I cannot believe that I have been working for a full year… Starting out as the only OT at a speech therapy clinic was super intimidating! I didn’t know whether it was a naïve choice, whether my confidence was just me trying to prove myself, or I truly thought I could make a difference.
Let me tell you something though, it was the best choice I ever made!!! Not going to lie, I literally cried the other day driving from work to my massage appointment (yeah, I get monthly massages lol), because I am so grateful for the people I work with and the families I have built such strong connections with.
To give you all some idea of what led me to this tiny little speech therapy practice (where I would have to build an OT department myself) rather than some other established practice, let me give you the rundown and the emotional turmoil I experienced lol:
- Beginning of 2021, I started looking into pediatric jobs in an area I was interested in.
- I applied to 2 jobs, one university-based outpatient center, and a larger private practice in the same town.
- I was interviewed for both, the private practice offered me the position, the hospital-based clinic had a timeframe of waiting for about 2 weeks before all interviews were completed and a decision would be made.
- The private clinic said they would wait for me to hear from this hospital.
- We waited, and the hospital was taking longer than expected, so I emailed the private practice to accept the position – they emailed back saying they hired a different clinician…
- I waited longer for the hospital-based position, which I was rejected from.
- Time to start over! I scanned Glassdoor and Indeed and found a clinic hiring an OT. It was a pretty vague job description, but essentially it was for an OT to start a department in an already existing speech therapy clinic (that consisted of only 2 speech therapists). No mentorship available to OT-specific things, no benefits, no health insurance… But I would essentially be making the OT practice exactly what I wanted it to be… So I accepted!
- Fast forward a couple of weeks, the day before I was scheduled to drive 4 hours to this new city to do headshots and formally meet everyone and check out the clinic – I get a call from the hospital-based clinic (with a great salary, full benefits, etc) that a position opened up and they want me. The caveat to this is that they need to post this job position online and allow internal employees to apply first and review these applicants before they can formally offer me the job…
- No WAY was I going to wait again. But it was a very tumultuous time for me! I was essentially choosing between a secure position with great pay and full benefits, mentorship, other therapists to learn from with a reputable hospital… versus a super risky job that can’t guarantee anything or provide mentorship for my new-grad self.
- Well, we all know which one I chose – and I am SO grateful that I picked the tiny speech therapy clinic to start my work as a pediatric therapist.
In the year that I’ve worked at this clinic, I have completed over 90 evaluations, including newborns, early intervention patients, school-age kids, young adults transitioning from school to the work-force, and every age adult for a wide range of conditions. I’ve completed over 1,400 treatments ranging from handwriting, breastfeeding/latching, feeding therapy, sensory integration, neuro-based treatment, ADL skills, cognitive skills, coordination, visual-motor and visual-perceptive skills, and so much more. I have been promoted to lead therapist, giving me more responsibility (now that we have grown so much as a clinic!). I became a Certified Neuro Specialist, enhancing my treatment skills with all of my neuro patients. I’ve cried with families when they received a hard diagnosis, and celebrated when we achieved goals and made progress. I worked tirelessly through my weekends to ensure that I was being the best therapist I could be for my kids and their families. I spent a lot of my own money for toys, classes, CEUs, worksheets, and books.
When I started at this clinic, I worked in a bare-bones room, with a 4-step staircase that my boss’s husband made, a futon couch, and a tiny Ikea table with a few toys and a swing. A year later I’ve moved into the largest room in the clinic with a swing, a rock wall, a ladder, staircase, counter-space and storage for the abundance of toys, obstacle course pieces, chalkboard and felt board, a table small enough for my littles but big enough for my school-aged kids, arts and crafts, feeding supplies, therapy balls and different types of swings!
Now we’ll get into some of y’alls questions about my experience!
Q&A
Did you ever feel a sense of imposter syndrome or having to fake it until you make it?
ABSOLUTELY!! I still feel like an imposter, especially now that I am the lead occupational therapist! This feeling definitely fluctuates though, lately I have felt more confident in what I am doing, but then that feeling sinks in again and I dive into researching to see if what I am doing is even right.
I don’t think imposter syndrome is truly a bad thing (to an extent). Humility is incredibly important in this profession, and understanding the limits of your expertise. I never make promises to patients, and when I don’t know the answer to something, I am the first to say “I have no idea, but let me do some research and get back to you.”
If you have put in the work to hone your craft and increase your knowledge, then it is important to reflect that confidence, but faking it until you make it can lead to some bad consequences and broken trust… Being honest with your clients, families, and even employers is so important in building that trust, and identifying areas where you may be lacking – so that you can work on those skills that need to be worked on!
What did it take to become a certified Neuro specialist?
I wrote a whole blog post on my experience becoming a Certified Neuro Specialist here.
How do you manage your caseload, evaluations and reasonable work getting done by end of day?
Where I work, we are required to complete documentation in 24 hours. During the treatment day, our sessions are 30 minutes, 45 minutes, and 60 minutes and treatment times is as such:
- 30 minute treatment = 25 minutes of direct treatment + 5 minutes to transition to parent, talk to parent, clean and document
- 60 minutes = 50 minutes of direct treatment + 10 minutes for other tasks
This doesn’t seem like a lot of time to document (it really isn’t), so the bulk of my documentation time is during cancellations or in my prep time before the workday (I come in 30-45 minutes early every day to prepare).
I work 8 am to 6 pm with a 1 hour lunch, with most of my days being back-to -back with patients, but in the outpatient world the cancellation rate is around 20-30%, so it is very rare that I actually work the entire day! I usually have at least 1 cancellation.
Could you tell me about your fieldwork in OT school and what your experience was getting a job after you graduated?
I had 2 fieldworks, one in outpatient pediatrics and one in acute care – I wrote blog posts about them:
What has been your favorite accomplishment thus far and why? And what was it like creating an OT presence in another speciality areas department, that sounds fascinating to learn more about.
My favorite accomplishment so far has really been just starting an OT department! I didn’t really have an idea of what I was doing when I started at the speech therapy clinic, I based a lot of my decision-making on my experience during my level 2 fieldwork, and I did a lot of research on best practice, what the best assessments were, etc. And we have grown so much that we’re physically growing out of the space we have! Last year it was just me (the OT), and 2 speech therapists. Now, we have 2 OTs, a COTA, 3 SLPs and 1 SLPA. AND we have a waiting list for patients!
What was something you least expected?
I think the thing I least expected was how attached I would get to my patients and families. I think about my patients almost all of the time, and have to consciously tell myself to stop focusing on “work” when I am home or on the weekends. I feel so emotionally attached to my kid’s development, and when they experience hard things or get a new diagnosis, I feel that pain alongside their families (probably not to the extent they do, but it all adds up with so many kids on my caseload!)
Do you see yourself staying their long-term? What are your long-term goals?
I went into this job with the knowledge that it would not be a life-long placement. When I accepted the job, my boss asked if I could commit to 1 year (and I did that!). I recently told me boss that I could commit to another year to help the clinic continue to grow before I start looking at new opportunities (I want to do travel therapy eventually), and she is very supportive of this – to the point that she was actively trying to convince me to just quit and move to Hawai’i (where my sister just moved) lol. Not that she wants me to leave, but she knows how much I love to travel and that my goal is not to stay in the same place forever.
My long-term goals right now look like gaining more education/knowledge on breastfeeding, improving my skills in cancer rehab (specifically with scar management to aid in lymphedema management), and just being the best therapist I can be!
Overall:
This year has been a whirlwind. Truly. I have learned so much, not only about occupational therapy and treating, but about owning and operating a small therapy clinic, interpersonal skills, managing employees, setting boundaries, and learning how to be assertive.
I’ve also learned that what appears to be unexpected and not at all part of my life plan – is just God leading me exactly where I need to be. God has graciously shown me what I am capable of, that my worth does not rest on my productivity or my ability to seem like I have it all together, that I am exactly where he intended for me to learn and grow. I feel so confident that God placed this job precisely for me at the right moment, because I needed to learn so many of these lessons, and meet all of the wonderful people that I have in my life now.
If you have additional questions about my experiences, please feel free to leave a comment, or reach out through the “Contact Me” button on my page!
OT Caroline 