In a message dated 4/23/2002 1:15:36 AM Eastern Standard Time, [EMAIL PROTECTED] writes:
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.
*I'm sorry you had such unproductive relationships in these various arenas. While I have met people of other disciplines in each of the above settings who don't have a good understanding of OT, after working with us in all of those settings, most of the ones I have dealt with have increased their understanding, and have respected our contribution. Again, I feel that the OTs who are most successful at achieving these results with other disciplines have been able to effectively mesh their occupational approach within the primary model of the setting in which they work, be it medical or educational, rather than trying to impose a different model on the rest of the team. There are some members of other disciplines who are not reachable, but in my experience they were the minority, not the majority.
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.
*While I don't discount the threat this poses, I also work with PTs on a daily basis, and most of them are clueless when it comes to approaching these areas, and don't tend to try to do stuff they don't feel comfortable with. We have a Community Re-entry program, and OT, PT, ST, and Rec. therapy all are potential disciplines to take the patients on the outings. PT is the least likely to participate, and the least comfortable in suggesting adaptive approaches to the patients while they are on the outings. I have known a few PTs over the years who are exceptions to this, but they were the minority.
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.
*This does pose a potential threat if we as OTs don't also seek to market ourselves to the community, and work with our state associations to protect our areas of expertise. I think that working with and developing strong relationships with our referral sources will be the most effective means of counteracting this threat.
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).
*I have heard your feelings on this area. This area of practice is the one that I think is the most threatened by being taken away by PT, but since you feel that these OTs are not really doing OT anyway, I'm not sure why you're concerned that PT is more recognized for these types of treatments(based on your previous response to me). And again, I would go back to one of my previous posts to you, regarding the fact that different OTs treating with different approaches is just different not right/wrong, or driving a wedge.
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.
*I'd be happy to see what you have, as I am always interested in hearing varying opinions. If the opinions are not backed by facts, than I tend to take them with a grain of salt. I'll be curious to see what facts these articles use to support the assertions they make.
6. Numerous discussion I have heard and participated in regarding the fusion
of OT and PT into a single profession.
*Discussions with whom? Have you seen any movement in this direction by the AOTA, APTA, 3rd party payor demands, etc.? I've heard nothing in regard to changes in legislation, reimbursement or educational programs related to this.
7. OT not being able to open Medicare home health case speaks volumes of our
diminishing role in that arena of care.
*OT had NEVER been able to open Medicare home health care cases, and if anything, are closer to achieving this goal than they ever have been, since at least legislation has been proposed in the past year to change this. Not sure why you see this as new evidence of our demise.
*This is something that I have perceived is consistent with your beliefs, based on multiple posts by you in the past. This is at the heart of what I find inconsistent about your concerns. You feel that true OT philosophy does not mesh well in the medical model of care, yet you express concern about potential loss of referrals from the medical community. If you don't think we mesh into that model, than why are you even seeking referrals (or mourning the potential loss of them) from MDs, 3rd party payors, or others in the medical profession? I happen to work in a medical model setting, and I daily see the valuable contribution that the OTs who work in my dept. make with their patients. The fact that someone published an article talking about how we don't fit is not at all consistent with the 20+ years I have spent working within the medical model.
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.
*Mental Health is not an area I have participated in since my fieldworks, so I don't feel qualified to judge anything going on there, but I would ask why OTs migrated out?
9. Several published articles discussing the ill-fit of OT and the medical
model of care
I think that with the shrinking reimbursement dollar, all health care professionals are feeling threatened. I frankly think PT has done a better job of reacting to this threat by actively planning to ensure their survival. This does not mean that OT cannot do the same. Their is an article in an OT Practice from last year that talked about OTs in I think KY who offered educational programs for case managers that sounded extremely effective in reaching this important referral/reimbursement source. I think doing more of this kind of thing would be a positive step that our profession could make.
Ann
