The recently concluded Midyear Assembly of the Philippine Academy of Occupational Therapists (PAOT) was one of my favorite PAOT events. I liked it a lot because the speakers taught us many life lessons that we occupational therapists (OTs) can apply in our personal lives. Moreover, the officers gave us a roadmap to career progression, as well as tools for determining how each of us can position ourselves into providing unique services that reflect our individual values and capabilities.
Because occupational therapy is a regulated profession, the talk on career advancement focused more on how we can level up on our specializations in accordance with the state standards. Thank you for the much-needed guidance, PAOT!
Career progression, though, does not only mean specialization. In fact, generalists have advantages that specialists don’t.
The Advantages of Specialization
Having a specialty benefits both the patient and the clinician. Our clients and their families stand a better chance of availing of better services from OTs with expertise in the assessments or interventions that they need. Obviously, that’s because those clinicians have in-depth experience or advanced training that the others don’t. (NOTE: The keywords are "better chance", which I will explain more later.)
This gives the specialist a competitive advantage. The clinician will possibly be more efficient and productive when he’s focusing on cases that are in line with his expertise rather than when he’s spending too much time and effort struggling with those that play to his weaknesses. That’s a win for the patients! Moreover, having a rare skill set increases the chance that clients will pay for the specialist’s higher professional fees. The expert then becomes an attractive potential hire for healthcare facilities, which expands his professional networks. With his unique work experiences, it then becomes easier for the specialist to get enough referrals to open his own therapy center.
A Fatal Flaw
The speakers at the PAOT Midyear Assembly were correct to point out though that advanced training does not automatically translate into competent practice. One explanation for this is that a therapist can possibly lack the wisdom on how to apply in real-life situations the knowledge that he learned from graduate school or from certificate courses. Why is that?
In a series of studies headed by psychologist Philip Tetlock, his research team discovered that the more specialized a person is, the more difficult prediction will be for him…even in his domain of expertise! This is quite concerning because much of what we do as therapists is hinged on forecasting. We set goals by foreseeing what the patient will need and will be able to learn. We choose interventions by first anticipating how they will respond. Moreover, therapists give clients home instructions by predicting how compliant and capable the family will be at applying treatment strategies in their households.
Tetlock’s findings make sense because having a specialty conditions us to frame a patient’s case in a particular way. The problem is that every single one of them does not neatly fall into the categories that we’ve assigned to them based on our expertise given that they are unique, complex individuals.
For example, if you specialize in delivering cognitive-behavioral therapy (CBT), you will view the patient as having faulty ideas that lead to inappropriate behaviors. That is correct to a certain extent, but that perspective is limited. Many people know the right thing deep inside, but they wouldn’t act on it because of emotions stemming from their traumas (e.g., fear of displeasing abusive relatives) or from their selfishness (e.g., love of money).
Investing a fortune into getting a CBT certification may even set the therapist up to double down on providing CBT to patients who will not benefit from it, a phenomenon called sunk cost fallacy. That CBT-certified clinician will then be wrong to predict that CBT worksheets will be effective for these types of clients.
Lack of Adaptability
Another pitfall of specialization is that catastrophes and technological innovations can restrict, if not completely wipe out, businesses that need one’s expertise. For example, mental health chatbots can now deliver CBT either for free or at more affordable prices. While the technology is still immature, it is bound to get better. When it does, many potential clients will prefer to undergo CBT through chatbots on their phones for free anytime they want for as long as they want while keeping their identities private rather than pay an OT 1000 pesos per hour of CBT session.
We also witnessed that therapists from standalone early intervention centers struggled to find patients during the pandemic. Some of those clinics closed down. Many specialized therapy centers are struggling to survive until now.
Yet at the height of the COVID-19 crisis, there were therapists whose careers remained relatively stable while the rest of us were panicking about our finances. Who are they? What were they doing during the pandemic? What can they teach us about how to achieve career progression that cannot be attained through expensive certificate courses? We’ll find out in Part 2.
Although I know nothing of the OT practice, I think this write up is a very good point of introspection. It is true about specialization. Specialists tend to view a situation through their exclusive lenses. As your lolo daddy once told me, if you ask an optometrist how your vision can improve, he'd suggest a new pair of glasses. But if you ask an ophthalmologist most likely he'd give you a complete eye examination🙂.