In discussions across various forums, I’ve been discussing the current state of Occupational Therapy. It’s been interesting to note that there seems to be an identified issue that is a common thread across a lot of professionals. The issue is that OT’s don’t seem to feel like they’re being allowed to practice the art and science of OT. Instead, their being forced into mediocre “gap filler” roles. Don’t get me wrong, I have no doubt that there are some OT’s who enjoy these roles in their job, it gives them purpose and a connection to the medical-focused MDT. The irony of it is that there is nothing wrong with this in a way. Connection and “belonging” are one of the core principles of many OT’s hold close to their clinical values. But just because its human nature, is it OT?
Firstly it’s important to understand that 9/10 the individual clinicians didn’t develop OT into these faux roles but that’s not to say that clinicians aren’t part of the problem. The profession evolved (devolved?) into these roles over time. But why? Well here’s my thoughts:
We’ve tried to fill a gap in the health market too fast and as a result, we’ve watered down what it means to be an OT. I know that statement is going to rustle a LOT of jimmies but hear me out. The Occupational Therapy profession is a community and as such has its own culture (defined: the ideas, customs, and social behavior of a particular people or society.)
So as a collective we have certain values, beliefs, and behaviors that we share across the whole community. We also know that if an entity has an unmet need it will actively fill it with something.
Another contributing factor has always been the lack of structure around the definition of the profession. How often have you heard students or even clinicians asked “so what is OT” and they either laugh and say they don’t know or say something comparative (oh its kind of like physio) or clinic specific (oh we provide equipment for people after surgery)? It ain’t right but it ain’t wrong… most definitely a reductionist view of the profession which is then perpetuated in the minds of the people that it’s told to.
So when we put all of these factors together we start to get a picture of what’s happened. (Overly generalised) We have an amazing idea for the rehabilitation of humans started by some diverse and amazingly forward-thinking people. We then start to develop that idea with a group of people splitting from the nursing profession. We have a subculture of nursing essentially. People that would share many of the values of nursing at the time but that also viewed this new concept of occupation as “the future” of rehabilitation and health care. The idea catches and demand for OT services skyrockets. So we see OT become its own entity, get its own schools, taught its own syllabus and pumping out graduates to fill the growing demand.
Then the healthcare culture changes. Evidence-based practice becomes the standard. All of a sudden everything needs to be quantified. Other medical professions are able to adjust to this quite rapidly as this is often how they operate anyway. Measurements are important. But for a profession that operates primarily qualitatively, this is a shock and creates somewhat of a global identity crisis. So now we have a large group of professionals in a profession without clearly defined borders, easily measurable processes or a clear scientific understanding of WHY it’s effective, trying to work within a structured, organised, measurable healthcare environment. Square peg, round hole. So what do we do? Two
Options. We could have stood firm, unified in the knowledge that what we do is effective, relatable and getting health outcomes no other profession could get. Or we could knock the corners off our “square peg” and try and fit in. Guess which way we went? Yep……we dug out our chisel and went to work.
We acquired skills and arm wrestled our way into practice areas we previously wouldn’t have considered OT fitting into. We elbowed our way into the medical model health system and pushed out our own little space that we’ve defended with all our might. We’ve even worked ourselves into areas that our clients have questioned why they would see an OT and not another [seemingly better fitting] profession. In other areas, we’ve been pushed into doing things that are so far away from our core construct of Occupation that it would be difficult to even call ourselves an OT…peg board anyone? I’ve heard people try and lay blame on the universities for teaching these redundant skills and thus shaping the profession, but I’m sure if you actually look at it the Universities are teaching what is being reported as being necessary skills from the clinical frontline. It’s in their best interest to prepare students for what they are going to be hit with when they are thrown into the mix. I feel this hypothesis is confirmed through the sheer number of students I’ve spoken too in forums and through my work who express feelings of confusion and frustration because “we learned this” but my “placement expected this”. When I went through this moment of juxtaposition was saved for new graduates so the fact that it appears to be happening earlier I feel is testament to university courses sticking to their guns and reinforcing the power of Occupational Engagement in their students and not just pandering to the “health handyman” mentality of the modern healthcare OT.
But what have we lost but cutting off our corners? What have we sacrificed in the name of “fitting in”? IMO, a lot. In my experience, OT has moved into that gap filler role
So that all sounds very dire but I’m in no way saying that its all been negative. The profession has learned a lot (obviously) we have grown exponentially and are know quite well known around the world. We are becoming more known by the general population and are starting to gain some exposure in the mainstream media. This has all be brought about by the rapid growth in the number of OT’s and the formation of professional bodies to represent members needs.
SO now we are in a situation where we Occupational Therapy is still growing rapidly in numbers, we have professional bodies that do a lot of advocacy and policy work in order to promote the profession to the broader public but the day to day promotion on the coal face is still somewhat of a grey area. Talking with students and even clinicians most STILL break into a cold sweat when they asked: “so what is Occupational Therapy?”. I will admit in the last 5 years I have noted some small improvement but I believe that this is caused by a lack of unified identity. We don’t know who we are due to the juxtaposition of what we were taught and what we are being expected to do by health services.
Do we need to fight for OT or should we just adapt to the direction dictated by health services? Has OT lost its autonomy? The easiest way to answer that question is this. If you were setting up a health service from scratch and money/resources were no barrier, what would you be doing day to day? Consider the environment you just fantasised and the difference between it and what you are currently doing in your practice. How many of those differences are actually 100% related to finances? I can almost guarantee that most of you would have come up with at least 1 small change that isn’t related to budget restraints.