Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

After I poured out my feelings about the way that occupational therapists are often forced to reduce their practices to meet employer’s productivity standards in my last column, Seeking Your Advice: Ideas for OT’s Future, I felt nervous.  I was worried readers might get angry or feel I was criticizing them or their areas of practice.  I am not afraid of spicy discussions or controversy, but I know that exchanges online can become very emotional, especially when they center on a topic as near to our hearts as OT is to most of us. I held my breath.

Nothing prepared me for the flood of responses to my column … not just the number of comments, but the uniformity of the responses.  Although each person had a unique perspective, there were no outright dissenters. Certain themes sang out among the responses:

A disconnect between values and demands 

  • “Days I am actually able to do client-centered meaningful tasks, such as cooking, with patients are productivity killers. Who has time for that? Here have this peg board instead! Sigh!” –A. J.
  • “…most OT practitioners did not go into the profession to do conveyor belt therapy.  We chose this profession because we care deeply about our clients and their wishes and desires.”–A. B.
  • “The last clinic I worked in had exercise equipment … period. There was no kitchen area at all. When I became the rehab manager, I really got to see the money game. I did not last long in that role. It’s shameful!”–A. B.

Empathy and worry for the next generation of OTs

  • “It’s sad that so many new grads will never know the pleasure of having the time to talk with family, collaborate with co-workers or try something unique because they are forced to keep to the bottom line.”–N.
  • “My rehab manager, who is a PT, has flat out told us to get over our feelings and realize it’s about money or get out. I [met] several new grads who [came] in with high expectations and before the first year is out are already questioning their field of choice.”–R.
  • “…It’s a constant ethical battle for me.  [I have burned out] after such a short time. I love when I am able to help others. However,  I do not feel I can do so while maintaining the business-side of practice. I am $38,000 in debt with student loans and already ready to retire. Wish I had an answer.” –S.

Calls to action 

  • “finding the right company to work for will likely be her best bet. A good company will provide good mentors and information [providing a good  working environment] using the Practice Act and Code of Ethics.” –E. C.
  • “Being a firm believer in providing quality care, I have taken a stand against this [reduction of session time]. It is not because I am resistant to change, it is simply because the population we work with requires the time spent.”–Lisa
  • “In my opinion, in order to counter the money-driven pressures in SNF settings the OT profession needs to do at least two things. First, we need to help our young clinicians truly understand what skilled therapy is. … The second thing … is (to) have AOTA and our state organizations [speak] with Medicare and OTs who work in SNF about how to influence these issues at a higher level. Could there be limits set by the government? By our professional body? If OTs as a group refused to apply for jobs with companies that have 90% productivity requirements, then those companies would be in a pickle because they have been mandated to provide skilled care to their patients.”–J. B.
  • “How about if we create our own union? We are already well organized with AOTA. We would have greater say in productivity standards if we bargained together as a whole instead of each clinic/hospital/snf individually.”–J

Every OT who persists in providing or striving to provide quality services despite the constraints of harsh working conditions is a hero. We must support one another and acknowledge that things need to change. Let’s keep up our good work, and continue to share our ideas, concerns and energy. I plan to send all of your comments to our leaders in the Practice Division at AOTA.

As with most complex problems, many solutions will be needed. We can do this; tailoring solutions is our specialty!