I was inspired because I was looking for a career where I could work directly with patients and liked the option of working in several different settings. Initially, I wanted to work in mental health and got my undergrad in psychology from the University of Minnesota. After undergrad, I took two years off of school to work in a social work setting where I was introduced to OT. I initially was interested in pursuing OT in the mental health setting and liked that I would be working directly with patients. I was drawn to the idea of giving someone their life and independence back after a traumatic life event when they felt hopeless. While it's great that doctors can save people's lives on the brink of death, it's still a tough situation if you can never walk again, speak with your friends, or even put a shirt on. I wanted to help with that.
I applied to grad school through an online platform (otcas.liaisoncas.com) that submits your application to several schools. For the application, you have to write several essays, get letters of recommendation, and complete 40 hours of observation with an occupational therapist in several different settings. The 40 hours of observation is very helpful because it ensures you know what you're getting into before starting applying to an OT program. For most schools, you also have to take the GRE standardized test.
I got into the University of Wisconsin-Madison's program, where being accepted is very competitive (only 23 people are accepted each year). In my opinion, the fact that I had taken 2 years off from school to work and gain real-work experience really helped me get in. Schools like to see you will be able to pull from your work experiences to better relate to patients and be a better clinician. My OT program was three years long: 2.5 years of classroom work and six months of clinical practice. Each clinical is three months long, and there are a few breaks throughout the 3-year duration. I would highly recommend that you do your clinical work in the setting you want to work in after graduation, because this will be the only OT experience you will have on your resume. Overall, I thought my program was pretty well balanced and not overly difficult compared to other grad programs I’ve heard about. In the first two years, you learn many broad concepts and don't go into a lot of specifics until you get to the clinical setting, most job-site specific training comes once you choose your setting.
Once you graduate, you take your board exams for your national license, called the NBCOT. The exam covers everything, so it's somewhat tricky with how broad the field of OT is. Pretty much everyone leaves the examination thinking they failed. I remember having a near panic attack because I thought I failed and didn't want to wait to retake it. Luckily, I found out I passed a couple of weeks later and had the go-ahead to start practicing and applying to hospitals.
When I arrive in the morning, I get my patient list and assignment for what unit I’ll be on that day. I do a full chart review for each patient so I know what their medical history is and why they are hospitalized. Acute care OT requires a lot of medical understanding in order to know how the patient’s body will respond to your treatment in relation to their reason for admission. You have to know what lab values are significant, what a patient can or cannot do after a specific procedure, or how far to push an unstable patient. For each patient, my job is to evaluate their current level of functioning and determine what is limiting them from being independent and returning to “pre-hospital” life. I’ll then create goals and a treatment plan to get them back to that level. I’ll also work with the patient and their family to determine the safest place for them to go when it’s time to discharge from the hospital. If I've already evaluated the patient, each therapy session will focus on addressing their goals and helping them get stronger, increase independence with daily activities, and prepare for discharge.
For example, if a new patient comes in for an acute stroke, they may have impairments related to coordination, strength, cognition, or vision. Each session will consist of functional, everyday activities to target this impairment. For example, if a patient has a visual field cut, we may have them work on visual scanning in preparation for walking in the community. If they have arm weakness or incoordination, we may have them load and unload a dishwasher with their impaired arm. We focus on doing “exercise” in the context of an everyday task, like a simulated kitchen activity, because research shows this increases neuroplasticity more quickly than traditional exercises. OTs can be as creative as they want to design treatment activities, and usually try to simulate daily life. At my hospital we have a fake kitchen, bedroom, bathroom, and even a car to have people practice with.
Usually, I see 8-10 patients a day, with a mixture of first time evaluations and follow up treatment sessions. In acute care, the individual therapist is often able to create their patient schedule and decide when they see patients, when they take their lunch, and when they complete their documentation. After eight working hours, my day is over, and it's nice because I don't have to take any work home with me. If you're a new therapist, you may want to study various things you see at work, but overall I have great work-life balance and leave my work at work.
Being an OT is very fulfilling because you meet many people at their most vulnerable point in life with little to no hope. If you can be that person to give them a glimmer of something during such a dark time, I think that's powerful.
Because it's such a broad field, there's always room for learning and growth. The medical field is ever-changing and growing and, if I wanted to, I could still move to a new setting or scope. Some examples include mental health, inpatient rehab, outpatient, pediatric, school, academia and research, etc. I also know if I want to move to a specific city or state, there will always be job opportunities there.
Looking at OT as an investment, I would say that schooling is a moderate sacrifice for a high gain. I had about $60,000 in loans from grad school alone that I have been able to pay off, and I now have a career that I can utilize for the rest of my life.
You need to be a people person and want to work directly with people. It's not a great job if you like to sit down a lot, or prefer to work in an office. The position is relatively physical, you're always on your feet, doing a lot of bending, lifting, standing, moving around, etc. It's not the most glamorous job; if a doctor comes in, we're often pushed to the side.
Working in acute care may not be as fulfilling as working in other settings; progress is often slow, and you don't always get to see the same level of improvement as a setting later in the patient’s recovery process..
We don't get paid as much as I wish we did, fingers crossed for a market adjustment!
Jobs are only growing for OT's. There's always going to be sick people, there's still going to be people who are injured, people who need retraining. Usually, there are not enough clinicians to go around; you'll always be able to find a job even if it's not necessarily the setting you want. I received a master's, but a lot of schools are transitioning to doctoral programs. I could see all the schools going this way in the next ten years or so. I don't see the benefit in a doctorate program, because students will be going to school for another year, paying more and getting the same jobs available today. Doctoral programs will likely weed out many potential OT candidates who don't want to invest that much time and money.
Try and narrow down what your passion is (what type of patient population) as early as possible and gain experience in that area. I get excited about the medical field and learning about new treatments. I like the hospital setting, the fast pace, being able to use my critical thinking skills. OT challenges me and working with this medically complex population has an element of risk to it. If I do something wrong or am not informed, I could hurt a patient, and that keeps me engaged and on my toes in a strange way. If you don't like fast paced settings or prefer more stability, working in a school, rehab center, or outpatient clinic might be preferable where it's more calm and relaxed.
Once again, I recommend that one of your clinicals be in the exact setting you want to get a job in later. This is a great career overall!