Are you struggling with choosing which setting to work in once you graduate from occupational therapy (OT) school? Been there! It has definitely been a journey and it might take you some time as well to figure things out, but that’s okay.
I am currently a pediatric home health OT and it took me a while to figure out where I belong and what makes me happy, but I finally did it and have definitely found the right setting for me. After exploring multiple settings when I first graduated, I realized there are three main things I look for when choosing a setting:
- Pay: make sure they pay you well, do not take anything less than 80k.
- Flexibility: I needed a flexible schedule and preferred something on the go.
- Independence: I love managing my own schedule with a caseload that isn’t too crazy, and I enjoy working independently.
My advice to current OT students or new grads is to ask to be placed in multiple settings for your level 1 and level 2 fieldwork placements so that you can get an idea of what each setting offers. Ask yourself, what are the three main things you’ll be seeking from a setting?
But for right now, if you are just exploring some options, I have created a list of common OT settings, their differences, what I enjoyed about them, and what I didn’t like. Hope this helps!
Occupational Therapy Settings
Outpatient
Outpatient OT services can be offered at clinics, private practices, and hospitals. In this setting, you will be working typical 8-10 hour shifts. I can only speak from my personal experience, but I would clock in at around 7 am and would see my last patient around 5 pm (depending on whether they showed up on time).
In this setting, patient diagnoses are diverse and can include stroke, traumatic brain injury, various orthopedic conditions, complex regional pain syndrome, etc.
Most patients in this setting are either moderate or mild functioning which means the focus of treatment would be to reach functional independence.
Collaborating with an interdisciplinary team usually consisting of speech-language pathologists and physical therapists is common in an outpatient setting.
Some differences you might see in a pediatric outpatient clinic include longer hours since most children need to be seen after school during the school year, and different diagnoses such as developmental delay, cerebral palsy, autism disorder, ADHD, etc.
What I enjoyed about working in an adult outpatient setting:
Having higher-functioning patients allowed me to provide higher-level exercises, activities, and treatments.
What I didn’t like:
Working in a building for 8-10 hours a day, 5 days out of the week, with no flexibility in my schedule.
Inpatient
Inpatient OT services are offered in hospitals or rehabilitation units. Work days are also around 8 hours a day and depending on your facility you may have some flexibility with your schedule. For example, when I was working at an inpatient hospital, if we wanted to leave earlier for the day we could clock in earlier so I would show up at 6 am some days so that I would be able to leave by around 2-3 pm.
Patient diagnoses may be acute or complex. You usually have a high caseload in an inpatient setting ranging from 8-10 patients a day, and each patient is usually seen for 1 hour a day for occupational therapy treatment. Again, there is some flexibility in your schedule as sometimes patient treatment time can be split into two 30-minute treatment sessions, or you can lead group sessions of 2-3 patients at one time.
Inpatient facilities are HIGHLY interdisciplinary. You are usually on a team of 3 consisting of an OT, ST, and PT (you are all seeing the same caseload), and your schedule is intertwined with the other 2 disciplines. That means, if the speech therapist is seeing one of your patients at 10 am and the physical therapist is seeing the same patient at 11 am, then you can only schedule that patient either before 10 am or after 12 pm (usually there’s lunch, so you’d see them after 1 pm).
Yes, you technically manage your own schedule, but you also have to be aware of scheduling conflicts with your team, with the physicians, with nursing, and with patient procedures (MRI, dialysis, etc.).
What I enjoyed about this setting:
Building close relationships with my interdisciplinary team where we were able to bounce ideas off of each other.
What I didn’t like:
Managing a high caseload.
Skilled Nursing Facility
Skilled nursing facilities (SNFs) offer long-term care and rehabilitation services. SNFs provide opportunities for ongoing interventions and establishing rapport with clients over an extended period.
I’ve personally never worked in a SNF, but I do know other OTs who have. They usually report a productivity rate of up to 90% meaning that if you are scheduled to see 10 patients that day, then you need to see at least 9.
In the SNF setting, you mostly work with geriatric patients, individuals recovering from severe stroke complications, or patients with cognitive impairments (dementia, Alzheimer’s). SNFs provide rehabilitation services for individuals transitioning from acute care or after hospitalization.
Home Health
Home Health occupational therapists may also be considered outpatient therapists, however, when working in a home health setting, you are usually required to drive your own vehicle or a company vehicle to patient homes.
OTs in this setting typically manage their own schedule and caseloads with visits ranging from 20-30 visits a week (5-6 patients a day). There is a lot of flexibility in managing your own schedule and is mostly independent work. Multidisciplinary teamwork is limited.
Patient diagnoses can range from adult diagnoses such as spinal cord injury, orthopedic injuries, stroke, etc., or pediatric diagnoses such as developmental delay, autism disorder, ADHD, seizure disorder, cerebral palsy, etc.
What I currently enjoy about this setting:
Managing my own schedule and ability to complete documentation on my own time.
What I don’t like:
While I enjoy being independent in my work, it does get lonely sometimes, and there is limited interaction with other therapists.
I hope this list was helpful. If you’re a student or just graduated from OT school, remember to try multiple settings, and don’t be afraid to leave a setting you are not happy in. We all need to explore at some point and get to know what setting fits our needs, personality, and skills the best so that we can provide quality services to our patients.
Leave a Reply