cons, you know, obviously, you're working weird hours, right. So like I said, I worked with some binghampton club sports teams 6am left, so gotta be there up at 430 get there, set up everything like that, just to make sure everything's ready to go and be done with that. And that's it for the morning. And then you know, you're at, I go out to the high school, and I'm there until seven, eight o'clock at night, sometimes if there's a game or something I stick around for, you know, you're not leaving there till nine o'clock. So a lot of times the hours started to stretch you out stretchy, thin, trying to do your Con Ed and everything during the day, getting ready programming, getting things set up, but just that can that can wear you thin really quickly, especially when you're the only person or one of two people at the school through the company that you work for, you know, you're almost on like an island out there, you know, there's not a lot of other interaction other than providing all the service. So and another thing, like I said before, to the level of respect within the healthcare industry, you know, strength and conditioning coaches, and the industry itself has so much to provide, as far as like health care, and everything like that goes as well. You know, good strength and conditioning coach can really do a lot as far as injury, I wouldn't say like injury prevention, because injuries can always happen. But you help mitigating some risk when you're making your athletes more resilient to getting an injury. So I feel like more respect should be put on what job strengthen conditioning coaches do, I looked into college strength and conditioning, when I got done with my time at Penn State, and I really didn't see a huge opportunity to go on and make a career out of being a strength and conditioning coach in college, just because it's it's hard to find, find a place for yourself get compensated for the amount of work that you're putting in there. So I feel like more respect needs to be put on the strength and conditioning coaches, the industry as a whole,

Nate Reynolds 17:13

you bring up a good point where there's not a lot of opportunity to be a college strength and conditioning coach, right? Like, if we're just gonna be throw out a random number, there's my three 400 Division One programs, and if you're going to be at a division one program, try to be like the top strength and conditioning coach. I mean, he went to Penn State, which is how many students 40,000 40,000. Right. And so like, you talked about the kinesiology program, there's probably 3000 kinesiology students, and I'm just ballparking that it could be less than that. But you know, you're all competing for not a lot of spots. You know, it's almost like when people talk about being like a professional quarterback, there's only 32 in the world, the very low percentage of actually making it there. And I'm not saying that, you know, you shouldn't pursue your dreams and go there. But when you add in the fact that you know, you have weird hours, you're not going to, if you want to have a family, majority of your hours are after three to seven, when kids get off the bus. And that's not it's not an ideal situation. And so I think from my experience, you know, we see a lot of athletic trainers and strength coaches that transition to physical therapy, because it's more of a traditional nine to five, definitely a con that people don't realize, while they're in school, and that's one of things that I didn't realize, when I became a physical therapist is, you know, having patience, it's, it's more of a rigid schedule, you know, I thought like, Oh, you could have a patient here and there, and it'd be pretty flexible. But now, like, you know, some issue arises at home, you know, that patients still coming in, you know, you got to figure out how to solve that. But, you know, I think what we do is valuable, and you know, we can make difference in people's lives. And so I definitely think that is, is worth it. If you enjoy it. You're not you're in PT school, you know, what were you kind of looking for in PT school, you know, if you could tell yourself anything, looking back on the process that you wish you kind of knew going in.

Ethan Calkins 19:09

So I was really big into places that were close to home from Pennsylvania. So places that were not too far away places that had a decent tuition rate. Obviously, the cost of tuition we can get into at some point, but the cost of tuition for a doctorate program and physical therapy is astronomical. So trying to mitigate how much debt I would be taking on and then other things like board pass rates, faculty to student ratio, stuff like that were important to me, where as you know, I looked at some schools that had much larger cohorts than the one I'm in the one I'm in has about 45 students. So pretty good faculty to student ratio. And so yeah, I ended up choosing a school that was kind of lower on the tuition level that that's a, that's a huge one. Like I said, I wasn't trying to put myself behind, before I even got started, because I had gotten accepted to a school that was a newer program and had new facilities, new forts, labs, and, you know, cadaver labs, stuff like that. And though it was flashy and nice, the price tag was about $150,000 for all three years of your DPT. So I just knew that realistically. Yeah, it would be incredible experience to go there. But I would be setting myself behind years and years trying to pay that debt off with realistically a very similar education at the end of the day.

Nate Reynolds 20:55

Yeah, I think a lot of people, you can even see it on the message boards and PT, you know, you know, I think there was a post, like a week or two ago, and it had like, over 500 comments, and it said, like, you know, choose the cheaper program. And I think the biggest takeaway is like, you're not going to get reimbursed more for your service, whether you went to, you know, what is the top school, Delaware versus, you know, Shenandoah or Stony Brook, good quality schools? You know, I don't even know how the rankings come about, is it research? Is it based on the past scores, and to kind of go off your financial aspect, I was going to give a PT Career Day talk at my old high school. And I was just looking around for information costs. And I came across this study from 2018. The title of it is called the physiotherapy education is a good financial investment, up to a certain level of student debt and interprofessional economics and you analysis, I think the key word to that statement is up to a certain level of student debt.

Ethan Calkins 21:56


Nate Reynolds 21:58

And it was looking at what they call the net present value, it was just comparing the costs and benefits of an investment such as healthcare education, and or just comparing to other other healthcare fields. So like, if you were, if you're, I don't have decided the number but like, if you're at $7,000, in debt, for PT, school, you are more profitable than occupational therapy, optometry, that being a chiropractor, but you're still less profitable than being at like a dentist, or pharmacist, an NP PA, or being a doctor. And then as soon as above 250,000, you are less profitable than all careers except for being on that and a chiropractor. And then, if you reach $2,000, in debt from PT school, it was they said that you may not achieve the recommended repayment and benchmarks. So like you wouldn't be meeting the criteria of getting back what you invested. And then if your $267,000 in depth, you were no longer more profitable than just having your bachelor's degree. So like, you were actually losing money by becoming a PT, which I was like, Yeah, like, if you're $267,000 in debt, because a PT school, you're only making 60 70,000 coming out, like that's, that's going to take, you know, years, or maybe even generations pay that off, you know, your kids will. Right.

Ethan Calkins 23:27

Right, I think it's a I think it's a conversation that has to be had, you know, it's one that doesn't happen often while we're in school. And I feel like that's a conversation that, you know, everyone here could benefit from, and really trying to get everyone on board to advocate for our profession and try to get salary increases and stuff like that. I know that whether or not you're a 10 year clinician, or a first year coalition, your hours get billed the same amount. So coming out as a new grad, accepting the 60,060 $5,000 salary, you're crazy to do that, if you think that you're going to be able to pay back that debt that you accrue dirt while you're in school, that you have to advocate for yourself, you have to be willing to negotiate and being taught negotiation techniques and stuff like that, too, I think would be very helpful in like a PT curriculum, or even just as, like an elective or something like that, you know, being more business savvy, as a physical therapist, I think could only help since it's become a doctorate degrees from a master's degree.

Nate Reynolds 24:41

Yeah. And I mean, they kind of build off that, like, you know, I had someone telling me that like, oh, like, your OCS doesn't matter because, you know, you're not gonna get reimbursed more. Yeah, but if you're 20 years into the field, and you're not a very good PT, you know, they're still gonna reimburse the same rate as me anyway. So you might as well have better clinical outcomes, what's the difference, you're getting a good quality clinician versus, you know, someone that you know, is putting stem and ultrasound on someone. And so, you know, to kind of flip that topic or someone's like, that's kind of my belief is that, you know, we should be geared more towards working towards quality clinicians. And, you know, I think we'll get reimbursed better if we have deliver better outcomes. And then on the the second part that you were kind of thought that we were kind of talking about earlier is, you know, I feel like there's a lot of courses that we take in undergrad, or in PT school, that really are not that valuable, you know, we're actually kind of wasting our time I was, I was joking before the podcast that I took a dinosaur class in undergrad. And I'm looking back, I'm like, I could have spent that $1,000 on way better things. I have a hard time like swallowing a pill to like, spend your money on an exercise bike. But, you know, that could improve my quality of health in long term fitness. But you know, I'm so glad that I understand that a T rex can stand upright based on how you know, the bow and the femur. And that's why it's not falling on its face when it walks. Those are super important things to know. Yeah, I

Ethan Calkins 26:12

mean, I agree, I took the importance of pets and society my freshman year at college, and I'll tell you what, definitely made me a well rounded student and glad that I spent my tuition money on that, as opposed to, you know, cutting down curriculum and getting the things we need to move on with our lives. Like I understand there are some some benefits to the enrichment of, you know, being well diverse. But like you said, I don't think the T Rexes are going to help you become a better physical therapists. So

Nate Reynolds 26:47

I think one of the things to go off that is, you know, I don't know, the study right off the head right off the top of my head. But I know that I think in 2010, they kind of repealed how much you could take out for grad school like there used to be kept. And like, I think the increase in tuition went from like, 1% per year for like, the last 10 years before that. And now it's up to like 6%. And, you know, my boss, UHF, like he, when he went to SUNY upstate, which is, you know, in the New York State College system, like the, the tuition per credit is the same. And so like, his, his tuition costs was 30,000, going to Stony Brook was 90,000. Like, in 10 years, it tripled. You know, that's like saying, like a house, that's, you know, $100,000 house is now worth 300,000, in 10 years. Like, if you put it in context of other fields, it doesn't make sense. But for some reason, you know, we allow colleges to increase their tuition costs at an unreasonable amount, you know, we can forgive as much student debt as we want. I'm not opposed to it, like, I'll take it, you know, but you know, I think there's a, there's a huge problem, and the root causes, these colleges are just charging an unreasonable amount. And, you know, there's going to be some huge consequences coming down the line.

Ethan Calkins 28:06

Yeah, I agree. And that's where leveraging yourself as a physical therapist, and, you know, maybe not taking the general outpatient job, where you're not going to be reimbursed as much as other or other areas in the field of physical therapy, you know, you have home health, you've got travel therapy, you know, there's cash based physical therapy, where you can open up your own clinic, areas like that, where, you know, you're not seeing a large volume of patients, and, you know, you're able to kind of control the salary a little bit more and, and hopefully make that debt to income ratio, a little bit lower and, and get those loans paid off quicker. There's definitely areas of interest that I've will look into before I graduate.

Nate Reynolds 28:58

Yeah, and I think to kind of summarize our conversation today, going into PT school, it's great to have a background in the field, because it kind of speeds up your learning curve, I think you need to pay attention to the cost of tuition, because that's going to be a huge factor. You know, you don't want those three years in PT school to affect the next 30. And then kind of what we were talking about, you know, I think there's a lot of value in what we do. And, you know, whether you're a strength coach or a physical therapist, you know, you do have value, you know, they really are closely connected, and we need to kind of work together and kind of bridge that gap. There really is kind of a gap right now between rehab and the fitness community. Couldn't agree more. So Ethan, thank you for coming on to the podcast. You know, I'd love to have you back soon where it would be a good place for people to reach out to you on social media or email if they have more questions about being a strength coach or or just checking with you.

Ethan Calkins 29:59

So Probably the easiest place is my Instagram account that I have for strength rehab and performance. It's called rehab x performance and you could shoot me a DM and I'll respond to you very quickly.

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