We had the special privilege of interviewing Dr. Richard Severin regarding his experience with his cardiovascular and pulmonary physical therapy residency. Dr. Severin has gone through two residencies (also an orthopedic residency) and is now completing his PhD., so he certainly has a lot of awesome knowledge to share with us all about cardiovascular and pulmonary physical therapy. Read the interview below:
What made you decide to pursue cardiovascular and pulmonary physical therapy residency training?
By the time I was a second-year PT student, I had already decided that cardiovascular and pulmonary was the area of practice I wanted to specialize in. This was in part due to the influences of a few of my early mentors while I was a student at the University of Miami in Meryl Cohen PT, DPT, CCS, FAPTA; Larry Cahalin PT, PhD, CCS; and Patricia Tedrick PT, DPT, CCS.
Not only were they excellent professors in the courses I took with them, they were also great resources outside of the classroom and really exposed me to this amazing section within our profession. I was also fortunate to be in a DPT program that was both supportive and knowledgeable of PT residencies and the application process; particularly Greg Hartley PT, DPT, GCS who at the time was the chair of the American Board of Physical Therapy Residency & Fellowship Education (ABPTRFE) and a program director of a Geriatrics Residency.
I had also done a fair amount of my own research on cardiovascular and pulmonary residencies and the application process. Therefore when it came time to decide upon and apply to programs, I felt fairly well prepared. Due to these factors and others, I also felt ready to pursue residency training immediately after graduation from PT school. Lastly, it would have also been much more difficult for me to achieve a specialization in cardiovascular and pulmonary in the timeline that I had set for myself and with the experiences and training that I wanted to receive early in my career if I didn’t pursue a residency program.
What residency program are you attending (or did you attend) and why?
I attended the cardiovascular and pulmonary physical therapy residency program at the William S Middleton VA Medical Center/University of Wisconsin-Madison; a VA heart, lung, and liver transplant center. This program provided amazing clinical experiences including a pre and post transplant rehab program, an early mobility program, simulation labs, cardiology grand rounds as well as the management some incredibly medically complex cases which really sharpened my clinical skills. You also can’t beat the experience of working and serving our veterans, which was incredibly humbling and rewarding.
Additionally, since this cardiopulmonary physical therapy residency program was affiliated with the VA Health system and the University of Wisconsin there were also research and teaching opportunities available, both of which I was heavily involved with while I was a resident. The hospital also had great facilities, great mentors, an excellent staff (both PT and other providers) and was located in the great city of Madison, WI. This program had everything I wanted in a cardiopulmonary residency program and everything that I think all cardiopulmonary program should offer residents. It was just a great experience overall.
Can you give an example of your “typical” day in this residency program?
Most days would start with my own case review, a brief meeting with my mentor and then a meeting with the inpatient team. I would start my inpatient caseload in the CCU and then follow up with a mixture of inpatient cardiopulmonary cases on the floors. I would then wrap up my mornings with our outpatient transplant rehab program. In the afternoons and until the end of the day I would have outpatient cardiopulmonary rehabilitation cases.
Depending on the day and portion of the program my schedule would vary. Friday mornings I attended had cath-lab conferences where the teams from cardiology, cardiothoracic surgery, pharmacology, and rehab would meet to discuss interesting or complex patients on the current hospital census. In these sessions, I learned how to read and interpret relevant diagnostic imaging and measures such as heart catheterization with angiograms, echocardiograms (including stress echos), chest radiographs, clinical exercise stress tests and others. During the fall, I served as an instructor for the cardiopulmonary course at the university and every 2 weeks I lead a discussion session that I designed for the course.
Every few weeks I would have a simulation lab experience where my mentor would evaluate my clinical examination, imaging interpretation, differential diagnosis, and reasoning skills in real time. In the first 2 months of the program, I would also have supervised patient examinations where my mentor would observe my skills with live patients. On Sundays, I spent time working in a research lab for a sleep apnea study.
A resident’s schedule is always busy, it’s part of the process. It wouldn’t be uncommon to put in at least 50-60hrs a week between the clinic, studying, reading, research and occasionally teaching. It was certainly stressful and chaotic at times and I was also the first resident to go through my program. However, to make progress, some stress is needed and the threshold has to be pushed a bit. It certainly helped me immensely. Fortunately, I had also mentors who were very receptive to my feedback and modified experiences and curriculum programming to best fit my needs as a resident.
What was your typical case load in the program?
Within the first month of my program, I was at a full caseload, which was a mixture of both inpatient and outpatient cases. I felt comfortable with this caseload due experiences I had during clinical rotations and the 2 years I spent as an inpatient PT tech during PT school. However, if I didn’t have some of those experiences or if my mentors didn’t feel I was ready they would have adjusted this as necessary.
How much does the program cost? (i.e. reduced salary or full salary but paying tuition)?
There was no tuition cost to my program. VA residents for all health professions receive approximately the same salary and full federal employee perks and benefits (which are really good). I wasn’t making the same salary as non-resident full-time PT but it was more than enough to live fairly comfortably. I was also able to have some conference registration costs and travel covered, with departmental approval.
What opportunities have you or will you seek out after finishing the residency program?
Following my cardiopulmonary residency, I enrolled in orthopedic residency with the goal of integrating cardiovascular risk assessment into orthopedic practice and eventually pursuing a PhD. Currently, I am a 2nd year PhD student with a focus on cardiovascular and respiratory physiology.
Cardiovascular risk assessment in orthopedic practice has now become quite a passion of mine and many would consider me an emerging leader in this area. I have led a session on this topic at CSM 2016, I have been invited to teach my cardiovascular risk assessment course to several different locations and am currently in the process of developing a few more exciting projects for this topic.
Due to my teaching experience a resident and my specialist training, I have been offered many opportunities to teach in DPT programs. Currently, I am the course director the cardiopulmonary course for two different DPT programs and I serve as an adjunct for a few other courses, which has been awesome. I love teaching, the course has been well received and I have amazing students.
These are just a few of some of the amazing opportunities I’ve been fortunate to receive following my training. There are many others which I am incredibly thankful for. Certainly, the orthopedic residency helped but there is no way I would have received some of these amazing opportunities without doing a cardiopulmonary residency.
What have you gained from attending the program (knowledge, skills, etc…) that you may not have gained otherwise?
Like most residency programs, I was fast-tracked into clinical expertise in my area of practice. Unlike other areas of our profession, the opportunities to practice in cardiopulmonary are limited, especially outpatient rehab. It would have been quite difficult for me to find facilities with similar clinical experience and exposure to this patient population had I not done a cardiopulmonary residency. More specifically, my program had a strong emphasis on transplant rehab, which is a fascinating area of practice which few ever get to experience.
I also felt my skills and ability as a direct access provider improved considerably from my cardiopulmonary residency program. A large portion of my training focused on differential diagnosis, clinical reasoning and managing complex cases in a setting with more autonomy than most PTs practice under. I also received an ACLS certification and advanced training with diagnostic imaging. Following graduation, I felt incredibly confident in my ability to make the right clinical decision or referral irrespective of the setting or area of practice.
What advice do you have for students that wish to pursue a residency after graduation?
If you’re ready to pursue a residency after graduation, there is no reason to wait. I honestly think the best time to pursue residency training is immediately after graduation from PT school. I also feel that it becomes more difficult to be mentored the further along you are in your career. The timing may vary for each person; some people might not be ready to pursue a residency as a new grad for whatever reason; which is completely fine. However, I don’t think it’s ideal to wait any longer than 3 years after graduation. After that point in time, I feel that many clinicians become much less malleable which makes it more difficult to be mentored. The key point is to do some research in order to find the right program that will fit your needs and allow you to reach your professional goals.
Is there anything else you would like to share?
It is important to develop professional goals; short-term, long-term and lifetime etc. It’s also important to have a reason for those goals. By that I mean, make sure your goals are relevant, realistic and that you’ve taken the time to reflect on them. They shouldn’t be arbitrary or belong to anyone else, they should be meaningful and specific to yourself. Develop a plan to achieve those goals which
Develop a plan to achieve those goals which will require some groundwork and research. Once those items have been developed, then you have to execute and take actionable steps towards progress. There will be moments in your career and life where the plan may need to be revised but as long as you remain focused on your goals and make incremental progress, even if it’s a little, you’re going to have success and a fulfilling career. Persistence, passion, pragmatism, and patience are key foundations to professional success.