OTarchive
Volume: 3
May 27, 2005
Issue: 2

Meeting the Needs: An Informal Survey

Recently, on four different OT-related list serves, I posted the following informal survey question:

"In the United States, occupational therapy is ideally suited to meet the health needs of people of allages."

Using e-mail, respondents were asked to rate how strongly they agreed or disagreed with the above statement. The results of the survey are found at the end of this editorial.

I posted the informal survey question because of Fred Somers' comments in the April 2005 edition of the American Journal of Occupational Therapy (AJOT). Mr. Somers' asserts that OT is ideally suited to meet the health needs of individuals and to flourish in the 21st century. While I strongly disagree with his comments, I was interested in others' thoughts. I must admit that I am surprised and confused at the results of this informal survey. In my opinion and experience, OT struggles and lags far behind other health professions. I believe that we are much closer to losing our profession rather than "flourishing", as suggested by Mr. Somers. OT loses ground every year because of encroachment, lack of unity, poor service delivery, lack of reimbursement, etc.

Having worked in OT for over 7 years, I wonder if the profession isn't experiencing a "white elephant". A white elephant occurs when there is an obvious and blatant problem but people refuse to acknowledge its existence. Often this occurs with the hope that ignoring the problem allows it to go away". I am confident that many OT are doing a find job, however, my opinion is that as a collective whole, the profession of OT is suffering. The previous edition of OTnews, Our Gears Don't Mesh: Why OT Struggles in American Health Care offers one explanation why OT struggles. Future editions of OTnow will address other possible explanations for this phenomena. While I offer only one therapists opinion and experience, literature suggest that some recipients of occupational therapy also agree that OT is not doing a good job.

Most interesting and in stark contrast to Mr. Somers' optimism, the same edition of AJOT shared some rather pessimistic opinion about occupational therapy services. In Gary Kielhoffner's article, "Scholarship and Practice: Bridging the Divide", he quotes several sources which paint a very negative but far to common experience that some patients have received in occupational therapy. Here's one such quote:

"The part of convalescence that I found most profoundly humiliating and depressing was [OT]... I was reduced to playing with brightly colored plastic letters ... like a three-year-old..." p.231

How is that the Executive Director of AOTA indicates that OT is "flourishing" and yet some recipients of our services report that OT left them feeling "profoundly humiliated"? Some readers may say that the above quote is just a bad apple or just one example. Unfortunately, my experience is that this type of OT treatment is done day in and day out year after year. My opinion is that in physical dysfunction settings, the same debasing and humiliating treatment describe above, is the norm!!

For many years, I have struggled with the profession's stature. In fact, since graduating in 1997, I have struggle with how to be an occupational therapist. After reading April 2005's AJOT, I now also struggle with a feeling that at a time when we can't even adequately identify who or what we do, National leaders tell us that the profession of occupational therapy is going to "flourish in the 21stcentury". I caution therapists to look at the facts rather than listen to the propaganda.

Here are some facts to consider which in my opinion, are counter-indicative of a flourishing profession:

  1. Occupational therapy can not open a home health case. It must be ordered by either PT or nursing
  2. By Medicare standards, occupational therapy is not a required service for a comprehensive outptatient rehab facility (CORF)
  3. Occupational Therapy is not a covered service by many major health insurance companies, including United Health Care
  4. The profession of occupational therapy has yet to reach a consensual definition of our specialty - occupation
  5. Our specialty (occupation) is not understood by the public, patients, doctors or payers.
  6. Due to concerns over perceived lack of support for Medicare direct access, the APTA is reconsidering it's relationship with AOTA.
  7. Despite heroic battles by AOTA and State OT Associations, PT is slowly advancing its scope of practice to include traditional OT roles.
  8. The Physical Therapy profession is actively trying to obtain Medicare direct access. Successful achievement of this goal may spell disaster for our profession.
  9. Mental health, our foundational practice setting, is now only practiced by a very small percentage of therapists.
  10. Despite almost 100 years of existence as a profession, one of AOTA's stated top priorities is to increase public awareness of OT. This is not indicative of a "flourishing" profession.

Results of the informal survey question:

     33 Total Responses received

Strongly Agree:    ++++++++++++++++++++(20)

Agree:             ++++++++++(10)

No Opinion:        (0)

Disagree:          ++(2)

Strongly Disagree: +(1)

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