Written by: Mirella Deisher, OTD, MS, OTR/L, CHT
Virtual Hand to Shoulder Institute, LLC
Founder & Faculty
Since I started the Virtual Hand to Shoulder Fellowship earlier this year, two hand fellows in the first cohort, that were working in pediatrics, have obtained positions working in hand therapy. Preparing the fellows for this transition began just a couple months into the fellowship with revising their curriculum vitae, followed by discussions related to:
Determining the environment that’s the right fit
Preparing for job interviews
Overcoming apprehensions
The use of remote mentoring via the Virtual Hand to Shoulder Fellowship
I am extremely confident in the Virtual Hand to Shoulder Fellows because I know the level of commitment they’ve made, both to achieving their goal of transitioning to hand therapy and to ultimately obtaining the CHT credential. Individuals participating in the fellowship are entering a process of obtaining the higher order knowledge needed to effectively practice within the specialty of upper extremity and hand rehabilitation. Throughout the year long Virtual Hand to Shoulder Fellowship they are being exposed to knowledge to effectively make sound clinical decisions. They understand the rationale behind the use of various therapeutic techniques, and they understand the scientific basis for the protocols they will follow.
Everyone that participates in the fellowship is driven by a strong desire to excel as a hand therapist, so that they can provide the best care possible to their patients. They want to do more than just follow protocols. They want to be fully engaged with a process that’s unique to each patient and be able to make needed adjustments to ensure patients achieve their best outcome. I know this because in order to make the commitment they are making and to believe in the process of this fellowship, they must feel this way.
However, despite how committed they are to develop their knowledge and skill set, I do find a commonality among clinicians seeking to transition into hand therapy.
They have so many questions!
So, with the input of current Virtual Hand to Shoulder Fellows, I created a list of the top questions they have had with the hopes it can offer someone guidance and encouragement to push hard towards their goal.
What are the different settings I could work in as a hand therapist?
While not an exhaustive list, these are the most common settings for a primary caseload of orthopedic upper extremity and hand therapy population:
Hospital based orthopedic groups with associated outpatient clinics
Privately owned orthopedic groups with onsite therapy clinics
Private orthopedic therapy practices
Rehab centers with outpatient clinics
Teletherapy within the specialty of upper extremity and hand therapy
What should I look for in my first setting?
You should take any opportunity you can get! It’s hard to find a job in hand therapy without training or work experience. You should apply everywhere, even if you’re hesitant about whether you have the skills to do the job. Just get your foot in the door so you can ask questions. There are reputable hand centers that look for applicants that demonstrate a passion and commitment to the specialty of upper extremity and hand therapy. They want to mentor you so that your practice skills will be up to their standards. Let them teach you so you can be among the best!
Will I get mentored?
In the situation I described above…yes. However, you can’t go in expecting that.
Remember, they are hiring you, so the most important impression to leave them with is how you can ultimately add value to them, and you DO have value to add! Come prepared to the interview to speak to that!
A current Virtual Hand to Shoulder Fellow who recently transitioned to working in a hand therapy setting, is a great example. Her previous experience in neuro-rehab gave her sound knowledge and experience in working with the shoulder, upper extremity, and hand from a different perspective. She also provided consult and mentorship in the department for stroke and TBI patients, which puts her in a position to educate and mentor her new colleagues, and add value to their clinical skill set. Similarly, clinicians with pediatric experience can offer unique experience and strategies for working with kids who may have challenging behaviors or developmental needs. Clinicians from a mental health background may have strategies for dealing with psychosocial or cognitive behavioral components that play a role in any rehab setting.
Bottom line, you DO have something to offer a hand therapy setting if you’re making a transition from another setting. Couple this with a demonstrated passion and commitment to develop your knowledge and skills in upper extremity and hand rehabilitation as evidenced in your CV (continuing education, fellowships, post graduate certificates programs…), and your potential employer will see the value you can add to their organization.
Make it evident to your potential employer that you would be a good investment for them. They ultimately want the best clinicians, clinicians that will grow their practice through excellence.
In the process of interviewing, look around and talk to therapists that work there. Ask them if they do journal reviews or have clinical education meetings; do they take students, and so forth. You should get a sense of the culture there, and whether there’s a high value on education, staying current with best practice, as well as whether the mentorship component would be left up to you.
If you find yourself with a good job opportunity and a lack of mentorship, however, you can easily fill that gap. The Virtual Hand to Shoulder Fellowship is designed to fill the knowledge gap that exists for clinicians trained as generalists, which is the intended purpose of our entry-level degrees.
What’s a typical day like?
Busy, but so interesting and engaging on every level! You never reach a point where you feel like you know it all; practice never feels rote. If it does, you’re not doing it right.
In the beginning you naturally have much to learn, but each patient offers a needed learning opportunity. The more you invest in learning and practice, the more rewarding your experience will be because you will see your patients benefit from your efforts and commitment to best practice.
Pay expectations?
Truthfully, my first inclination is to respond to this question by asking, “Does it really matter?!”
How badly do you want to be a hand therapist? I know pay does matter, but get the skills to demonstrate your worth first. Once you have the skills and ultimately your CHT credential, you will have the opportunity to command a higher salary. If salary is a driving factor for you, then consider an ultimate goal of management and leadership positions.
What to ask in an interview to ensure it's a good fit between your skills and their expectations?
Try to avoid too many questions that ask what your employer can do for you, and lean towards questions that ask, “how can I best meet your needs?”.
Of course, you want to learn about benefits, and ensure its an environment having high standards that will allow you to develop professionally, but ultimately you want to leave that interview with them feeling you will add value to their organization.
Things you may want to ask are:
Are there productivity benchmarks you would like me to meet?
What are my responsibilities outside of providing therapy services?
Do I schedule my own patients?
Do I obtain insurance authorizations?
Are there regular staff meetings?
Are there supports for continuing education?
How is performance evaluated? (i.e. annual review, patient satisfaction surveys)
What types of growth opportunities are there?
Additional skills /certifications to focus on to increase your value as a hand therapist?
Joint mobilizations, orthotics, and modalities would probably offer you the greatest value at the start of your entry into hand therapy practice, but that’s with the assumption that you already know your anatomy, and understand biomechanics, kinesiology, pathologies and pathomechanics.
You don’t have to start your hand therapy career functioning only as a technician that knows how to apply modalities, tapes, casts, orthotics, and so forth. Grow these technical skills on a solid foundation through comprehensive, higher-order knowledge within this specialty area. Whether it’s a graduate level certificate program in upper quarter and hand therapy, or a fellowship program that includes a strong didactic curriculum; growing these skills on solid footing can make all the difference in feeling you’re on a career launchpad or just trying to keep your head above water.
