The Top 3 Challenges for Occupational Therapists and how to promote change

Occupational Therapy is poorly understood and overlooked as a profession in the medical community. In this article, I’ll discuss the biggest challenges of Occupational Therapy and what OTs can do to leverage their profession.

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#1 OTs are Mislabeled as PTs

On a daily basis, Occupational Therapists are mislabeled as Physical Therapists. It happens with doctors, nurses, and even patients. Why does this happen?

Most healthcare professionals mislabel OT, because it’s sometimes difficulty to differentiate disciplines. At times, I’ve mislabeled a respiratory therapist for a registered nurse. I’ve also mislabeled an ultrasound technician for a doctor.

Some facilities will have different departments wear different colored uniforms to make this easier. This is a good idea, but most therapists (PT, OT, ST) end up wearing the same color.

How OTs can avoid being Mislabeled as PT

If OTs want to stop being called PT they need to find a way to stand out. This might include adding a tag to their name badge with OT written in large bold lettering.

Another way to stand out is to speak up. Help your patients to know and understand what OT is before they leave the facility. At each followup visit test their knowledge on OT.

For ideas, share this post on how OT can be used to make life more meaningful.

#2 OTs are Overlooked in the Medical Community

OTs aren’t only mislabeled in the medical community, they’re also overlooked. For example, a doctor or case manager may only look at PT notes before deciding to discharge a patient.

They may decide to discharge a patient who has walked 500 feet with Physical Therapy, but ignore the note from OT that says that the same patient is unable to get off the toilet, perform lower body dressing, and draw a clock.

Many doctors don’t know that OTs are able to do the same things that PTs do and much more. This is often due to extrinsic factors and the culture of the facility.

How OT is considered less important than PT

Occupational Therapy is also overlooked by medical professionals because OT focuses on activities that appear less important. For instance, self-care activities such as dressing, personal hygiene, and bathing may appear less important than walking (PT).

These tasks may be seen as simple compared to the exercises and ambulation activities performed by PT, but in reality, dressing and bathing can be more challenging and rigorous than a simple walk and some light exercises.

What OTs can do to leverage their profession?

The best way for OT to leverage their profession is to speak up and educate. Provide an inservice to physicians, case managers, and other hospital staff.

Ask what PT does that OT doesn’t do? Educate them on the importance of OT and why walking isn’t a great indicator for discharge.

In a hospital setting, ask when PT should be ordered for a patient and not OT? Explain that in almost every scenario OT should be ordered when PT is ordered.

If PT is only ordered to see if a patient can go home, explain that OT takes a more holistic approach and assesses not only gait, but cognition, vision, and the ability to perform some of the more difficult tasks at home that include dressing, toileting and bathing.

You might also use this MET level chart used by the CDC to explain the importance of assessing ADLs. This could easily be presented during a lunch hour.

ActivitiesMet Levels
Doubles Tennis5 Mets
Hot Shower4.5-5 Mets
Met Levels Comparison (Tennis and Bathing)

#3 The Negative Culture of OT in the Medical Community

One factor that downplays the role of Occupational Therapy is the culture of the facility. This happens when doctors deny OT services. This also happens when a facililty defines their own policies and procedures for how OTs should provide services.

When Doctors Deny OT services

Why Doctors don't order OT

I’ve worked in hospitals where doctors don’t believe in the value of OT. As a result, many doctors won’t even order OT. This is a disservice to OT and the patients who would benefit from OT.

In many instances, a patient is unable to go to a rehab facility unless they have an OT evaluation.

If the patient hasn’t seen OT, this may bottleneck the discharge process and further delay the patient from receiving the services they need in rehab.

Denying OT services can cause readmission

Denying OT services can also lead to issues of malpractice and increase the hospital readmission rate. For example, most falls and injuries in the geriatric population happen during ADL activities.

When OT services aren’t ordered, a patient may go home from the hospital and have a fall while performing a simple ADL. This can result in readmission. When it happens, it reflects poorly on the hospital and staff members.

When OTs are told to not walk their patients

I once was walking a patient through the hospital halls when a PT asked what I was doing? It was clear that he was upset that I was walking his patient. In his mind, ambulation was not part of OT.

Walking is probably one of the most important Activities of Daily living as it is required for almost every functional task. It’s also extremely beneficial for patients who need rehab and have have been in a hospital bed all day.

Many OTs in hospitals are discouraged to walk patients, because if a patient becomes tired after walking with OT they may not want to do it again with PT. This may negatively count against a Physical Therapist’s productivity and may poorly affect billing.

Some would also argue that OTs should not walk patients because it’s not in the OT scope of practice. This is simply not true. Walking and ambulation are considered activities of daily living and part of the OT practice framework.

Physical Therapists are better at recognizing and assessing gait patterns, but there is no reason OTs should not walk their patients or practice stairs.

How OTs can change the Healthcare Culture

OTs can change the way they are perceived, by working on goals that are most beneficial for the patient. If the patient is independent with their ADLs, they might challenge the patient by working on intense IADL activities.

If you’re having a hard time thinking of intense activities, look at common Met levels for ideas (i.e carrying groceries upstairs).

If the facility doesn’t have a place to work on IADLs, or the patient doesn’t want to do IADLs, practice walking household distances.

If the patient has to carry groceries from the car to the kitchen or up the stairs, think of a creative way to practice this activity at the facility.

If the patient isn’t willing to work with both PT and OT, combined treatments should be implemented. You can always justify co-treatment by documenting that the patient declined or was unable to tolerate both sessions.


The way we change the facility culture is by focusing on the goals of the patient. It’s not about meeting OT or PT needs, it’s about collaborating to meet the patient’s needs.

When we focus on the patient’s needs first, we become more productive, client-centered, and build a better facility culture.

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