The Value of the Generalist -or- Why I Am Still An OT

I graduated from a rural state university. I had looked at a couple of other OT schools, but they weren't the right fit for me. 

I've touched a few times on how I finally decided on majoring in OT. During a college tour, I explained the debate between architecture and OT to a professor who encouraged me to look into home modifications. That was my first area of OT that I found particularly exciting, and it stayed that way for the first years of OT school, right up until my Level II fieldwork approached in said field. That fieldwork let me know that I could not continue with that specialty, and I haven't done any work in the field since.

Let's pause for a moment to be thankful that I wasn't in an OTD program with a push to develop as an expert in a single area. Because if I had been 60-75% through a program and found out that I hated my focused area, I would be done. I certainly would not have continued research and another fieldwork in that area. Would I have been as open to the other areas of OT? Hard to tell. It may have seemed better to cut and run into another field entirely- PR, Med School, PT... who can say? It is certainly a common theme that many medical students get into their residencies and dislike their area of expertise, and many do leave the whole field.

However, my program was not focused on developing "experts," but excellent entry-level therapists. My research project was in a field that I have never chosen to work in, my favorite classes were not necessarily what controls my day to day work, and I knew that there would be on the job learning. (PS- ALL entry-level therapists regardless of degree will need to learn on the job). I knew that I had a great base in the basics of OT, clinical reasoning, and enough information to get me started in any job. Our school had an excellent pass rate on the NBCOT exam, and I was confident that I would pass. My first job at a small-town hospital center required me to treat acute hospital patients, skilled nursing patients, outpatient pediatric clients, and hand therapy patients. My background as a generalist paved the way for my success in this hospital system, and my own work following graduation built the skills I needed to continue to be successful.

To have a diverse workforce, you must have generalists. However, I have yet to see the OTD program that didn't have specific narrowed focus topics and advertising to make experts, not generalists. Anecdotally, I have not seen "experts" return to their small rural areas because there is no market for their services. Those areas that are an hour car ride away from a hospital need a generalist. And a specialist is not going to abandon their expertise to provide general services. While people often consider inner-city areas as underserved, they frequently forget that rural areas are underserved too.

Our commencement speaker asked us to embrace the idea of giving back to the small-town rural areas that represent so much of our university graduates. She stated that it should not be considered lesser to pursue a track as a generalist and provide the services that are so needed in a rural area. This idea struck a chord with me. For a long time, I had seen this idea of specialists being the most desirable practitioners in any field. I had not considered the value of a generalist, and that it was not a lesser role, but an extremely needed role for many people.

I'm very thankful for my education as a generalist. While I now feel like I am in my permanent job for the next 30 years, I started my career with 7 jobs in 7 years. It took me awhile to really find my niche and see where I want to specialize. I love OT because there is such a wide range of practice and it has been the best fit for me as I have grown and changed. But if I had picked a specialty in home mods, or acute care, or spinal cord injury, I would not have been able to find a job in our area. And I would not have necessarily kept one I could get. I would have looked for a different type of job entirely. And I would hate to have a person like me leave our terrific field due to hating their specialty or being unable to find a job that will pay specialist level money in their area.

I fully support a post-professional doctorate option for OTs. Several options- a clinical doctorate, a PhD, an EdD, whatever fits best for that person. But I think that pushing specialization early will keep a person from really trying out the OT field and finding the best fit. I know that was what kept me in OT even when my first idea was no longer feasible. Let's not lose this valuable part of our field.

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