Ok, I am going to take a stab here at what is a very complex issue...I myself
have pondered this very question and have come up with the following conclusion.
One: the roots of this profession, as far as treatment venues are concerned,
are with the Army. As with anything closely associated with the government
(until very recent history that is), there becomes a sort of complacency about
having to explain the rationale for why something is or why it even exists.
Two: Building upon fact one above, for many years the VA and government run
psychiatric facilities were the largest employers of OT's. Same analysis.
Three: Enter Medicare and mandated coverage for services. OT is a covered
service; no questions asked. Hence there is no need to explain or even
differentiate ourselves from PT. OTgets reimbursed because it is on the list
of covered services.
Four: Now the mandated service is extended to the public schools. Same
scenario as above.
Five: enter managed care. and its infiltrating influence to the government
programs, culminating in health care with the Balance Budget act of 1997.
Suddenly everything is being scrutinzed as never before.
Througout the history of this profession, we have privately (in our own little
professional body) expressed our exasperation at the lack of understanding of OT
to the public and to our colleagues in other professions. I am sure there have
been many efforts by individual practitioners or even by subgroups within OT to
promote the profession. But the bottom line is this: we have never been
collectively challenged to justify our existance until very recently. And the
result is a profession that has gotten lazy.....again, I know that there are and
have been dedicated OT's doing research, fighting to make a name for OT etc.,
and thank God for them! And our founders, what a vison they had of what OT
could be! But something has gone wrong in this profession since about the 60's
on...Until 3 years ago, if you asked your average OT on the street how critical
it is to make OT known, I don't think you would have gotten the same response
you would get today.
Before I rile too many more people up, let me add this: I remember in 1992, as
a FW student, asking my supervisiors why something was "OT" or why it
wasn't....I was at a VA and a community hospital psychiatric unit in a major
metropolitan area known for cranking out OT's. I remember vividly the day
that my Supervisior at the psych hospital said: "Just do a good job and make
sure the clients like OT...don't worry so much about what OT is or isn't...we
are a covered service and they wouldn't know what to do with the patients all
day without us". I remember even as a very green young therapist how taken
aback I was by her response. I was depressed to realize that even she didn't
care to know if what we were doing made any difference.
Fast forward one year, 1993 to my job as a staff therapist at a large regional
medical center. Here I am, new graduate, looking up to senior therapists as
mentors. Out of a group of 25 OT's, there were 2 that were members of AOTA or
the state association. Two. If the hospital didn't pay for it, then they
didn't do it. This was a group of well compensated (the height of the add on
bonus era I might add) group of people who had no excuse not to support the
profession. I remember them saying "AOTA doesn't do anything for me".
Continuing ed was seen as a way for the hospital to pay for a trip somewhere and
a few days away for the clinic. I again remember the department director saying
"they love OT at this hospital.. we and PT are the bread and butter around
here. We make money for the hospital".
As time progressed and I became more experienced, I wanted to engage in research
in the clinic. I was shot down. "we don't need to do that" I was told again
and again.
Then the reimbursement started tightening up thanks to manged care and suddenly
the pressure was on. Now the excuse to not engage in research was that
productivity would be an issue. And then turf wars really heated up....I could
go on and on.
Let me conclude with this: If you are reading this diatribe you are not likely
part of the problem...you ARE a dedicated OT, trying to prove our worth and
asking the tough questions. It is our colleagues who were signed on for the
good times only (read: many of the graduates from the mid eighties until
1996...) that were lured into the profession by lucrative salaries, etc., who
are hindering NOT HELPING our cause. And they are leaving the profession in
droves, and I for one am glad. Let a new crop of dedicated students who will be
prepared to engage in research and ask the tough questions come into the
profession knowing full well the challenges ahead.
I am now in an academic setting where I feel like I can do my part to encourage
students to support the profession and articulate what OT is and what it isn't.
One area of research I hope to engage in is to study the impact on a profession
when sign on bonuses and inflated salaries are major enticements to enter a
profession. The literature from the business sector indicates that ultimately
the practice backfires and committment to an organization (or in our case , a
profession) are even lower than before all the incentives were added on.
Well, let me have it! Prove me wrong every one out there! I want to hear it
loud and clear. Thanks, Terrianne
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