Hello Ann:

Thanks for writing back, I enjoy your posts because you really make me
think!

Regarding evidence of OT being swallowed up, I guess I have several sources
for my statements:

1. My experience working in Rehab, Home Health, Private Practice and in
Education clearly demonstrates to me that by far, the majority of people
(clients, Doctors, other therapists) have little idea of what OT is or isn't
and some have little respect for our role in client care.

2. Several years ago, PT Practice Guidelines expanded to include themselves
as wanting to be recognized experts in community, and home reintegration and
in self-care management.  These Guidelines represent an expansion of PT
philosophy at the National level and clearly represent a challenge to OT's
traditional domain of concern.

3. PT's are changing their State Practice Acts to incorporate the above
guidelines.  The Practice Acts provide language for what PT can legally
claim to do. Whether they can actually do it better than OT doesn't matter.
Once it's in their practice act they can legally claim expertise in the
area.

4. The strong separation between OT professional philosophy and actual
practice. For example, I have yet to read anywhere were OT is considered to
be upper-extremity experts.  However, many OT's practice and receive
referral for injuries above the waist while PT's receive referrals for below
the waist injuries. This separation of Philosophy and Practice drives a
severe wedge in our profession and makes us weak (in my opinion).

5.  Several articles published in the last 10 years or so which suggest the
possible demise of OT unless changes are made in our practice patterns.  If
you are interested, I will provide some references.  In fact, I have OTD
students read some of the articles.

6. Numerous discussion I have heard and participated in regarding the fusion
of OT and PT into a single profession.

7. OT not being able to open Medicare home health case speaks volumes of our
diminishing role in that arena of care.

8.  The migration of Mental Health OT's out of traditional Psychs settings.
This left a tremendous gap in psych services which has been filled (in many
cases) by non-skilled technicians.

9.  Several published articles discussing the ill-fit of OT and the medical
model of care

Finally, Ann, I don't think that OT is alone with its professional identity
battles.  Even PT has ongoing debate about the nature of their professional
identity.  And, I don't think all is ill with OT.  Like other readers have
pointed out, their are MANY, MANY OT's who are working hard to make ends
meet and thriving in the mass market of 3rd party reimbursement.  My hat
goes off to all of them!  And, I certainly don't mean to slander any single
therapist.  I guess, if anything that is written on this list applies to a
reader then they may want to consider what's said.  If what's written
doesn't apply, then maybe readers should just take it with the grain of salt
and go on with business as usual.

Take care and I look forward to more discussion.

Ron

~~~~~~
On Monday, April 22, 2002, [EMAIL PROTECTED] wrote:

Dac> Ron-  I think there are a fair number of OTs that feel the way that you do, 
Dac> but frankly, I'm quite surprised that is your personal reason.  In the past, 
Dac> your posts have made it quite clear that you see the roles of OT and PT as 
Dac> very different, and have stated that you feel one of the "problems" in our 
Dac> profession are OTs who function more as PTs.  I would think those OTs would 
Dac> be the ones most threatened by a better known PT profession "stealing" away 
Dac> their business.

Dac> To which practice areas do you feel that your scenario applies?  It seems to 
Dac> me that this potential situation would occur primarily in the outpatient 
Dac> arena, and frankly, there are many clients treated in outpatient PT programs 
Dac> who are most appropriately seen by PTs.  In a school setting, at least in my 
Dac> experience, the OTs are as well known as the PTs, and sometimes more likely 
Dac> to be called upon.  In a rehab. center, every patient is exposed to the 
Dac> entire interdisciplinary team, not just PT.  In an acute care hospital, there 
Dac> are frequently critical pathways that have referrals built in for OT for 
Dac> certain diagnoses like CVA, and while the OTs often play a smaller role, it 
Dac> is quite possible for proactive, effective OTs to expand their role, and the 
Dac> awareness of the MDs, by offering meaningful functional suggestions for their 
Dac> patients.  The same goes for home care.   Non traditional, non-medical model 
Dac> settings are not traditionally areas that PT gets as involved in, except 
Dac> maybe work hardening.  I think that area is as open to OT as it is to PT, 
Dac> depending on the marketing skills of the individual therapist. Again, I am 
Dac> not stating that I think we are necessarily well known, or that there aren't 
Dac> MDs out there who don't know what we do, but at the places I have 
Dac> worked(rehab., outpatient, home care, school, preschool, long term care), the 
Dac> MD is not the only referring source.  The nurses, teachers, OTs, and SLPs 
Dac> have all referred patients to me in these various settings.  Developing a 
Dac> good relationship to them and letting them see what I can do for their 
Dac> patients has led to these referrals increasing.  Working within the medical 
Dac> model(or the educational one) rather than trying to impose a purely 
Dac> occupational model on them has also helped strengthen these working 
Dac> relationships, as we are all "talking the same language"
Dac> On a different note, in your reply to Irene, you state:
Dac> 1.  I believe OT may be in danger of being 'swallowed up' if we don't make
Dac> some fundamental changes
Dac> 2.  I love OT and hate to see it disappear
Dac> What evidence do you have that either of these things is happening, or that 
Dac> PT thriving in their profession is going to result in OTs demise?
Dac> Ann

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