There are so many things to love and respect about our profession. We serve people in need with our knowledge, skills and hearts. I want to celebrate these beautiful qualities — we are, after all, celebrating OT Month! However, the state of things in some of our workplaces requires us to add some additional virtues and behaviors, such as courage and toughness.

Occupational therapists are known for optimism and a can-do attitude. It’s part of what makes us popular with our care teams and clients. We can bring this positive attitude to advocacy to our clients and to those we supervise, and we can adopt this positive attitude ourselves. We love our profession because it is occupationally focused, client-centered and holistic. We want to practice to the fullest extent of our capabilities and to encompass these values. OTs value harmony, and that’s what makes us good team members and co-workers. Our easy-going and flexible styles also help us to create success with many difficult clients.

Of course, there’s another side to being so agreeable. Unlike groups that are trained to expect adversity and conflict in their daily work (think attorneys and police officers), the clinical OTs I know are often unsettled and upset when they have to generate or deal with disagreement or unhappiness. When I researched what we teach our students in university OT programs about sharing bad news, some educators were offended that I would even suggest such a topic. Not doing so may ensure our popularity, but there are times when being nice and popular is not in the best interest of those we serve or ourselves.

It’s no secret that occupational therapists and other professionals can be pressured to maintain impossible levels of productivity (i.e. time that can be billed to insurance). These expectations are set by people far removed from patient care and whose main focus is on financial gain for their corporations and stockholders. I regularly communicate with distressed OT practitioners who are experiencing frustration, anguish and guilt because they cannot keep up with the demands. They know that the quality and integrity of their work is being compromised, and they think they are helpless.

If you are working in these difficult conditions, you are not helpless and you are not alone. You are a licensed professional who is mandated to uphold the standards of practice of the American Occupational Therapy Association and your state’s licensing board.

As of January of this year, an occupational therapist and physical therapist brought a suit against a major national rehabilitation corporation that coerced practitioners to commit fraudulent practice and they won! This case is critical for us all. Not only is the rehabilitation company under scrutiny, but also the skilled nursing facilities who hire such companies and who allow fraudulent practice to occur.

If you are being told to practice inappropriately, you can bring the articles I link to above to your administrative supervisors as a word of warning. They need to know that you are aware of your patients’ rights to skilled, individualized occupational therapy and that an occupational therapist will be the one to decide what and when OT services are appropriate. Let them know that you want to work with them to design therapy programs that are clinically and ethically sound, as well as reasonably cost-effective.

It’s time to prepare for and engage in this fight wherever it’s needed. Our patients and their families cannot be expected to advocate for their own care; we are their voice. As a certified and licensed OT practitioner you have the right and obligation to practice your profession according to AOTA standards and codes. AOTA’s Practice Division is continuously working to defend these rights, and provides support and resources. We can do this. Read what the AOTA says about ethics in billing and reimbursement.