Occupational therapy private practice: A day in the life

I received an email yesterday from an anonymous commenter who wanted to know what one of my actual days looked like as a private practitioner.  So here goes a listing of what happened today, which seems as representative as any other day :D :

4:30am Wake up.  Read email, respond to email.  Check local and national headlines, reading 1-2 articles of interest.  Check Internet forums, respond to messages.  Look at clock and sigh.

5:15am Go back to sleep. 

7:15am Wake up, again.  While having breakfast read email, respond to email.  Complete a journal and focused medical news scan, reading 1-2 articles of interest. Check Internet forums, respond to messages.  Look at clock and sigh.

8:30am  Wonder why children are still sleeping, pay attention to the cat and dog, leave for the office.

8:50am Arrive at office.  Meet with parents in the waiting room while their children are in for therapy.  Banter, advise, support.  Repeat as needed.  Schedule meetings to resolve lingering issues with marketing consultant and accountant.

9:30am Sit at office computer, load up email program, Twitter, Facebook, and news readers.  They are now prepared for scanning throughout the day.

Write reports.  Schedule incoming appointments with new families.  See children.  Talk to more parents.  Supervise and monitor Level II student.  Meet with staff.  See more children.  Talk to even more parents.  Respond to emails.  Ruminate, generate questions, and research morning issues including:

1. What are all the possible reasons why a child who has dual diagnosis of Down Syndrome and Autism would have neurodegenerative regression during the preschool years.

2. What are appropriate (sensory tolerable) calorie enhancers to suggest to a parent whose child has a constricted diet.

3. Is inappropriate use of social media a problem in itself or does it represent a foundational ethical problem with maintaining appropriate professional boundaries.

Act on information obtained following rumination and research.  Direct staff, advise parents, rant on professional forums.

12:45pm Look at clock and sigh.  Eat lunch rabidly.

1:00pm Complete evaluation of a new child with Level II student.  Make decisions.  Consult with family.

3:30pm Read email, respond to email.  Check Internet forums, respond to messages.  Look at clock and sigh.  Consult with COTA about caseload issues.  Try to return phone calls and wish that more people worked later in the afternoon. Start some letters, but only finish the marketing one to the cardiologist about the recent study in Circulation re: neurodevelopmental problems in children following complex cardiac procedures. 

4:30pm Worry about personnel shortages in rural areas.  Commiserate with colleagues about shortages.  Call another colleague and commiserate about the child/family who is having feeding difficulties.  Ruminate, plan, coordinate.

5:00pm Tell student to go home.  Tell staff to go home.  See more children with COTA.  Meet with parents to discuss MD plans to add Metformin to an Abilify regimen.  Discuss activity level, changes in routine, and difficulty with measuring behavioral effects when overall routine is disrupted by summer schedule.  Worry about how to give MD the best information to understand effects.

5:30pm Worry more.  Research cardioprotective value of Metformin.  Try to find articles related to use in children who have autism.  Tell COTA to go home.  Look at clock and sigh.

6:00pm Look at what didn't get done today.  Didn't address billing today.  Didn't pay bills today.  Didn't finish letter thanking someone for interviewing.  Didn't receive payment from  some vendors that owe some money.  Be thankful that payroll is NEXT week.

6:15pm  Write pointless blog post outlining my day.

6:30pm Leave office.


Barbara TherExtras said…
Chris, you are adjectively superior. (Comment spellcheck says that is not a word. Donotcare) I esp like morbidly.

I ruminate also, in the cognitive sense, counting on you not meaning in the bovine sense.

I disagree that this was a pointless post. I see it on the priceless end of the scale.

Summatively, (donotcare that is not a word either) THE point of this post is that we think. Thinking is the essential part of our work to benefit children and their families, training new therapists, employing people.

For anyone who would look at you over a day and not understand your (our) work, their image of occupation is limited.

Thanks for expanding some minds here today, Chris.
Cheryl said…
you found time in your day to make me smile with a comment! Sorry I don't live in NY... I would love to come work at your clinic
Thank you both; I am blessed with such great blog buddies!
Mike said…
"12:45pm Look at clock and sigh. Eat lunch rabidly."

I'm guessing you did not have a napkin as you ate your slice of pie with whipped cream, so your mouth was foamy?

Donna said…
I am an OTA student in Virginia and helpless to understand why Occupational Therapy is not the therapy of choice for mental illness and wellness recovery. I am a mother of a child with AS, a daughter in law of ailing, elderly parents and wife to man suffering PTSD like symptoms from being downsized & still struggling to find meaning. And, no one within the medical or psychiatric community in which I live can help. One saving grace in my daughter's wellness was finding a pediatric OT trained in Sensory Integration Therapy. Yet, insurance, in its wisdom would not cover it. A counselor with half the training of an MOT can set up shop and be paid from insurance. But, OT? -- still at the mercy of Medicare and Physician's Referrals. Is this pervasive? Tell me there's hope! - Donna S.
Hi Donna - thanks for writing.
I have been in private practice for many years and I find that it is quite rare when health insurance does not include occupational therapy as a covered benefit. Whether or not insurance covers intervention approaches which are evidence-based or not is another matter - but I don't think that we should expect insurance to cover treatment approaches that are still investigational. That being said, a child who has AS may benefit from many aspects of OT including improving social skills, addressing motor delays if they are present, and developing situational coping skills. There are mental health parity laws in many states so coverage for a wide variety of concerns is often possible. I think that there are many opportunities to make sure that we can meet the needs of children and families at the point of the problem, but if we persist in functionally politicizing our coding system by coding something 'sensory integration therapy' (which in itself has been poorly defined from the start) then WE are the ones who are placing the barriers up for people who need services. There are also many opportunities for families to receive services through municipal systems (like schools) so I would say there is a lot of hope - as long as we know how to effectively navigate these systems.

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