Time to escape the comfort zone.

Time To Escape the Comfort Zone Alrhough I have renewed my membership in rhe American Occuparional Therapy Associarion (AOTA) as a pracricing rherapisr, I am concerned abour our profession's furure. Wirh rhe influx of managed care dicraring healrh care delivery, occuparional rherapy is ar a crossroads berween sragnarion wirh professional parochialism and growrh wirh rhe vision of role enhancemenr. The AOTA has seemingly ignored rhe rrends rhar are rhrearening rhe furure of occuparional rherapy, and mosr imporranrly, rhe parienrs and dienrs whom occuparional rherapisrs serve. Firsrly, while rhe represenrarives of our Association have worked energerically on inrernal issues affecring rhe AOTA, such as rhe disagreemenrs wirh rhe Narional Board for Cerrificarion in Occuparional Therapy, rhey have provided only lip service ro congressional and executive leadership ar rhe srare and federal level wirhour arracking rhe sysremic issues rhar are limiring occuparional rherapy services. For example, rhe Healrh Care Finance Adminisrrarion has minimalized rhe viral roles occuparional rherapy pracririoners perform for parienrs who receive home healrh care by nor allowing occuparional rherapy pracirioners ro provide srand alone servies, rhus limiring our conrribu rion. Secondly, rhe Associarion appears unable ro conrrol rhe proliferarion of projecred an increased need for occuparional rherapy services unril rhe year 2005, rhe ourpur of new graduares will surely override rhe demand. These "career rrend" srudies appear ro ignore rhe obvious willingness of many healrh care adminisrrarors ro forego rhe expenise of professional level rherapisrs by using less cosrly aides and assisranrs ro provide rherapy services. The morivarion of healrh adminisrrarors is profir. Ourcome goals will be affecred as healrh care managemem dicrares rhe level and an10unr of rehabilirarion ro each pariem or diem. As a response, rhe Associarion's Commission on EcIucarion and Accredirarion Commirree should implemenr a cerrificare of need prorocol wirhin rhe accredirarion process as a srop gap measure ro counrer rhe over-proliferarion of academic insrirurions inreresred in srarring occuparional rherapy educarion programs. The simple marrer is "greed." Wirhour dear evidence of rhe necessiry for developing new occuparional rherapy programs, we will only enrich rhe academic insri[Urions ar rhe expense of rhe profession. Lasrl y, and probably mosr comroversially, our leadership has done a lor ro aruacr arremion ro rhe very posirive role of occuparional rherapy in healrh care bur has done lirrle proacrively ro ensure rhe furure of our profession rhrough role enhancemenr and cross rraining. As demands increase ro provide services ar a capirared rare, employers will focus on rherapisrs who are willing ro cross rrain and diversify rheir skills in rhe healrh care delivery sysrem. This may mean rraining in a complemenrary profession or redefining rhe occuparional rherapisr's role wirhin a rransdisciplinary environmenr. Alrhough AOTA is againsr such posirions ar rhis rime, healrh care mainrenance organizarions and hospiral adminpy profession over rhe desire of profirs. Perhaps a separare associarion of occuparional rherapisrs, physical rherapisrs, and speech-language parhologisrs who are willing ro consider rhe benefirs of cross rraining ro counrer rhe influx of managed care needs ro be esrablished. Or, we may need ro reesrablish a new professional idenriry rhar will creare a new level of rherapisrs who can specialize in rheir inreresr areas and, ar rhe same rime, be available ro a diverse referral base. As for rhose who wish ro hold our in rhe vain arrempr ro keep rheir "sacred" idemiry inracr, ir may be possible bur ar rhe peril of rheir employmenr.