Occupational therapists and assistants are more than my colleagues. They are my former students from the classroom, fieldwork and internships. They are passionate about our profession. They are my co-learners at professional conferences. Today they are my readers, and people whose words I may read one day. They are my pals and partners in crime, as we’ve invented the just-right challenge therapy group or a lab activity. They are the people I can call on at a moment’s notice and who have always responded with hands-on help, words of encouragement and ideas for how to get things done. They are my role models — the people I never want to disappoint or let down. I see them as compassionate, smart, hardworking and generous to the point of giving until it hurts. I love them all.

I really want to write blogs that inspire and energize OT and OTAs. The rub is that I know how very difficult practicing real occupational therapy can be right now.

For years, I have been hearing from therapists all over the country and in many different practice settings (SNFs, acute care hospitals, rehabilitation centers, public schools and non-profit agencies, to name a few). They have been warned against providing any services short of or beyond what has been predetermined as billable. Many are threatened with sanctions or termination if they are caught documenting after-work hours, although there are not enough minutes allotted in the day for this. The very notion of providing client-centered, occupationally-focused and holistic care is frustrating and foolish, in these workers’ worlds.

I have witnessed the acculturation of my students to this reality, when they would come to my classrooms after their Level I fieldwork experiences looking confused and frightened. With gentle encouragement, they openly wondered why I was wasting their precious time and tuition teaching them to perform quaint and irrelevant evaluation and intervention techniques (things like activity analysis, active listening, the Occupational Self-Assessment, the Canadian Occupational Performance Measure and the amazing therapeutic value of crafts and cooking), when what they really needed to learn was which CPT codes to use.

So why I surprised to receive the negative feedback from my presentation proposal for the AOTA Annual Conference next spring? What got to me was that the reviewer felt my idea was perhaps too advanced for many OT practitioners today. My topic centered on ways to rejuvenate their clinical work by amping up its occupational focus, client-centeredness, community participation and evidence basis. The reviewer suggested that many conference attendees would need to first master more basic skills, such as activity analysis, grading activities and using occupations as means and ends. I hate to think that the therapists attending our largest annual event need to learn entry-level OT skills and concepts, but clearly some experts have that concern.

Constantly talking about how awesome our profession is feels inappropriate, or even cruel, when I am acutely aware that a lot of my colleagues are at risk of losing their positions if they even try to apply their full clinical skills. I know for sure that many PTs, SLPs, nurses, teachers and clergy also suffer mightily from the “McDonaldization” of their professions. I regularly read blogs about physicians’ pain and their high rate of suicide secondary to heartbreak and burnout in today’s harsh workplaces.

Know this: Many of the systems we work within are broken. It’s not your doing.

At the risk of becoming tiresome, I will continue to speak out about the problems besetting us because we must face reality if we are to change it. As an independent OT practitioner, I am well positioned to say controversial things. I’m not going to fire myself for being too outspoken. While I am a member of the AOTA and my state OT association, I do not officially represent them. I am free to speak, and I plan to continue doing so with the hope that, first, some of my colleagues will find relief in knowing that their plight is understood and acknowledged, and, second, that some OTs will be spurred to actively resist further degradation of our profession and ourselves.