In 2010, “CNNMoney” and “Forbes” magazine both listed occupational therapy among the top jobs in the country. Occupational therapy ranked 19 out of 100 best jobs in America, according to “CNNMoney.” Why all the hoopla? It’s all about demand, and that’s shifting into high gear.
Many signs are pointing to longtime soaring demand for occupational therapists, says Frederick P. Somers, executive director of The American Occupational Therapy Association (AOTA) – among them an aging population, more children diagnosed with autism and demands of healthcare reform.
According to the Bureau of Labor Statistics, employment of occupational therapists is expected to increase by 26 percent between 2008 and 2018, considerably faster than the average for all occupations.
And there’s one more factor driving demand for OTs. New Medicare rules encourage one-on-one occupational therapy sessions. While group sessions are allowed, organizations can no longer bill for all the time a resident spends in a group session. They can, however, bill for an entire one-on-one session. “So a lot of organizations are looking to increase their OT staffs to accommodate the new rules,” says Melinda Galloway, MS, OTR/O, rehabilitation manager of Presbyterian Homes of Louisville, Ky.
Despite the job’s healthy prognosis, expansion may be hampered by the impact of federal legislation limiting reimbursement for some therapy services. OTs would be wise to hone their skills for a market that will fragment and fluctuate.
Occupational therapists develop treatments to help restore their patients’ skills and abilities, working with the elderly, children, disabled and mentally ill patients. Whether they’re teaching a stroke victim how to dress, bathe and prepare a meal, or helping a child with learning disabilities conquer the mysteries of handwriting, occupational therapists provide crucial lifelines for people needing to learn – or relearn – living skills.
“The ‘occupation’ in occupational therapy refers to the things people do in their daily lives, not just on the job. It means self-care, mobility – the whole gamut,” says Frank Gainer, director of conferences for AOTA.
AOTA summarizes therapists’ jobs as the following:
– Develop programs to help patients perform better at home, work and in their communities;
– Evaluate homes and workplaces to recommend changes;
– Assess patients’ skills;
– Suggest needed equipment and train patients to use it;
– Educate family members and caregivers.
OTs can work their way into management supervisory roles.They can also return to school for post-graduate studies leading to research or teaching positions, but the most tried-and-true path to career advancement is acquiring a certification in an advanced practice specialization.
A day in the life of an occupational therapist
Being an occupational therapist goes beyond just liking to work with people. Gainer recommends therapists have to be comfortable working with ill and disabled people, or even autistic children who can be “very, very challenging.” And, the work is on-your-feet active. “If you want a desk job, this isn’t for you,” he says.
Sometimes an OT will use physical exercise to build muscle strength, while other times they’ll teach clients exercises that help build mental acuity, such as in helping a person with short-term memory loss to create lists. Computers also play a large role in a patient’s therapy, encouraging abstract thinking, problem-solving and perceptual skills.
For individuals with permanent disabilities, OTs teach the use of special equipment, from wheelchairs and orthoses to eating and dressing aids. In the workplace, OTs evaluate a client’s work space, and may collaborate with their employer to modify the space to fit the client’s needs.
Assessing and recording a client’s activities and progress play an important role in an occupational therapist’s job. Accurate records are essential for evaluating clients, for billing and for reporting to a client’s physician or other healthcare providers.
Occupational therapy requires a minimum of a master’s degree, national certification and a license in the state in which you practice. A number of states require an extra credential for treating children with feeding disorders because of the high risk of aspiration.
For those looking for a way to learn about the profession in a more gradual way, with fewer educational requirements, there is high demand for certified occupational therapy assistants (COTAs). OT assistants enter the field with a two-year associate’s degree, but can perform work only under a therapist. While the OT is the one who assesses, the COTA can create and conduct activities with a patient. COTAs’ median pay in 2009 was $44,000 a year.
Enhance your career with certification
All entry-level educational programs prepare an occupational therapist to be a generalist.
Gaining certification in one area of practice would be something you would pursue after you graduate and successfully pass the national exam. According to AOTA, there are eight certification areas, with the aging of the baby boomers leading several of these new practice arenas:
1. Gerontology. Eldercare is a booming specialty. OTs who certify in this area help older adults lead more active and independent lives by assessing their physical abilities, from doing the most simple tasks to the most complex, as they adapt to age-related changes.
There is a new term in geriatric healthcare: active aging. It means that healthcare teams now work to help older patients do much more than survive into their 80s and 90s; they help them thrive. Occupational therapists are key members of teams devoted to helping seniors remain active and vital longer than ever before.
The active-aging approach to rehabilitation is one factor increasing demand for OTs in geriatric care.
2. Mental Health. OTs in mental health settings work with individuals, who are mentally ill, developmentally challenged, addicted or emotionally disturbed. They teach patients specific life skills designed to mitigate the day-to-day difficulties that individuals in this group often encounter. The number of OTs working in mental health has dwindled, but the number of people who need these services has expanded.
3. Pediatrics. Pediatric specialists treat a wide range of disorders in infants, children and adolescents. Therapists evaluate, treat and manage a variety of neuromuscular, skeletal or cognitive limitations.
With children, the “occupation” is play, says Silke Hamilton, OTR/L, ATP, SWC, founder of OTchildren in Redondo Beach, Calif. For many reasons, children may have trouble with that process.
People considering becoming a pediatric OT should be masters of two main things, Hamilton says; this includes keeping children constantly engaged and motivated; and knowing how far you can push a child and how far you can push the parent without generating so much frustration that all progress is lost.
OTs must also realize that some of the children who need the therapy are severely disabled and may not survive. Someone considering the specialty should ask themselves whether they could handle dealing with a young patient’s death, Hamilton says.
4. Physical Rehabilitation. The goals of the OT are to devise and implement a rehab plan that will allow patients to be able to participate in the activities that they need and want to do. Patients are evaluated for limitations that require intervention and for strengths that can be used to compensate for weaknesses.
5. Driving and Community Mobility. Specialized training in driver rehabilitation will allow a therapist to assess an individual’s ability to drive during both clinical and on-the-road tests, and to then make recommendations for adaptive equipment and training.
6. Environmental Modification. An environmental modification is an adaptation to a building that will increase its users’ comfort, safety and independence. OTs evaluate homes and work spaces to assist patients in regaining their independence.
7. Feeding, Eating and Swallowing. OTs will train to mitigate problems stemming from a patient’s difficulty gathering food and getting ready to suck, chew or swallow it. Therapists in this area will work with everyone from infants to the elderly.
8. Low Vision. Low vision is a visual impairment severe enough to interfere with performance of daily activities. Certified OTs will be able to assess each patient, train them in the use of adaptive equipment and teach them techniques that will help them return to independent living.
You’ll need to meet the eligibility requirements before applying for any of these certifications. Check the AOTA program information.
Beyond the certifications offered by the AOTA, you can further your career by gaining additional credentials in these areas.
Diabetes Educator. By 2050, the Centers for Disease Control and Prevention estimates that one in three U.S. adults could have diabetes if current health trends persist. Aging, obesity, diet and lack of exercise will contribute to this epidemic, especially Type 2 diabetes. David Randal, chairman for the National Certification Board for Diabetes Educators, says, “To help people with diabetes maintain and improve the quality of their lives, it is critical that we dramatically increase the number of qualified healthcare professionals who provide diabetes self-management education.”
If you primarily perform diabetes related functions in your job you may be eligible to take the Certification Examination for Diabetes Educators, administered by the National Certification Board for Diabetes Educators. Occupational therapists must meet certain requirements, including a minimum of two years professional experience, with 15 hours of accrued continuing education relating to diabetes, before taking the national exam.
Dementia Care. According to the Alzheimer’s Association of America’s annual report, 5.4 million Americans — the vast majority of whom are women — have Alzheimer’s disease. Another 1 to 1.6 million have some other form of dementia. And, while they are cared for at home in the early stages, 75 percent of these Americans will be hospitalized or be cared for in a nursing home or dementia-care facility by the time they are 80.
Due to the complex and ongoing care needs of those with dementia, this means that occupational therapists who want to give their careers (and income) a boost should be getting additional training in dementia care.
For program and certification information, check with the National Council of Certified Dementia Practitioners and Dementia Care Professionals of America (a division of the Alzheimer’s Foundation of America).
Alternative Therapies. Alternative pain therapies like yoga and acupuncture are gaining in popularity, especially with the baby boom generation, and you might want to consider integrating these therapies into your traditional treatment plans. There are courses and certification programs available to help you become a traditional/alternative practitioner. Look for yoga training programs through The International Association of Yoga Therapists. Check out the National Certification Commission for Acupuncture and Oriental Medicine to learn more.
While alternative therapies like yoga and acupuncture can often yield dramatic results, experts agree that they are best employed as complements to — not replacements of — traditional therapeutic measures.
Hand Therapy. There are only about 5,000 certified hand therapists in the country, which may be a result of the rigorous requirements, says Dorit Aaron, OTR, MA, CHT, FAOTA, president-elect of the American Society of Hand Therapists. Hand therapists practice primarily in outpatient clinics — private or publicly owned or part of a hospital or doctor’s office. The work can also be in-patient if there are multiple traumas.
Before you can be a hand therapist, you must complete an accredited program in occupational therapy. To be certified in hand therapy, you have to have five years of practice in OT, two of which must be in the hand specialty and you must pass a certification test given by the Hand Therapy Certification Commission.
Rigorous training can pay off in larger salaries — larger than those for entry-level OTs. Depending on where you live, an entry-level hand therapist would probably make at least $80,000, Aaron says.
Where the jobs are
According to the Bureau of Labor Statistics, most occupational therapists work in ambulatory care centers. But hospitals, assisted-living homes and other healthcare facilities are big employers, too. Also don’t overlook opportunities in the field of mobile healthcare – where the medical team goes to a patient’s home.
“We know from discussions with major employers that shortages are acute in long-term care settings, and school systems often report difficulty in recruiting occupational therapy practitioners,” says Somers of AOTA. “State government workforce planners increasingly identify occupational therapy in their focus on shortages in healthcare professions…. These shortages are also reflected in the growth we see throughout the country in the numbers of university and college-based programs designed to educate occupational therapists and occupational therapy assistants, and the growth in students enrolled in these programs, which has averaged 11 percent annually over the past two years. The fact that most of our students have jobs lined up before they graduate is another strong indicator.”
There is no one region or city considered the hot spot for OTs. “This is a shortage field,” reports Gainer with the AOTA. “There are openings everywhere.” Even cities like Boston and Philadelphia that have four or five master’s level programs have OT shortages, Gainer says.
Salaries range from $60,000 to low $70,000s, though cities with high costs of living like New York and San Francisco may pay higher. The median salaries for those with a master’s degree is $60,000; OTD: $68,700; PhD: $76,000; and ScD: $86,000, according to the AOTA. And, like other healthcare professions, OTs may earn the most in rural areas with greater shortages.
Trends transforming the rehab profession
The exploding population requiring rehab, the levels and varieties of services required and the way it is paid for, have drastically changed that model. Rehab professionals who understand the “new” rehab reality and embrace these trends will be well-positioned to not only prosper in the future, but move up the career ladder, too.
1. Rehab is expanding to include prehab: Due to the increasing number of elective procedures (hip replacement, knee replacement, back surgery, etc.), rehabilitation facilities as well as fitness centers, active-aging community wellness centers and personal fitness trainers are offering preprocedure “conditioning” programs that enable patients to go into the hospital in better physical and emotional shape. This also speeds recovery.
2. Rehab is going holistic: The prehab-through-recovery focus places physical recovery at the center of rehabilitation, but, since all facets of a patient’s life (occupational, emotional, spiritual, intellectual and social) impact recovery, rehab professionals are broadening rehab to include a holistic approach. To better serve clients, many rehab professionals are getting additional training or certification in stress management, behavior modification, health coaching, Tai Chi and others.
3. Rehab is becoming collaborative: Due to the holistic approach, rehabilitation professionals are increasingly consulting/collaborating with like-minded professionals in kinesiology, chronic disease management, sports medicine/rehabilitation, home healthcare, personal training or massage therapy. Or, with additional training through organizations such as National Wellness Institute and Society of Sports Therapists, they are adding some of the expertise found in those professions to their own skill set.
4. Technology is playing an increasing role in rehab: High-tech equipment, such as computer-based biofeedback and tutoring programs, Wii-hab exercises and games, ultrasonic tissue and bone stimulators, is accelerating recovery and improving patient outcomes. Other devices (minicams, motion sensors and gait monitors) are individualizing therapy and improving client record keeping and collection of the kind of data required to validate and improve practice.
5. Reimbursement is in free-fall: Rehab services are primarily paid by Medicare, Medicaid, Workers’ Comp and insurance plans (third party payers). Consequently, the documenting, billing and reimbursement environment (especially the “bundling” of care and treatment services) will become more restrictive and complicated as the additional mandates outlined by the Patient Protection and Affordable Care Act are implemented. Expected cuts to state Medicaid programs and higher insurance co-pays will also complicate reimbursements.
Contributors: Terry Sheridan, Marcia Frellick, Elisabeth Greenbaum Kasson, Sue Mellon and Eileen Beal.