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I Burned Out on Outpatient Ortho Physical Therapy. But I’m a Stronger Person Because of it.

My journey into outpatient ortho physical therapy started when I was 16 years old. There I was, sitting on the doctor’s exam table. I was feeling destined for another 4 weeks in “the boot,” due to a cross-country running injury.

My doctor came back into the room and reported back to my mother and me, “Well, Sara, based on your bone scan, your foot stress fracture looks healed…” (internal angels singing) “…But, I’m sorry to tell you, you are going to need knee surgery.” (Enter complete and utter shock).

“Knee surgery?!” I repeated.

Of course, at this point I was only in high school, and knew little professionally about the human body, but my common sense sirens were wailing off the charts, and I was thinking:

  1. My knee was not even hurting
  2. I had CIF cross country championships approaching and was #1 runner on my team at that time
  3. Was the doctor even in the right room?!

I felt dumbfounded, confused and pressured into making a decision towards knee surgery without even knowing the cause or, worse yet, the recovery time.

I was given a formal diagnosis of Osteo Condritis Dessicans (OCD). There had been a congenital lesion in the cartilage of my knee that needed to be removed before it finally did become a mechanical problem.

At the time, all I knew was that I wanted to keep running.

At 16 years old, I felt like time out for 2 months was like the end of my athletic career, the end of my reputation, and, realistically (enter high-pitched teenage freak-out voice), the END OF MY LIFE! After 20 minutes of questioning, I gave into the recommendation and waved my white flag of surrender, as my mom rubbed my back to comfort me.

I was going to have surgery.

After the operation, I walked into my post-op physical therapy clinic, which specialized in treating children, and met the therapist who would show me what a physical therapist does (and introduce me to the career with which I would soon fall in love). I learned a lot about the body, my body, and felt that was such a valuable investment of time and learning.

I realized this roadblock of knee surgery had become a challenge of character but a potential catalyst into the next chapter in my life.

Flash-forward a year and it was like I was eating those roadblocks for breakfast – I was an accomplishment machine.

My list of accolades was extensively growing to the point they almost became addictive.

  • High school AP classes
  • Early acceptance into San Diego State University at 17 years old
  • Div. I collegiate cross country/ track at SDSU
  • Admission into University of St. Augustine’s physical therapy doctorate program at 21 years old
  • Postdoctoral three-time Ironman athlete.

I had found a career in physical therapy that was 100% me and made me feel alive.

Friends would often comment on my endeavors as no less than testing the lengths of the human spirit, while I often remember myself saying, “No injury is bad enough that it can’t be fixed in the clinic on Monday!”

Progression through my entry-level PT life was fast, and it was focused.

I had been blessed to find an outpatient clinic that reflected my values and interests, and I thrived in the environment for 5 years.

But, there I stood 7 years after PT school, accustomed to working until 7:30pm on weeknights with stringent documentation/ productivity requirements and dedicating weekend time to clinic community events, that I would find myself at another roadblock.

Although my $100,000 student loans were paid off via also undertaking a per diem job on weekends, I found myself focusing more on operation efficiency and productivity, rather than learning and growing (with the end goal of getting the financial monkey off my back). My work was becoming routine and I knew I needed change.

I needed BIG change.

I was well-studied and athletically endowed, but felt emptiness that the lack in my work/life balance had only allowed me to partially reach my life goals. I just turned 31 years old, and I was learning the true power of introspection and its sometimes-ugly face roaring back, “Think about your future, lady!”

It was time to re-visit WHO I was and re-establish WHY I had been doing what I was doing with my career. The next decision I made would likely alter my life forever. I needed to leave that outpatient clinic.

With that aha moment, a light bulb went off that made me realize I had not made extensive ground on building a quality relationship with a partner, a future family or a future home. My short-term goals were being met, but there wasn’t a realistic link from them to my long-term goals in the way I envisioned them. I was in an outpatient setting where professional growth was usually self-driven, and opportunities for growth from a hierarchical standpoint within the company were slim, considering there had been a good following of managers keeping their positions long-term.

I had realized that this must have been a ‘well, that’s life moment,’ where the hardest decisions come with the most self-analysis and steadfast trust that the future can hold dreams not even dreamt. I had gained so much at the company I was with, but it was just time to move on in this stage in my career.

My physical therapy career was starting to feel like a game of Chutes and Ladders.

Although working in this outpatient ortho physical therapy clinic was the most meaningful, education-dense experience thus far in my life, it was likely not the ladder that was going to get me to the top of my game. I learned so many valuable lessons about clinical practice, marketing, interpersonal skills among teammates and working with the public that I will be forever grateful. I cherish those experiences and use them to propel me into the future version of what I call “Sara Unstoppable.”

I did struggle with finding the strength and courage to move forward, because I was crippled with several thought patterns:

  • Fear of what others would think. I had built good relationships and knew I had valuable skills to contribute to my team, but I was insecure of what hit my reputation would take.
  • Shame of being unemployed without a plan. My support team was the very team I was leaving. My friends at work were around me even more than my own family. I felt defiant, financially irresponsible and lost without a plan.
  • Feeling too busy for change. I had a new 4 month old niece; my parents and grandparents were aging with rising health concerns; I was training for my 1st ultra marathon; I wanted to finally take the CSCS and MTC tests, which cost money I didn’t have.

I took these same struggles and re-worded them to remove their negative power and give me positive energy:

  • I stared FEAR straight in the eyes. Since my relationships at work were genuine, I knew I could rely on those who looked out for my best interest even through an employment change would ensue.
  • I sat with myself and knew I was a CONFIDENT person and had nothing to be shameful about. I realized my family was my most important support team and those ties have become stronger.
  • I was too Busy NOT to change. I now help care for my 4 month old niece once-a-week; I see ‘average’ as acceptable while training for 1st ultra marathon; I turned ‘wanting and worrying’ about taking certifications exams into actually paying and signing up for them to allow me to focus on their completion.

After rediscovering and redefining myself, I felt a sense of relief.

I was becoming more me and less what the clinic, and all the patient expectations, were driving me to be.

I was no longer surviving for the sake of an award in resilience, but for the sake of making healthier decisions. Decisions that would fuel my future.

I have been able to move from setting to setting in patient care by holding true to my value of loving the evolution of mankind and helping people. I am currently working per diem in an acute care setting, but also keeping my options wide open for unique employment opportunities that reflect my values and reflect my need for personal space. My free time is being used to work on my relationships, spend time with my family, and overall reignite my passion for patient care.

I want the same for you.

Here are a couple tips on how to fine-tune yourself as a practitioner, to help find a sense of peace:


  • Stop being perfect and start being authentic.
  • Constantly re-assess and recalibrate yourself and your position, just like we do with our patients.
  • Let creativity drive what gives you true joy in your work to find what makes you click.
  • Ask an old friend or family member to speak candidly about your career move.
  • Do a values assessment to understand what truly makes you tick as a clinician. Use the results of this values assessment to look for jobs that will reflect these values.

REDEFINE Yourself.

  • Know what makes you click as a practitioner and as a person. Is it intimate co-worker friendships? Is it engagement in community events? Is it having your name displayed on the front windows of the clinic practice? This will allow your work to feel less like work and feel more aligned with your own values.

What I learned from this is that there is no rush to find the perfect job, just to please others or fit a certain mold that is expected of an orthopedic physical therapists. I need to find the right job for what I want out of life. And I’m OK with that being a living, breathing process. I’m enjoying the path as I find out what that is.

Along my path, I spoke at length with the team at www.covalentcareers.com. They were the first staffing company who truly worked to understand what makes me tick as a human, rather than seeing me as a warm body to fill a slot at a company. And a friend of mine from www.NewGradPhysicalTherapy.com encouraged me to write my story down, as a way to reflect on how far I’ve come professionally. So that’s what I’ve done. I hope you have enjoyed my story!

There are many more lives to help out there in the context of my next career chapter…this is just another roadblock I will have to hurdle, pole-vault or cartwheel over in the sport I call Life.

About Sara Cates

Sara Cates
Sara is a licensed physical therapist and a nationally certified massage therapist/ holistic health practitioner who has been practicing physical therapy since 2010. She received her doctoral degree from USA (San Diego) with undergraduate education at SDSU (San Diego) where she competed Track & Field/ Cross Country. Sara’s experience is extensive in outpatient sports medicine setting emphasizing biomechanics. She also is versed in pediatric and acute care. She is a certified Graston Technique provider and certified Clinical Instructor with a real passion for teaching. Sara is native to Carlsbad, CA and enjoys training for endurance sports such as triathlon and running. Her varied experiences in the practice of physical therapy has helped her develop a unique combination of manual skills with a holistic approach of treating the mind, body, and spirit of her patients and athletes. “The most gratifying part about my job is helping someone find inner strength and commitment to themself to overcome injury or attain a personal goal.”


  1. Did you stay in outpatient?

  2. Sara Cates

    Thanks for the comment Drew. . . I switched to inpatient and am enjoying still “helping people” on a daily basis with my PT skills but there is a breath of different air in not being strapped down by the emotional outpatient clinician/patient relationships. I don’t really go home with my work. It’s a great professional challenge too to think “if there was only ONE thing I could give you to help, what would it be? 😉

  3. What do you do for health insurance on a per diem schedule?

    • Sara Cates

      Thanks for the question Lora! I applied and receive insurance through Covered California and it’s rated based on your income so the higher the income the higher the monthly premium. I have no pre-existing disease/ ongoing health needs beside routine care which helped. I am not choosing per diem as a long term option for full time work and this has worked for interim need!

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