Occupational Therapy and the 'Seat at the Table' Fallacy
I’ve been writing about occupational therapy’s educational evolution for nearly two decades, and this feels like the conversation we need to have next. For years, the justification for moving occupational therapy education to the doctoral level has centered on an oft-repeated promise: we will gain a seat at the table.
The logic was simple enough - if we matched the credentials of our peers in other health professions, we’d gain equal standing, influence, and voice. I believe that assumption, though comforting, is wrong.
A degree doesn’t grant influence. Credentials open doors, but they don’t dictate what happens once you step through them. A “seat at the table” means very little if the table itself was built by someone else, and if all we do is wait to be served.
I’ve been a vocal critic of the mandatory entry-level OTD for exactly that reason. The last time we went through a similar transition - from bachelor’s to master’s - we promised transformation and ended up with little more than degree inflation. More credits, more cost, more coursework - but not necessarily more contribution.
Now, as I watch so many programs making the same move again, I worry we’re repeating the cycle. If all we do is repackage old content under a new credential, we’ll have missed the point entirely.
But I’ve also come to believe that resistance alone isn’t enough. If we are going to be doctoral, then we need to do something with it. The degree itself isn’t the problem; the problem is when we fail to leverage it toward creation, collaboration, and genuine innovation.
That is why I left a very comfortable position at a smaller institution and left to start a doctoral program in a very different kind of place. At Rochester Institute of Technology, I see what a different model can look like - one rooted in design, technology, and interdisciplinary work. Not because those things are trendy, but because they position occupational therapists where new ideas are actually being made. In that kind of environment, the goal isn’t to ask for a seat at someone else’s table. It’s to contribute to the making of the table itself.
OT education should not be about credential parity. OT education should be about cultivating the kind of presence and capability that make our voice indispensable. We should be the ones designing adaptive devices, improving systems, leading human-centered innovation, and translating research into practice.
That’s the only justification for doctoral preparation that holds water.
Not more degrees.
More doing. (Many OTs like that frame).
The next chapter of occupational therapy shouldn’t be defined by who lets us sit with them.
It should be defined by what we build, together, when we stop waiting to be served.
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So here’s the challenge:
If your program is transitioning to the doctoral level, what are you doing to differentiate - rather than inflate?
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The uncomfortable truth is that too many OTD programs - old and new - are mistaking undisciplined activity for advancement. The profession’s great migration to doctoral education was supposed to spark innovation. Instead, in far too many cases, it has generated inflation: more courses, more credits, more capstones… but not necessarily more contribution.
I’ve started calling the trend unstructured hobbyism, or the tendency for doctoral capstones to drift into the personal interests of students rather than the strategic needs of the profession.
We have all seen this happen: projects on goat yoga, climate advocacy, art journaling, or “the role of OT in [insert trending topic].” They’re often well-intentioned, sometimes even charming, but they are rarely reproducible, scalable, or evidence-based.
The doctoral capstone was meant to create new models, tools, and frameworks that advance practice. Instead, it often validates personal enthusiasm as scholarship. When every hobby or special interest becomes a capstone, we risk diluting what it means to do doctoral work at all.
This isn’t an attack on curiosity or creativity. It’s a call for discipline and a call for turning passion into systems, not self-expression. A real doctoral project should outlive the student who designed it. It should move knowledge, not just feelings.
One student spends a year developing and validating a sensor-based assessment platform that tracks upper extremity recovery post-stroke, working with engineers and clinicians to pilot it in an outpatient setting. Their work generates data, contributes to a publication, and lays the groundwork for a clinical trial.
Another spends the same year designing an “OT role in soup kitchens” type of project, creating educational handouts, hosting a few sessions on adaptive cooking, and writing reflections about occupational justice and community engagement. It’s compassionate work, but it leaves behind no new data, no replicable model, and no framework for sustained practice.
Both walk across the stage with the same letters after their names: Doctor of Occupational Therapy.
That equivalence erodes credibility. When every project, regardless of rigor, scope, or sustainability, receives the same validation, the degree loses its power to signal excellence. The issue isn’t that one project is “academic” and the other “creative.” It’s that only one meaningfully expands the profession’s knowledge and capability.
Doctoral education isn’t about “doing what you love.” It’s about creating work that matters to others and to the field - and making sure that they effort is replicable, measurable, and impactful.
And then, as if summoned by the algorithmic gods, along comes the perfect example that have caused me to come back to this post and expand it.
A recent LinkedIn post making the rounds featured an OTD student championing “The Distinct Role of Occupational Therapy in Football.” The post earnestly explains how OTs could help NFL players recover faster, manage stress, and perform better under pressure. The call to action: “Tag your favorite NFL team to help spread awareness!”
Within days, many comments poured in - OTs tagging the Ravens, the Eagles, the Cowboys, the Bills. A tidal wave of hashtag advocacy - passionate, performative, and ultimately toothless (dare I say, worthless?).
This isn’t to mock the student’s enthusiasm. It’s to ask a harder question: what does this accomplish? Does tagging a professional sports team bring OT closer to being integrated into sports medicine systems? Or does it reinforce the illusion that awareness alone equals progress?
Awareness does not equal progress. We need to stop thinking that it does.
The profession continues to conflate visibility for value. “OT belongs in sports.” “OT belongs in climate change.” “OT belongs in politics.” These statements are slogans, not strategies. They make us feel included in global conversations without actually contributing to them.
Real inclusion requires evidence, collaboration, and systems thinking. If OT truly wants a role in elite athletics, then our doctoral programs should be producing research on sensorimotor performance, neurocognitive recovery, or biomechanical optimization. Not #GoBills hashtags.
Doctoral education should equip graduates to walk into that NFL training facility with validated data, a prototype, or a clinical algorithm in hand - not a social media campaign.
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The Doctorate as Design, Not Destination
To bring this back to the original theme, the next generation of OTs doesn’t need more tables to sit at. They need more workshops to build in. The doctoral degree should be a design lab - a space for constructing frameworks, technologies, and evidence that make occupational therapy indispensable.
The problem isn’t that we think too small. It’s that we mistake talking big for doing big.
So how about that challenge?
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