Throughout the last several years, particularly during the COVID-19 pandemic, working Occupational Therapists (OTs) and Certified Occupational Therapy Assistants (COTAs) have faced egregious working conditions, requiring us to choose between ethical behavior, our patients'/students' well being, or our employment. The National Board for Certification in Occupational Therapy, Inc. (NBCOT) has a mission to uphold the ethical and safety standards of occupational therapy practice, but those standards cannot be upheld under such conditions. While the American Occupational Therapy Association (AOTA) has set guidelines for ethical behavior, it lacks substance in supporting its members for enforcing those ethical principles within the workplace. 

According to AOTA’s own research, high productivity standards increase the levels of moral distress felt by clinicians by placing exorbitant demands on the individual clinician’s time management skills (1). A national survey of inpatient rehabilitation professionals reported that productivity standards impacted their ability to provide quality care (2). While clinicians have been called upon to come up with their own solutions, the fact remains that this is a systemic problem, not an individual one; therefore, it cannot be solved at an individual level. This has been widely acknowledged in the literature; a 2022 study published in the American Journal of Occupational Therapy found that individual factors were not protective against feelings of burnout; however, organizational factors were (3). The US Surgeon General’s advisory for reducing burnout across healthcare professions also stressed the importance of recognizing the problem at a systemic level. (4) Additional research is available upon request. 

Here are the actions we propose that NBCOT and AOTA should take to address patient safety and clinician burnout at a systemic level.

1. Create realistic and ethical standards for productivity and ways to measure productivity for OTs across all settings, particularly in hospital-based and skilled nursing facilities.

2. Determine and legislate appropriate caseload sizes for school based OTs and COTAs.

3. While considering productivity, outline ethical and appropriate down time percentages for chart review, writing evaluations, prep time for therapy sessions, interdisciplinary patient care coordination, and other non-billable time so this can be built into our job descriptions instead of being forced to clock out between patients.

4. Allocate more resources towards promoting Medicare/Medicaid reimbursement, so that clinicians can be adequately compensated for their skills and patients can benefit from fair pricing.

5. Set guidelines for compensation for all work related items, including Individualized Educational Plans (IEPs) and Individualized Family Service Plans (IFSPs), which are often completed outside of contracted work hours.

6. Set guidelines for clinical education specifically that acknowledge the extra labor required in taking on a fieldwork student and disincentivize workplaces from pressuring clinicians to take students they do not desire or feel prepared for.

7. Set guidelines for the Accreditation Council for Occupational Therapy Education standards that better prepare clinicians for the reality of practice, including a focus on teaching intervention methods, to promote improved quality of patient care.

We look forward to receiving NBCOT and AOTA’s prompt response.

 

(1) Farniok, A. L. (2016, July 11.) Managing Productivity Requirements as a Level II Fieldwork Student. OT Practice Magazine. 

(2) Bennett, L. E., Jewell, V. D., Scheirton, L., McCarthy, M., & Muir, B. C. (2019). Productivity Standards and the Impact on Quality of Care: A National Survey of Inpatient Rehabilitation Professionals. The Open Journal of Occupational Therapy, 7(4), 1-11. https://doi.org/10.15453/2168-6408.1598 

(3) Shin, J., McCarthy, M., Schmidt, C., Zellner, J., Ellerman, K., & Britton, M. (2022). Prevalence and predictors of burnout among occupational therapy practitioners in the United States. American Journal of Occupational Therapy, 76, 7604205080. https://doi.org/10.5014/ajot.2022.048108

(4) United States. (2022) Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce.