Interview with Nikki Huffman: Sports PT, Residency and the SCS

I just want to thank everyone who participated in the survey I sent out on social media.  Over 35 people participated in the survey to help form today’s questions for our guest.

Here are just a couple of statistics from the survey:

  • ~ 50/50 male to female ratio
  • 5 participants are certified athletic trainers
  • 11 participants are certified strength and conditioning specialists
  • Roughly equal distribution of year in schooling ranging from a first year physical therapy student to the new graduate.
  • 62% of participants were interested in pursuing the OCS specialization and 97% of participants were interested in the SCS specialization
  • 86% of participants were interested in attending a residency

The topic for discsussion today will be on Sports Physical Therapy, The SCS exam and Sports Residencies.  Most of the questions came from the survey and some that I came up with.  We will be guided by Nikki Huffman, PT, DPT, SCS, ATC, LAT.  She is an Athletic Trainer and Board Certified Sports Physical Therapist at Duke University.

So Nikki, could you tell us a little about yourself? 

My name is Nikki Huffman. I am a PT/ATC currently with Duke Athletics/Duke Sports Medicine. I am from a small town in NC, part of a big family where I learned first how to be a teammate. I played many sports but focused on basketball. The first athletic training I ever experienced was helping my dad reduce his patella dislocation in a backyard basketball game….I was hooked!  I attended Averett University (VA) for undergrad where I obtained my B.S in athletic training and played 4 years of basketball. It was here that I was under the mentorship of Gray Cook and Lee Burton of Functional Movement Systems who were my professors. I then went on to the University of St Augustine (FL) where (in my humble opinion) I received the best manual training in the country and my DPT. Following this, I worked 1 year at Atlanta Falcons Physical Therapy Centers before I realized that I needed mentorship. I missed the college athletics environment. I wanted more than orthopedics. I needed to get better. I applied to Duke’s Sports Residency program and was selected for the 2013-14 spot. I then went on to complete the Duke Division I Sports Fellowship, which is currently the only one in the country credentialed by APTA. I cannot express what these programs have done for my knowledge base, my network, and my career.

What got you into athletic training? Physical Therapy? Sports Physical Therapy?

I shadowed my high school athletic trainer and decided that this was something I wanted to do. Most of the schools that recruited me for basketball would not allow me to be in an athletic training program due to the time commitment until I found Averett University, whose athletic training program boasted NFL internships and a small class size, clinching lots of mentorship. After getting my degree, my mentors pushed me to consider PT and PA school. I knew it was physical therapy for me. I wanted to stay in the training room, but increase my knowledge base. After PT school, working in a clinic environment with sports clients was good practice, but not for me. I needed to run around, get my hands dirty, participate in a fast paced environment. I wanted to help build injury prevention and strength and conditioning programs and be a part of an interdisciplinary team. I wanted to be on the sidelines, put in the work as part of something bigger than myself.

What is the difference between a residency and a fellowship?

“A clinical residency is designed to substantially advance a resident’s expertise in examination, evaluation, diagnosis, prognosis, intervention, and management of patients in a defined area of clinical practice (specialty). This focus may also include community service, patient education, research, and supervision of other health care providers (professional and paraprofessional). Often, the residency experience prepares an individual to become a board-certified clinical specialist.

A fellowship is designed for the graduate of a residency or board-certified therapist to focus on a subspecialty area of clinical practice, education, or research.”

Think of PT as shoes, a residency as Nikes, and a fellowship as Nike Flyknits. Maybe you are more interested in Nikes (sports PT) then high heels or Adidas (rest of PT world). Then the flyknits would be a sub specialty of the Nike shoe. A residency can be entry level right out of school or for someone who has work experience. The resident enters the program trying to gain experience working in the sports world, learn ATC skills, appreciate the schedule as a sports PT, learn biomechanical demands of different sports, gain volume covering sports events and acute injuries. All areas of the speciality practice guidelines will be covered in the program. A fellowship requires more experience ( and often a board certification) to start the program (generally minimum two years) as the fellow is expected to perform at a high level, contribute to research, manage a caseload of high level patients, basically complete the highest level of training in our field. The medical model is another good way to look at it. A medical doctor finishes med school, then does an orthopedic residency where he learns to operate on total joints, sports injuries, exposure to foot/ankle, wrist and hand, all things orthopedic. Then they complete a fellowship in shoulder maybe, or even sports, or hip. It is a very specialized program.

What’s the difference between the OCS vs SCS credential?

The OCS covers all things orthopedic with sections on spine, TMJ, etc. The SCS has components of athletic training, sports physicals, equipment, demands on an athlete specifically.

“What recommendations would you have for someone who is torn between OCS and SCS? Which would you pursue first if you were planning on sitting for both certification exams?”

I would first ask what are the long term goals of this person. Often a PT who does not have an ATC and wants to work in collegiate or pro sports will need an SCS to show that they are competent in these areas working with athletes. I have however spoken to different organizations both in collegiate and professional world, some desiring one over the other. I will say I have seen the SCS required more times than not, however having both is a plus. If you are not an ATC I would say go for the SCS first. If you are an ATC, then going for the OCS may demonstrate that you have a good knowledge of spine and general ortho, which is a benefit as well.

“What are some of the pros and cons to attending the residencies for specialization vs having work experience in the area to qualify for sitting for the exam?”

Experience is always a great thing! However, focused experience is worth much more. Quality over quantity if you well. My mentors and those who have been through our programs at Duke equate our residency worth 3 years of experience and our fellowship worth 3-5. Having gone through both, I completely agree. It’s about becoming an expert over a veteran. If you have the privilege of finding a great place to work after school with excellent mentorship where you can grow, you may accomplish this without residency or fellowship. However, with these programs it is almost guaranteed.

“Is a specialization really worth it? Does it help you get a specific job, increase pay, etc?”

If you needed surgery on your face….would you choose a general surgeon or a plastic surgeon? That’s generally how I see it in my head. A specialist is the very best at what they do. High level programs want the best working with their populations. Pay will be different all across the board, however the more skills/board cert/extras that you can show, it makes you more competitive and you can negotiate your salary based on facts, not your opinion of yourself. Specialization doesn’t mean you’ve “made it”, it means you are at the starting line with a direction.

What are the differences between Sports Residency Programs and how do I chose the right one for me?

Every residency program is different. You should choose a program based on your goals. Do you want to get into research? Gain ATC experience? Interested in working with throwers? etc, etc. I would encourage you to go to the link below and check out all programs. https://www.apta.org/uploadedFiles/APTAorg/Careers_and_Education/Career_Development/Residency_Fellowship/ResidencyFellowshipProgramsMap.pdf  You can then filter based on if you want residency/fellowship, sports, look at specific areas of the country and narrow down your search. I would then suggest calling/emailing those program directors/past residents and gaining info on their programs. Please go on the websites first and find everything you can. I can not tell you how many emails I have gotten requesting information about Duke that is already on our website. It does not come across very well, as it shows that you have not done your own homework and are expecting information spoon fed to you. Program directors and residents/fellows are crazy busy. Be respectful of their time and allow them to best help you by having specific questions and an efficient interview process.

When is the best time to go for a residency? Would it be beneficial to apply to one right after school?

It is based on your needs and wants. It is never too early or too late. If you are right out of school and know you want to gain more experience in a specific area, go for it! Many residents are newly graduated PTs. Also, if you are burnt out with physical therapy, have decreased job satisfaction, feel frustrated with your current skill set, aren’t meeting your life goals, I would encourage you to re-evaluate where you want to be and consider if a residency will help get you there. Knowledge is power!

What are the time commitments for a residency?  What is the pay like?

Ohhhhhhh this question….ha! Expect to work 12 hours a day and if you don’t it will be a nice surprise! It seems excessive, but if you are considering working in the sports world, this is how the schedules work. Long days, but many tasks so the time is not all spent in one place. In addition, know that your time spent is an investment. You are growing, and growing takes putting lots of time and effort in to get a large gain in a small period of time. The pay will be different with every program and is usually a portion of what a full time staff member there would make. This is question to ask each program you speak with as they vary greatly.

When is the best time to submit the application? Is it based on a rolling cycle?”

All deadlines are different. Most sports residencies begin in July or August thus will conduct their interviews in April-ish. From my experience, Duke is usually the earliest of the group with a February deadline on applications. All of this information will be on the websites for each program. Make sure to keep up with it, it will sneak up on you!

”Why do all the programs only have 4 hrs a week of mentorship, accumulated to be only 150 hrs ( less than 10% of the hours of the total amount of hours in a residency program)? It doesn’t seem worth it, when looking at the breakdown of material. These programs are specifically designed for 1:1 mentorship and they barely offer any. Why is this?”

This time is “scheduled” time that you are guaranteed with one of your mentors each week. Sometimes it is used for patient care, sometimes not. Honestly I cannot count the number of hours of mentorship I experienced through both of my programs. Most of the learning will occur during unplanned situations where conversation starts over a complicated case, perhaps an emergency situation you handle with a mentor or co-worker and review after, chats with surgeons you work with. The learning never ends, the mentor hours are just a bare minimum the APTA guarantees to credential a program.

“How competitive are the programs? I know they normally only accept 1-3 applicants, so just curious how many people actually apply?”

Programs are getting more competitive every year. From my personal experience here at Duke, they only take one resident and one fellow. The applicants (usually 30-40 or so) are narrowed down to interviews which may be 3-5 applicants and then one is selected from there. Other programs may take up to 7 residents. Any way you look at it, the process is generally tough, which makes it worth it in the end. You should be proud to be part of it!

”What do committees look for the most when choosing a resident? What makes me a qualified applicant?”

Again this varies depending on the program. However some general tips I can offer are: think of the typical applicant and try to stand out from that. Everyone will most likely have a DPT. Most will have an interest in sports…etc etc. Is there a certain sport that interests you specifically? Do you have unique experiences with certain types of athletes or sports? Did you play collegiate sports yourself? Do you have an interest in research in a particular area? Are you an ATC, or CSCS? None of these things are requirements, but be memorable. OWN the essay, this is where you get to shine! Review boards are looking for someone with goals, not just an interest in sports.

What should I do while in PT school to best position myself to be chosen?”

Try to create specific goals for yourself NOW. Always have a 1 year, 3 year, 5 year goal plan that you can edit as you change your mind, but that will always serve as a guide. You can always check yourself on how you are measuring up to your goals. If you some extra time, seek out someone who does what you want to do and work backwards from there! Contact them, ask them questions, shadow them if possible. Volunteer to help cover events. All experience that you can add is beneficial not just to your resume, but to helping you rule in or out opportunities you may want to pursue.

Do I have to be a Certified Athletic Trainer?  Are there advantages to being one?  Am I at at a disadvantage of not being one?

You do NOT have to be an ATC to do a sports residency. In fact many programs may prefer someone who is not an ATC as they may gain the most from the residency. There are advantages to being an ATC and still doing the program. For example, I knew going in that I did not need the ATC part specifically so my mentors and I were able to use that time for me to accomplish other goals I had with college strength and conditioning programs, research etc. Many programs will be flexible to an extent to help you meet your specific needs.

“I don’t really understand the difference between the role of an athletic trainer and a sports physical therapist with a team. Can a sports PT work both with a team and work in a clinic or are there time constraints?”

Again, this is different everywhere. Some PTs are employed full time with a team while others may have clinical responsibilities. This goes from the lowest level to the highest level. We have a unique set up at Duke in that there are 5 PTs employed in the training room alone. Our ATC’s are specifically assigned to their team, in charge of physicals, meds, travel, etc for their own teams. We have PTs in our football building, basketball facility and in Olympic sports. They handle post op care, long term rehab cases (ACL, tommy john) as well as cases that may require PT expertise or advanced techniques such as dry needling, manipulation, etc. Our ATCs and PTs work hand in hand on a daily basis. During football camp, we all tape together in the morning, and during rehab times we are all working. There is a lot of crossover but also the skills of each are utilized when most needed. We also have PT/ATC working in our Sports Medicine Clinic. You will see many organizations where a PT may spend a certain amount of time in clinic and then come to training room for a period of time for rehab with the athletes there.  It is entirely up to the individual needs for each school/team.

”As a Sports Physical Therapist, do you have any experience with on field work/injuries? If so, could you discuss this experience further.”

I have LOTS of experience in coverage (both on my own and with a team of PTs and ATCs, MDs) ranging from football, basketball, baseball through lacrosse, gymnastics, wrestling, etc. During the residency you get a high volume of events to cover thus you see a lot quickly. Even as an ATC I saw things multiple times during my residency (i.e. patellar tendon rupture, dislocations) that I had maybe only seen once before. You gain experience handling heat emergencies, head injuries, sickness, fracture management, dislocations, you name it. Just when I think I have seen it all, something very random will occur! It’s not about having seen everything, it’s about learning the decision making and management skills to handle anything that comes your way…..because it will!

How well does a residency prepare you for the SCS exam?

You cover everything that is in the ABPTS outline for a sports physical therapist to know. Weekly didactic sessions hit each topic throughout the year and then some. More so, the SCS is about thinking critically versus picking out an answer. I felt more than prepared to take the exam when I sat for it and my residency wasn’t even over at that point.

“What are the requirements to sit for the exam? And is this changing in the near future?

http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/About_Certification/SpecCertMinimumCriteria.pdf

See link above. Basically 2000 hours or a proof of residency! I am not aware of any changes in the near future but this would be a question for ABPTS for a final answer.

Any comments, thoughts or words of wisdom before we end the interview?

Residencies and Fellowships don’t teach you everything, they teach you how to LEARN. So latch on and become a sponge wherever you go. Write down your goals and be honest with yourself! Aim big! Imagine yourself doing exactly what you want to do, and enjoying every second if it. Remember that you aren’t required to know everything, but you can learn how to find the answer to anything. If you are willing to work hard, the world is yours!!

And finally, don’t forget that at the heart of what we do…are relationships! I care nothing about the string of credentials. I am a PT by job title, I am a coach and a friend on a daily basis. My athletes and my colleagues are the reason I continue to do what I do every day. My passion is investing in their lives and in turn they have affected mine. Stay humble and hungry always.  If serving is below you, leadership is beyond you!


Thank you Nikki for answering all our questions about Sports PT, The SCS exam and Sports Residencies.  We can’t thank you enough!  Best of luck to you this upcoming year and hopefully we meet up someday as colleagues! Below is some contact information for Nikki should you want to get in touch with her.

NikkiH

Nikki Huffman, PT, DPT, SCS, ATC, LAT

Doctor of Physical Therapy

Board Certified Sports Clinical Specialist

Certified Athletic Trainer

Twitter: @NikkiG_13

Personal Email: Nikki.Huffman13@gmail.com

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