Public Health Physical Therapist – Cara Whalen Smith

This week’s spotlight features Cara Whalen Smith, a pediatric PT who dreamed of creating big changes for disabled children. Now, she’s working as a public health physical therapist in a principal investigator (project director) role, and loving her non-clinical career.

What is your full name and title at your current job?

Cara N. Whalen Smith, PT, DPT, MPH, CHES
My current working title is Principal Investigator, as I function as a project director. My current title is technically Project Manager, however I am currently misclassified in terms of my job function and responsibilities. This will be corrected in the near future and my new title will likely be Project Director, Director, or something similar that is more descriptive of my role.

I work at Ohio Colleges of Medicine Government Resource Center (GRC)

Where are you located?

My office is based in Columbus, Ohio, but I work remotely from my home in Batavia, Ohio (a suburb of Cincinnati).

Where did you go to PT school, and what year did you graduate?

I graduated in 2012 from The Ohio State University School of Health and Rehabilitation Sciences.

What did you do when you first finished school, and for how long?

I worked clinically as a pediatric physical therapist for three years. I primarily treated children with developmental disabilities and developmental delays. I was fortunate to be able to treat in an outpatient clinic where I worked with kids one-on-one, co-treated with OTs and SLPs, led group programs for patients in the summer, treated in the home, treated in the school from pre-K through high school, and did hippotherapy (treatment on horseback) all within the same clinic.

Concurrently, I also conducted an adaptive dance class for children with disabilities (running it as a community-based treatment program for health and wellness) and was a physical therapist for an NIH R01 research trial, in which I delivered home-based constraint-induced movement therapy (CIMT) for children with cerebral palsy.

I also continued volunteer work I had been doing (and continue to do) in Rwanda to assist a community center for people with disabilities in the workforce development of their staff to improve their services for people with disabilities.

Wow! That is a lot! Dare I ask if you had time for anything else in your life?

In the first year post DPT graduation, I was also in my fourth year of a PhD program (I was in a dual-DPT/PhD program). While I was a PhD student, I held appointments as a graduate research associate, working in a variety of labs.

I was also a graduate teaching associate, primarily teaching anatomy to PT and OT students, interprofessional teamwork for working with patients in poverty to interdisciplinary graduate students, and in the DPT pediatrics curriculum.

I see in your title that you’re an MPH, not a PhD. What’s the story there?

In my second year after graduating with my DPT, I decided to transfer from my PhD program to a Master of Public Health (MPH) program because that was a better fit for my career interests. I was in my MPH program for 1.5 years.

During that time, I still worked part-time as a PT clinically and in the community. I also completed a one-month public health internship with the Ohio Disability and Health Program, was a pediatric lab instructor for DPT students during the summers, and was hired by Health Volunteers Overseas (HVO) to co-develop and co-teach a continuing education program in pediatrics for Rwandan physiotherapists in Kigali, Rwanda.

WOW! You were so busy! What did you learn about your career goals during that time?

I loved working directly with patients and getting to play every day for a living. I also loved the camaraderie of working with fantastic pediatric PTs, OTs, and SLPs while getting to pick their brains about challenging cases. I thoroughly enjoyed the variety of diagnoses, ages, and settings (clinic, home, school, community). Every day was different and presented exciting challenges.

Side note: my current role affords the same type of variety and challenge. I do not do well in settings where there is little variety and I do the same thing over and over again.

Things I did not enjoy about my clinical roles were:

• The enormous amount of documentation that often led to numerous hours of unpaid overtime
• Evening and weekend work
• Clinic management pressure for productivity (kids get sick and miss appointments!)
• Absolute exhaustion from treating back-to-back patients and the energy demands of working in pediatric practice
• Limited opportunities for professional development that was supported from the clinic
• Only having a limited impact on one patient at a time 

When did you realize you wanted to go into public health?

I have always wanted to have an impact at the systems level. From the start, I knew I would use my PT training to affect whole populations instead of being limited to one individual at a time.

What are you doing these days?

I serve as a principal investigator (acting as a director) or co-investigator on projects that improve health equity for people with disabilities and healthcare-workforce development projects that address health equity for underserved populations in Ohio. For example, I work with the Ohio Disability and Health Program, a CDC funded initiative, to assist with program development, provide content expertise, and lead evaluation efforts on initiatives designed to improve the health and well-being of people with disabilities in Ohio.

In my free time, I also provide technical assistance and consult with physiotherapy and disability expert partners in Rwanda on a community-based rehabilitation (CBR) program for a center for people with disabilities. 

Are you still treating patients, or are you solely non-clinical?

I have been solely a non-clinical physical therapist for nearly three years. When I first entered public health full-time after graduation from my MPH program, I still treated children with disabilities in a group context through an adaptive dance program at a local dance studio. However, after getting married and moving to Cincinnati, I had to give up my adaptive dance program for children with disabilities.

I plan to get involved treating children with disabilities again in a group setting in Cincinnati to stay current with issues that people with disabilities are facing. 

How long have you been a public health physical therapist?

I have been at my organization for nearly five years, and I’ve been in my current role as a principal investigator (project director) for nearly three years.

How did you find your job? Did you apply or find it through a connection?

My hiring manager delivered a lecture about her work to one of my MPH classes about a month before my graduation. During her lecture, she identified gaps in her knowledge about some of her upcoming work. I had the specific experience and expertise to fill those gaps.

So, after her lecture, I reached out to her and provided her with a cover letter and my CV, highlighting the value I would add to her team. There were no open positions at the time, but I scheduled an informational interview with her to share my skills and expertise and to find out more about GRC.

Shortly after our meeting, she told me about a new job posting at GRC. I then applied and interviewed for the job.

Did you do anything special to your resume and cover letter? 

Yes, in my cover letter I made sure to connect how my previous positions, public service, education, and certifications qualified me for the position. I made certain to use terms from the job description throughout my resume to demonstrate I met and exceeded the qualifications.

Also, when entering my job application to the online system, I used more descriptive terms that aligned with the qualifications, in addition to my titles rather than just the title (i.e. physical therapist). I found the first time that I submitted the application, the system automatically ruled me out when I used my actual titles of physical therapist.

After speaking with a job coach, I was advised to use descriptors of what I did that aligned with the job qualifications, rather than just using my official titles so I wouldn’t get weeded out of the automated system by an algorithm.

Finally, the hiring system pulled my application for the hiring manager, which ultimately resulted in an interview request.

What was the interview like for the role?  

I was interviewed by three individuals: the hiring manager, a member of senior leadership, and another employee. They asked me questions related to my previous experience and expertise, as well as questions to assess my fit with the team-based environment of the organization. 

Did you get any special certifications or training to become a public health PT?

In addition to my PT training, I have a Master of Public Health (MPH) degree with a specialization in health behavior and health promotion. I am also a Certified Health Education Specialist (CHES), which tells employers that I have expertise in community health assessment, health program planning, implementation, and evaluation. 

What are some of the things you did to stand out, take initiative, and advance into a principal investigator role?  

I advanced very quickly through the organization. I came in at an entry-level position, and within two years I was promoted to the highest level of a project manager and became the first project manager to be granted principal investigator (PI) status.

Ultimately, with PI status, I was able to independently direct projects. Within those first two years, GRC also added me to the leadership team due to my advancement and my role as PI. There are also plans to promote me to a project director or director level in the near future to more align with my current job duties and to potentially also supervise staff beyond managing the staff on the projects I direct.

I attribute my advancement success to my commitment to taking initiative, spearheading innovation, and ongoing professional development. I also think that my background as a clinician has given me an advantage, as I bring to the job a wealth of relevant expertise and practical clinical experience that is important for our projects.

Because of my unique experience, I find that my opinions and recommendations are highly valued. What has set me apart from my co-workers is my willingness to go above and beyond the job—a trait I feel is very typical among PTs in general.

This is exemplified by serving on and chairing numerous internal strategic planning committees and workgroups, serving on local, regional, and state workgroups and committees, serving a term on the Board of Directors of the Charitable Healthcare Network (formerly the Ohio Association of Free Clinics), and being elected to leadership positions within APTA’s HPA The Catalyst Global Health Special Interest Group.

Do tell regarding your professional development!

I consistently attend training opportunities related to my role and related to areas in which I want to grow. I have also been able to serve as a mentor to coworkers and students, while seeking out and creating formal mentorship relationships with national experts.

I present frequently at the organizational, local, regional, state, national, and international level on my work. I have also completed HPA the Catalyst’s LAMP leadership program (LAMP 101, 201, and 301), which has contributed to my success and helped me create and implement my own Personal Leadership Development Plan.

All of these activities demonstrated my commitment to advancing myself and my organization, which I believe is a major factor for my quick advancement through the organization. 

How have people reacted to you leaving patient care?

People knew from the beginning that I would eventually leave direct patient care, as my goal was to earn a PhD to eventually teach and lead research.

However, when I transferred from my PhD program to my MPH program, people thought I was switching careers from physical therapy to public health. Those who do not know me best probably still think that I switched careers and do not think of me as a PT anymore.

How do YOU think of yourself?

When I made the decision to change paths from a PhD to MPH, I did have a bit of an identity crisis. I felt for a moment that maybe I had wasted my time in PT school and my PhD program only to decide I wanted to work in public health. I felt isolated and sometimes embarrassed to tell people what I was now doing.

It was difficult to figure out exactly what I wanted to do in public health and how to keep my PT identity and training relevant. I tried to find people like me who were not in academics as mentors and role models, but I could not find anyone, and had to blaze my own path.

I quickly realized that just because you have left patient care does not mean that you have left the profession. I just got more training and changed jobs to do my part to advance the profession. I was on the road to be a leader in the PT profession.

Now, when people ask what I do, I always say that I am a PT who works in public health, directing programs and initiatives for people with disabilities.

Even though it is not my exact job title, I feel it is important to remind people that I am a PT to represent the profession in an area where we are not typically found. Being a PT is part of my identity, and it is my career.

Not treating patients or working in an academic setting should not make anyone feel any less part of the PT profession. With the ever-changing health care system, the PT perspective is desperately needed in many non-clinical and non-academic roles.

What’s a typical day or week in the life like for you? What types of tasks and responsibilities fill your time?

Every day is different, which is really exciting. At any given time of the year, I am usually directing three or four large projects related to workforce development, access to care, health promotion, and evaluation/research with a focus on people with disabilities.

I spend my time working with a diverse group of professionals across many different local, regional, and state organizations/agencies, as well as academic institutions.

Here are some of my daily activities:

• Attending meetings
• Facilitating conference calls
• Organizing and facilitating statewide meetings/conferences
• Sitting on committees and work groups
• Planning and implementing programs
• Managing millions of dollars in state and federal funding
• Writing project proposals
• Setting goals and objectives
• Collecting and analyzing data
• Writing reports to affect state policy direction
• Delivering presentations and guest lectures
• Publishing peer-reviewed journal manuscripts

What are some of the challenges of your role? What are the rewards?

Probably the biggest challenge is coordinating and facilitating meetings between multiple state agencies, academic medical centers and health sciences colleges, community organizations, and other partners.

It is particularly challenging to manage competing priorities and agendas while establishing consensus and mobilizing organizations into action. 

What is most rewarding is the opportunity to create sustainable change that improves health equity at a population level.

How do you think working as a PT prepared you for this role? Which skills transferred?  

I honestly use all of my degrees, certifications, and past experiences every day in my role. Though I am not treating patients, the skills I gained from my PT training and work as a clinician are essential to my current role.

Skills I have learned along the way have all been transferrable, especially those related to:

• Critical thinking
• Reasoning
• Assessment
• Evaluation
• Goal and objective setting
• Research
• Communication (verbal and written)
• Problem-solving
• Knowledge of the health system and patient care

Roughly speaking, how are the hours and pay in public health compared to physical therapy?

The hours are definitely fewer because in clinical care I always worked beyond my standard hours to finish documentation. The hours in my current role are also more flexible, as I can work with my supervisor to set my own hours each day, within reason.

I also never work evenings or weekends, as was typical when I was in clinical care.

The pay depends on which area of practice, setting and area of the country you live in. But for me, I have outpaced my projected earning potential in pediatric physical therapy by working at the leadership level in public health.

What type of person do you think would do well in public health? 

The type of person who would do well is someone who is a self-starter and can work independently but also function well in a team. This person would also have subject matter expertise and excellent communication skills.

Do you work remotely or on-site?

I work remotely from home most of the time. But attend in-person meetings in my office or at other locations about 1-4 times per month.

Does your organization consider other clinicians for these public health physical therapy jobs ?

Yes, all backgrounds are considered. Job applicants just need to have the relevant experience in public health, program design, program evaluation, health policy, administration, and/or research.

Open positions are found on the GRC website: http://grc.osu.edu/careers

Did you read any books, take any courses, or do anything special overall to get you where you are today? 

Professional development is a major focus and priority in my career.

Beyond my formal training, which includes a Bachelor of Science in Health Sciences with a concentration in Health and Wellness, Psychology minor, Doctorate in Physical Therapy with a specialization in Global Health, and Master of Public Health with a specialization in Health Behavior and Health Promotion, I have taken every opportunity to further my expertise and knowledge.

Examples include:

• Attending, local, state, national, and international conferences relevant to my career
• Reading books on disability and health, disability and inclusion, and global health and disability
• Reading national and international reports on disability
• Keeping up with relevant peer-reviewed journal articles
• Taking online continuing education courses or certificate programs
• Volunteering for relevant committees, boards, and work-groups at the state and national level

What is a typical career path for someone in your role?

For my role, you need to have at least a master’s degree in a relevant field or an equivalent combination of education and experience.

People in my position are required to have experience in program planning, administration, and/or health policy. Most people come from various state agencies, local health departments, organizations, or academia prior to working at my organization.

There are opportunities for entry-level jobs directly out of undergraduate or graduate programs, as well as opportunities for student internships and graduate research assistant positions.

What is next for you? What do you want to do with your career long-term?

Senior leadership at my organization recently approved a proposal for me to lead disability inclusion efforts in all of our projects through providing expert consultation on all of our projects and provide training and resources to our staff to ensure people with disabilities are not left behind in our projects.

The goal is to some day lead a disability inclusion section at our organization with numerous staff who also have expertise in this area. I am also developing a graduate interdisciplinary course on Global Health and Disability to begin teaching in the fall of 2021.

Long-term, I want to keep doing what I am doing. It is my passion to work on projects related to improving access to care and the community for people with disabilities.

Most personally to me as a dancer, teacher, and PT, I want to lead a coordinated movement in the world of dance where all dance studios and companies adopt models of integrated dance, so people of all abilities can enjoy the physical, mental, and social benefits of dance without needing it to be adapted or being in segregated classes.

All forms of movement and art should be accessible to anyone who wants to participate. Disability does not mean inability!

What would you recommend to a PT/OT/SLP professional considering a career in public health?

The best advice I received as I transitioned into this role was from my husband. As I was completing my MPH program, I was having trouble finding jobs that matched what I wanted to do with my career (working to improve health equity for people with disabilities).

As I was looking at position postings and deciding between interviews and job offers, my husband told me to not get hung up on the job description. There is always flexibility, and you should make the job your own.

So, I selected an organization that hired for talent and potential, valued innovation, and above all valued professional development. From day one, I paved a new path and re-invented the role to fit my interests and expertise.

Don’t be afraid to be a change agent within your organization and let your talents and expertise shine! 

What would you like to change most in your profession, and why? How would you propose doing so?

More PTs need to be involved in public health. Public health is traditionally dominated by non-clinicians, physicians, and nurses. PTs have essential skills, knowledge, and perspectives that are missing from current agendas and priorities.

PTs are well suited, and perhaps better suited, to address public health issues of wellness, fitness, physical activity, and disability. For example, wouldn’t it make sense for a PT to be leading efforts in the design of the built environment in communities trying to ensure healthy and easy living space for residents by making parks and trails accessible? 

The lack of PT representation in public health needs to change through DPT programs that encourage students to take elective courses in public health. Programs should incorporate lectures on public health into their curricula, allowing students to complete practicums/internships/culminating projects in public health settings or offering dual DPT/MPH degree programs.

Also, PTs who practice in public health need to share widely with other PTs and professionals about their efforts to increase the visibility that this is a viable and important career path for PTs.

Professionals in public health need to know that PTs have an important perspective that is necessary in the field of public health.

If you could give yourself one piece of career advice you wish you had during your PT school program, what would it be?

It is more advice for DPT programs than for me. I wish DPT programs would require that students receive a seminar series or guest lectures in their first semester on the different career opportunities that they can explore during the course of their studies.

These seminars should include people in those careers telling students:

• Exactly what their job is like
• How they got there
• The pros and cons of their job
• Resources for students to find out more (i.e. opportunities to shadow, volunteer, professional organizations and message groups to join, coursework to consider taking, etc.).

Often, you are locked into a course of study from nearly day one of what track you want to pursue (for me it was a PhD program).

In hindsight, I didn’t really understand what that career was like when I initially choose to pursue a PhD. If I had more information from the outset and was able to see all the different possibilities, I probably would have taken a different path and would not have stayed on a path that I ultimately retread. 

If you could teach anything to today’s graduate students in your profession, what would it be?

First and foremost, all DPT students need to be proficient in the following Core Competencies on Disability in Health Education in order to improve health equity for this population: https://nisonger.osu.edu/wp-content/uploads/2019/08/post-consensus-Core-Competencies-on-Disability_8.5.19.pdf.

I would also advise students to remain open to a variety of opportunities and career paths. Students should seek vastly different clinical experiences and settings. Students should strive to do out-of-the -box electives, practicums, and projects during the course of their DPT program.

I recommend getting as much variety and varied experiences as possible. You never know, you may find a new and exciting career than what you originally envisioned! But, even if you stick to the path you originally went to PT school for (i.e. outpatient ortho), you will be a better clinician for having experienced a broader and better worldview.

If students are interested in pursuing public health, let your DPT programs know that there is student interest. Who knows, perhaps more formal DPT/MPH programs will start to emerge across the country if enough students start demanding such programs.

Do you have any special advice for others who want to follow in your footsteps?

Find a mentor and seek out as many professional development opportunities as you can. Make sure people you work with in the public health space know that you are a PT and understand what knowledge, skills, and unique perspective you bring to the table.

Get involved with the APTA, special interests groups, and catalyst groups—make your voice heard and demand more programming at CSM on this topic to support PTs on this career path. 

Well, this was a really fascinating look into the world of public health and project management. Thanks for your insight, Cara!

Public Health and Project Management are among the many career tracks in Non-Clinical 101!

Plus, NC101 students get exclusive access to a 45-minute bonus video where Cara goes even deeper into public health careers, and how to land these roles wherever you are in your journey!