Outspoken OT

Michelle Eliason, MS, OTR/L, ITOT
  • 5.0 (3)
  • Medicine
  • Updated Semiweekly

This podcast says what needs to be said in occupational therapy—conversations that impact practitioners far beyond the boundaries of “occupation.” When occupational therapy practitioners speak up and engage in the broader discussions of medicine, science, public health, and global wellness, we step into our rightful place as leaders. Topics include: Functional Cognition, Brain Health, OT Politics, AOTA Updates, Outpatient OT, Entrepreneurship, Private Practice, and unapologetically personal opinions.

Episodes

  1. 1d ago

    Episode 12: OT Does Not have to Choose Between Science and Occupation (1940-1969)

    Part 4: OT Does Not Have to Choose Between Science and Occupation (1940–1969)   Episode Description World War II. Polio epidemics. The birth of rehabilitation medicine. The discovery of neuroplasticity. And some of the worst ethical violations in the history of modern healthcare — all happening at the same time, in the same system, often to the same vulnerable populations occupational therapy was built to serve. The period from 1940 to 1969 is one of the most consequential in OT history — and one of the most misunderstood. This is Part 4 of Occupation Under Pressure, and it covers the three decades that built modern rehabilitation. When World War II produced casualties on a scale medicine had never encountered, Colonel Howard Rusk — with support from President Franklin Roosevelt — helped develop a systematic rehabilitation model grounded in the idea that recovery requires more than medicine. It requires engagement, purpose, structure, meaning, and participation. Physical Medicine and Rehabilitation became a formal medical specialty in 1947. Occupational therapists were trained through emergency wartime programs and deployed throughout VA hospitals across the country. The work looked different from the arts-and-crafts era — splint fabrication, ADL training, adaptive equipment, upper extremity rehabilitation, work re-entry, veteran reintegration — but the underlying premise had not changed. Then polio arrived. Children and adults across the country lost movement, independence, and function. Iron lungs became a symbol of an era defined by fear and dependence. And once again, occupational therapists stepped into the gap — becoming leaders in neuromuscular rehabilitation, pediatric intervention, activity-based strengthening, and functional retraining. Meanwhile, science was making a discovery that would eventually reshape everything. Researchers were beginning to demonstrate that the nervous system could change. Donald Hebb's foundational principle — that neurons that fire together wire together — offered the first scientific explanation for something occupational therapists had been observing clinically for decades. Purposeful activity was not simply keeping people busy. It was reshaping the brain itself. But while rehabilitation science was advancing, healthcare was also producing some of its darkest chapters. The Guatemala Syphilis Experiments. Henrietta Lacks. Willowbrook State School. The Jewish Chronic Disease Study. Vulnerable populations — people with disabilities, institutionalized individuals, minority communities — were exploited in the name of scientific progress. These violations eventually forced the development of the Nuremberg Code, the Declaration of Helsinki, informed consent standards, and research oversight frameworks that still govern healthcare today. And in parallel, disabled people themselves were organizing — building the earliest foundations of what would become the disability rights movement. OT was present throughout all of it. And the profession was growing — more scientific, more medically integrated, more sophisticated than it had ever been. Willard and Spackman's textbook was published. OTA education was formally established. Research infrastructure expanded. By any external measure, the profession was thriving. But by the late 1960s, therapists were beginning to ask a question that would ignite the next major shift in OT history: in becoming what the healthcare system needed, had the profession drifted away from what it was originally meant to be? Michelle's Hard Take pushes back on the most common framing of this era — that it was the period when OT became too medical and lost its roots. Her argument is more precise and more uncomfortable: the problem was not that OT became more scientific. The problem was that the profession began confusing its tools with its purpose. Goniometry, splints, biomechanical frameworks, sensory integration protocols — these are powerful tools. But they were never the destination. The destination has always been the person. The participation. The life. The weekly challenge asks you to take one intervention you use almost automatically and ask a single question: what is this actually helping the person get back to? Not the impairment. The life. Then put that answer in your documentation. In This Episode World War II and the scale of injury that forced healthcare to ask not just how to save lives but how to rebuild them Colonel Howard Rusk, President Roosevelt, and the development of systematic rehabilitation medicine PM&R becomes a formal medical specialty in 1947 — and OT's role inside it What OT practice actually looked like in the wartime VA system — how far it had evolved from the arts-and-crafts era The polio epidemics of the 1940s and 1950s — iron lungs, mass disability, and OT's leadership in neuromuscular rehabilitation Donald Hebb and the discovery of neuroplasticity — the first scientific explanation for what OT had been doing all along The ethical violations running parallel to rehabilitation progress: Guatemala, Henrietta Lacks, Willowbrook, the Jewish Chronic Disease Study The Nuremberg Code, the Declaration of Helsinki, and the birth of informed consent The early disability rights movement — National Federation of the Blind, Paralyzed Veterans of America, community mental health advocacy How OT responded to the scientific revolution: biomechanical frameworks, kinesiology, sensory integration, bottom-up models Willard and Spackman, OTA education, expanding research infrastructure — the profession at its most organized The question emerging by the late 1960s: where did occupation go? The Hard Take: the problem was not scientific integration — it was confusing the tools with the purpose Why rehabilitation methods are the vehicle, not the destination Progress without humanity is dangerous. Humanity without progress is limited. OT has always lived between those two realities. Your weekly challenge: reconnect one intervention to one life role Key Figures and Concepts Colonel Howard Rusk, President Franklin Roosevelt, Donald Hebb, Willard and Spackman Neuroplasticity, Physical Medicine and Rehabilitation, Biomechanical Approaches, Sensory Integration, Bottom-Up Intervention Models, Informed Consent, Disability Rights Movement Key Events and Dates 1940s–1950s — Polio epidemics and OT's expansion into neuromuscular rehabilitation 1947 — PM&R established as a formal medical specialty 1940s–1960s — Guatemala Syphilis Experiments, Henrietta Lacks, Willowbrook State School, Jewish Chronic Disease Study Post-WWII — Nuremberg Code and Declaration of Helsinki developed Mid-20th century — Earliest foundations of the disability rights movement established Your Challenge This Week Pick one intervention you use almost automatically. Strengthening. Balance training. Sensory work. Cognitive rehabilitation. Upper extremity recovery. Then ask yourself one question: what is this actually helping the person get back to? Not the impairment. Not the body structure. The life. The role. The routine. The relationship. The identity. The occupation. Then put that answer in your documentation, your goal writing, and your clinical reasoning. Rehabilitation methods are not the destination. They are the vehicle. This week, reconnect one intervention to one life role — and remember why the intervention mattered in the first place. Series Context This is Part 4 of Occupation Under Pressure, an eight-part series on the real sociopolitical history of occupational therapy. Part 1 covered 1790–1899: occupation before OT existed. Part 2 covered 1900–1919: the birth of the profession. Part 3 covered 1920–1939: the first identity crisis. This episode covers 1940–1969: reconstruction, reductionism, and the rise of rehabilitation medicine. Next episode: the 1970s and 1980s arrive, and occupational therapists begin pushing back — hard. The philosophical revolution that follows will challenge everything the profession had spent three decades building. And the debate it ignites will sound remarkably familiar. Connect and Continue the Conversation If this episode reframed something you thought you understood about OT's relationship with medicine, share it with a colleague who is still choosing sides. Leave a review, send a message, and stay outspoken.

    21 min

  2. 5d ago

    Episode 11: The Fight That Never Ended, OT's First Identity Crisis (1920-1939)

    The Fight That Never Ended: OT's First Identity Crisis (1920–1939) Episode Description Have you ever sat through a faculty meeting, a conference presentation, or a social media debate about whether OT is too medical or not medical enough — and wondered why the profession is still having this conversation? The answer is in this episode. The years between 1920 and 1939 were the first time occupational therapy looked in the mirror and asked what it actually was. The profession was barely three years old when the forces pulling it apart became impossible to ignore. Medicine was growing more scientific, hospitals more structured, rehabilitation more measurable — and OT found itself caught between the values that created it and the system it was trying to join. Meaning, purpose, identity, creativity, and participation on one side. Measurement, standardization, efficiency, and medical legitimacy on the other. Both sides were right. At the same time. And that is exactly what made it so hard. This is Part 3 of Occupation Under Pressure, and it covers the two decades that gave the profession its first formal organizational structure, its first educational standards, and its first open internal division. In 1921 the National Society for the Promotion of Occupational Therapy became AOTA. In 1935 AOTA partnered with the American Medical Association to establish educational standards — a move that brought credibility and recognition and immediately raised new questions about how much medicine should shape a profession built on something medicine had historically struggled to measure. Out of that tension came two identifiable camps. The Diversionists, who believed crafts and meaningful occupation were therapeutic in themselves — restorative of identity, purpose, and agency. And the Therapists, who argued occupation was primarily a vehicle for improving measurable function, strength, endurance, and performance. The profession was not divided over whether occupation mattered. It was divided over why it mattered. And that distinction, Michelle argues, is the fault line that every subsequent OT debate has been running along ever since. The episode also places this identity crisis inside its full historical context — the height of the American eugenics movement, the beginning of the Tuskegee Syphilis Study, segregation embedded throughout healthcare and education, and the forced closure of OT's first school for training African American practitioners. While occupational therapy was fighting to define itself, it was doing so inside a society actively debating whose lives were worth valuing. That context matters for understanding both what the profession was up against and what it was fighting for. The Hard Take challenges the framing of the entire debate. Michelle's argument is not that OT should choose between science and meaning, between the medical model and the social model, between function and participation. Her argument is that the false choice itself is the problem — and that OT was never designed to pick a side. It was designed to bridge. The profession's future, she contends, depends on becoming more rigorous and more scientifically precise while refusing to trade away the thing that made it irreplaceable in the first place: the capacity to see a person's whole life and help put it back together. The weekly challenge asks you to find one place in your practice where you have accepted a false choice — and build a bridge instead. In This Episode How occupational therapy transformed organizationally between 1920 and 1939 — from NSPOT to AOTA, from emerging practice to national profession The 1935 AOTA-AMA partnership: what it gave OT and what it cost The emergence of the Divertionist versus Therapist divide — and why the debate was never really about crafts Why the question was never which side was right but how to bring both sides together The eugenics movement at its American peak — Carrie Buck, forced sterilization, and the broader context of whose lives were considered worth supporting The Tuskegee Syphilis Study, segregation in healthcare, and the closure of OT's first school for African American practitioners The Hard Take: OT's greatest threat was never medicine or measurement — it was uncertainty about its own identity Why Michelle does not think OT was ever supposed to be anti-medical — and what the founders were actually trying to build The false choice that has followed OT for a century: medical model or social model, function or meaning, science or occupation Why the future of OT depends on refusing to separate rigor and humanity OT's mental health scope of practice reality: recognized in every state, formally credentialed in almost none The precision rehabilitation argument: why OT should be leading those conversations, not running from them Key Figures and Organizations Eleanor Clarke Slagle, American Occupational Therapy Association (formerly NSPOT), American Medical Association Key Events and Concepts 1921 — NSPOT becomes AOTA 1932 — Tuskegee Syphilis Study begins 1935 — AOTA-AMA educational standards partnership The Divertionist versus Therapist divide The American eugenics movement at its peak Buck v. Bell and forced sterilization Segregation in OT education Your Challenge This Week Find one place in your practice where you have accepted a false choice. One intervention, one patient, one session. Build a bridge. Use a meaningful occupation and measure it. Address mental health while targeting function. Combine participation with objective outcomes. Combine meaning with measurement. Then ask yourself: what happened when I stopped choosing and started integrating? Document it. Reflect on it. Because that is exactly what OT was trying to figure out in the 1920s and 1930s — and the answer still matters today. Series Context This is Part 3 of Occupation Under Pressure, an eight-part series on the real sociopolitical history of occupational therapy. Part 1 covered 1790–1899: the philosophical roots of occupation before the profession existed. Part 2 covered 1900–1919: the forces and founding moment that made OT a formal profession. This episode covers 1920–1939: the first identity crisis — and the debates that never really ended. Next episode: the world hands OT another defining challenge. War returns. And the question is no longer what kind of profession OT wants to be — it is whether the profession can prove its value fast enough to survive what is coming. The wheel of change moves slowly. It always has. But it only moves because someone is willing to push it. Connect and Continue the Conversation If this episode made you rethink a debate you thought was modern, share it with someone who needs the historical context. Leave a review, send a message, and stay outspoken.

    18 min

  3. Jun 8

    Episode 10: Occupation Under pressure: The Birth of a Profession (1900-1919)

    Episode Description The early 1900s were not a quiet time to be building a new profession. America was industrializing, medicine was becoming increasingly scientific and measurable, and two completely opposing philosophies about disability and human worth were competing for dominance in the same cultural landscape. One said certain people were a burden on society. The other said every person deserved opportunity, dignity, and the chance to participate in life. Occupational therapy was born on the side of that second argument. In this episode, Part 2 of the eight-part series Occupation Under Pressure, Michelle traces the forces that transformed occupation from a philosophy into a formal profession. From the early reformers who prescribed meaningful activity before OT had a name, to the Reconstruction Aides who served soldiers returning from World War I with injuries medicine could stabilize but could not fully rehabilitate, to the six individuals who gathered at Consolation House on March 15, 1917 and founded what would become AOTA — this is the story of why occupational therapy exists. But this episode does not stop at the history. Michelle's Hard Take challenges one of the most common narratives in OT education: that the profession was born because medicine failed. Her argument is more precise — and more uncomfortable. Medicine did not fail. Medicine was incomplete. And the distinction between those two things has enormous consequences for how occupational therapists understand their role in modern healthcare, position themselves within medical systems, and make the case for their own value. This episode also confronts the tension that has followed OT for over a century: the pull between scientific rigor and human-centered practice, between proving legitimacy within medicine and preserving the profession's original mission. It is a tension that was present at the founding. It is still present today. Weekly Challenge: The weekly challenge asks you to do one thing: pick one patient and document the participation problem — not just the impairment. Because that is exactly what the founders were doing in 1917. And it is still exactly what the profession exists to do. In This Episode: Why occupational therapy emerged during the same era as the eugenics movement, and what that contrast reveals about the profession's founding values The early contributors who shaped OT before it had a name: Herbert Hall, Susan Tracy, Adolf Meyer, and William Rush Dunton Jr. How World War I created a problem medicine alone could not solve — and why that problem became the tipping point for a new profession The founding of NSPOT on March 15, 1917 — who was in the room and why it mattered The Hard Take: OT was not born because medicine failed — it was born because survival and participation are not the same thing Why Michelle argues the future of OT depends on thriving within medicine, not positioning itself against it The scope of practice reality: OTs can address mental health in all 50 states, yet most states still do not formally recognize them as mental health providers What precision rehabilitation actually means — and why the concepts OT has always practiced are healthcare concepts, not soft concepts Your weekly challenge: document the participation problem, not just the impairment Key Figures Mentioned Herbert Hall, Susan Tracy, Adolf Meyer, William Rush Dunton Jr., George Barton, Eleanor Clarke Slagle, Susan Cox Johnson, Thomas Kidner, Isabel Newton Key Dates 1907 — Indiana passes the first involuntary sterilization law in the United States 1910 — Susan Tracy publishes Studies in Invalid Occupations 1917 — The United States enters World War I; Reconstruction Aides established March 15, 1917 — Founding of the National Society for the Promotion of Occupational Therapy at Consolation House Series Context Next episode: OT enters the 1920s and 1930s and faces its first real identity crisis. The question shifts from whether OT belongs in healthcare to what kind of profession it is going to be. A profession rooted in meaning? A profession rooted in medicine? Michelle warns that fight never really ended. Your Challenge This Week Pick one patient. Ask yourself: what problem am I solving that medicine cannot? Then look at your documentation. Did you document the participation problem — or only the impairments? This week, document the life problem. Document the reason OT exists. Connect and Continue the Conversation If this episode challenged how you think about OT's place in healthcare, share it with a colleague who needs to hear it. Leave a review, send a message, and stay outspoken.

    17 min

  4. 12/01/2025

    Episode 9: Meaning vs. Medicine: OT’s First Fight (1790-1899)

    Occupation Under Pressure, Part 1: Meaning vs. Medicine, OT's First Fight (1790–1899) Description Most occupational therapists were taught that their profession began in 1917. A founding meeting. Six people. A new organization. The official birth of OT. But that is not where the story starts. In this episode — the first in an eight-part series called Occupation Under Pressure — Michelle goes back to where the real roots of occupational therapy actually begin: the late 18th and 19th centuries, a period historians call the Age of Enlightenment, when society first started asking whether compassion, meaningful activity, and human dignity belonged in the practice of healthcare. The answer, it turned out, was complicated. Because at the exact same moment that reformers were arguing that what people do shapes their health, medicine was moving in the opposite direction — into labs, microscopes, and strict scientific measurement. The body was becoming a set of parts to fix rather than a person to understand. And the tension between those two ideas — meaningful activity on one side, biomedical reductionism on the other — created a fault line that runs directly from the 1790s into every OT clinic operating today. This episode traces that fault line through the movements that quietly built occupational therapy before it had a name. The Moral Treatment Movement, where William Tuke and Philippe Pinel replaced asylum restraints with structured daily routines and purposeful activity. Benjamin Rush, the father of American psychiatry, prescribing occupation-based therapy in the 1790s. The settlement house movement, which modeled community participation as health. The Arts and Crafts Movement, which pushed back against industrial dehumanization and brought intentional making back into clinical settings. And the tuberculosis sanatoria of the 19th century, where graded activity programs created the three core principles OT still practices today — grade the activity, use meaningful tasks, and expect functional improvement through participation rather than rest. But the Hard Take in this episode is not really about history. It is about a misunderstanding that has followed OT for over a century and is now being used against the profession by the very systems it operates within. Michelle's argument is direct: OT did not just drift from its roots. It misinterpreted them. Occupation was never supposed to mean ADLs. It was never supposed to mean functional task performance. It was supposed to mean meaningful work — identity-shaping, dignity-restoring, agency-building human engagement. And the moment OT narrowed its own definition, it handed the system a box to trap it in. The weekly challenge is small, specific, and deliberately uncomfortable: pick one client, replace one ADL-based justification with a meaning-based one, and document the life problem instead of the impairment. One session. One shift. One reclaiming of the profession's actual origin story. This is Part 1 of Occupation Under Pressure. The series gets more complicated from here. In This Episode Why OT's origin story starts in the 1790s, not 1917 — and why that distinction matters The Age of Enlightenment and the first arguments that meaningful activity shapes health The rise of biomedical reductionism — and why the tension it created with occupation-based practice has never been resolved The antivivisection movement and the moral roots that eventually became OT's professional values The Moral Treatment Movement: William Tuke, Philippe Pinel, and Benjamin Rush — what they were actually prescribing Settlement houses, Toynbee Hall, and why community participation as health is not a modern idea The Arts and Crafts Movement as clinical rebellion — how intentional making replaced busywork in hospitals The tuberculosis sanatoria and the birth of graded activity: Otto Walther, Marcus Paterson, and the three principles that still define OT practice today The Hard Take: OT didn't lose its way — it misinterpreted where it came from, and the system is now punishing that misunderstanding Why occupation was never supposed to mean ADLs — and what it was actually supposed to mean How OT was built on activism and resistance, and what happened when the profession went quiet Your weekly challenge: document meaning, not movement — for one client, in one session Key Figures Mentioned William Tuke, Philippe Pinel, Benjamin Rush, John Ruskin, William Morris, Otto Walther, Marcus Paterson Key Movements and Concepts Age of Enlightenment, Moral Treatment Movement, Antivivisection Movement, Settlement House Movement, Arts and Crafts Movement, Tuberculosis Sanatoria, Biomedical Reductionism, Graded Activity Key Locations and Institutions Toynbee Hall (London, 1884), Nordrach Colony, Brompton Hospital The Three Principles Born in 19th Century TB Care Grade the activity based on the person's physiological response Use real, meaningful activities — not artificial exercise Expect functional improvement through participation, not rest Your Challenge This Week Choose one client. Replace one ADL-based justification in your documentation with a meaning-based one. Not endurance for bathing — but identity, purpose, mastery, and motivation. Not functional task performance — but occupational engagement. One client. One session. One shift toward the profession's actual origin story. Series Context This is Part 1 of Occupation Under Pressure, an eight-part series tracing the real sociopolitical history of occupational therapy — the complicated, messy, deeply human version that most therapists were never taught in school. The full historical document this series is based on is available inside the BOT Portal. Next episode: the story moves into 1900–1919, the era that transformed occupation from a philosophy into a formal profession — and introduced the forces, the figures, and the founding moment that most OT curricula compress into a single paragraph. The tension between meaning and medicine does not get resolved. It gets institutionalized. Connect and Continue the Conversation If this episode made you rethink something you were taught about your own profession, share it with a colleague who needs to hear the real story. Leave a review, send a message, and stay outspoken.

    17 min

  5. 11/23/2025

    Episode 8: HR1 Exposed Us: The Financial Crisis OT Should’ve Seen Coming

    Episode 8 HR1 Exposed Us: The Financial Crisis OT Should've Seen Coming Episode Description This one runs long. It has to. When the One Big Beautiful Bill Act dropped and Grad PLUS loans disappeared overnight, the occupational therapy community erupted. Social media feeds flooded with panic, confusion, and anger. AOTA mobilized. Students did the math and realized the numbers no longer worked. Educators started warning about pipeline collapse. And practitioners who had been quietly absorbing a decade of reimbursement cuts, prior authorization barriers, and identity confusion suddenly found their voices. Michelle's response to all of it is not relief that people are finally paying attention. It is frustration that it took this long — and a clear-eyed insistence that the profession understand what is actually being exposed here. HR1 did not create this crisis. It made it impossible to ignore. This episode is a full breakdown of what the bill actually did, why occupational therapy was classified as a graduate program instead of a professional program, and what that classification reveals about how policymakers — and the broader healthcare system — understand the value of OT. The professional program list that determines borrowing limits has not been updated since 1998. Medicine, dentistry, law, veterinary medicine, and theology made the cut. Occupational therapy, physical therapy, speech-language pathology, nursing, and physician associates did not. But the legislation is only the surface of what this episode covers. The deeper argument is about a decade of warning signs the profession absorbed quietly — falling reimbursement rates, AI auditing creeping into documentation, CPT code cuts, cognitive care denials, leadership exclusion, and a workforce pipeline already strained before loan caps entered the conversation. Michelle names each of them directly and asks the uncomfortable question: where was this energy then? The episode also gets personal. As a nontraditional student, Michelle states plainly that she would not have been able to become an OT under the new loan caps — and that thousands of future practitioners from similar backgrounds will face the same closed door if the classification is not corrected. The equity implications of pushing students toward private loans are not abstract. They are structural, generational, and profession-shaping. The Hard Take does not end with the bill. It ends with the argument that even if HR1 is reversed and OT is added to the professional program list, the underlying problem remains unchanged. A profession the public cannot describe, that policymakers misunderstand, that fights internally instead of strategically, and that has never fully resolved its own identity crisis will remain vulnerable — bill or no bill. This moment is a mirror, and the reflection requires more than a single advocacy campaign. Seven specific action steps close the episode — from taking action through AOTA's portal today to committing to the long game of identity reform, unified messaging, and a collective refusal to ever go this quiet again. In This Episode What HR1 actually did — the elimination of Grad PLUS loans and what replaced them The borrowing cap breakdown: $20,500/year for graduate programs versus $50,000/year for professional programs — and which category OT landed in The professional program list that has not been updated since 1998 — who made it, who did not, and why theology is on it The three camps dividing social media: disbelief, outrage, and workforce alarm — and why all three are correct AOTA's coalition of 40–50 organizations, the rulemaking meetings, the negotiator acknowledgment — and the Department of Education's non-response How private loan dependency compounds inequity and threatens the diversity of the future OT workforce The tuition inflation reckoning: whether loan cap pressure forces program reform or program closures The OTD debate reignited — mandatory doctorate, unresolved affordability The decade of warning signs: reimbursement cuts, prior auth barriers, AI documentation auditing, leadership exclusion, and a profession that stayed quiet through all of it The personal dimension: who gets locked out of OT under these caps and what that costs the profession Why the crisis does not end if the bill changes — and what the profession actually needs to become undeniable Seven action steps for practitioners, educators, and students right now The 9-Point Breakdown Grad PLUS loans eliminated — one federal loan option remains for OT students OT classified as graduate, not professional — despite requiring a master's or doctorate, licensure, NBCOT certification, and advanced clinical rotations The professional program list is frozen in 1998 — healthcare evolved, the policy did not Social media divided into three response camps AOTA advocating hard — Department of Education not moving Students pushed toward private loans — inequity compounds Practitioners calling out tuition inflation and the salary-to-debt gap The OTD debate back at full volume The core fear: OT shrinks — fewer applicants, fewer clinicians, less diversity, reduced access to care Your Action Steps Right Now Take action through AOTA at aota.org/takeaction — email your representatives today Flood your networks with accurate information — faculty, fieldwork sites, alumni groups, state associations Pressure your program to respond — ask directly how they are preparing for the 2026 loan cap shift Get loud at work — make sure leadership understands that loan caps are a staffing pipeline issue Support OT students — mentorship, scholarships, flexible fieldwork, honest conversations, advocacy connections Start building the long game — unified OT identity, clear value language, strategic professional advocacy Commit to never being silent again — use this momentum to rebuild a louder, more undeniable OT Key Resources Mentioned AOTA Take Action Portal: aota.org/takeaction Series and Show Context Episode 8 of Outspoken OT — the podcast where the quiet parts get said out loud. New episodes tackle the systemic, political, and professional forces shaping occupational therapy in real time. If this episode made you feel something, share it with every OT, OTA, student, and educator in your network. The profession does not move without people willing to make noise. Leave a review, send a message, and stay outspoken.

    21 min

  6. 11/11/2025

    Episode 7: The Petition that Predicted the Pipeline Crisis

    In this episode of Outspoken OT, host Michelle Eliason, MS, OTR/L unpacks the data behind the 2023 OT Petition and National Survey — a grassroots effort that captured thousands of voices from across the profession. Practicing OTs, OTAs, students, educators, and even those who have left the field all said the same thing: the system designed to produce and protect competent occupational therapy practitioners is breaking down. Michelle explains what experts would call a pipeline crisis — when the sequence from education to employment to retention begins to fail. From inconsistent curriculum and unpaid fieldwork to unsafe productivity demands and loss of medical identity, she traces the threads connecting burnout, inequity, and professional erosion. This isn’t a rant — it’s workforce data and lived experience combined. It’s about accountability, reform, and refusing to normalize dysfunction as “the way it is.” In this episode: What the 2023 petition and survey revealed about the OT workforce Why “pipeline crisis” isn’t a buzzword — it’s a system diagnosis Michelle’s hard take on complacency and silence in the profession Practical ways we can defend, rebuild, and realign occupational therapy Key message: We don’t have a talent problem. We have a structure problem — and the only way to fix it is to start talking about it out loud. As always, stay outspoken about the things that matter.

    17 min

  7. 10/18/2025

    Episode 6: Equality’s Out, Equity’s In — But What Does That Mean for OT?

    In this episode of Outspoken OT, host Michelle Eliason, MS, OTR/L dives into the American Occupational Therapy Association’s 2025 Code of Ethics and its two major updates: replacing equality with equity and adding advocacy as a core professional value. What sounds like a simple word change actually signals a deeper philosophical shift for occupational therapy — from fair processes to fair outcomes. But what does that mean for clinicians? How do we balance advocacy, neutrality, and scope of practice without drifting into politics or losing clinical clarity? Michelle unpacks the differences between equality and equity, explores what “advocacy” really means in a clinical context, and challenges OTs to reclaim advocacy as a therapeutic skill — not just a social talking point. Whether you’re an educator, clinician, or student, this episode will help you think critically about how ethical frameworks shape practice, policy, and the profession’s future. 📬 Contact Michelle - DM: @Buffalo.OT - Email: USOTconcerns@gmail.com - Follow for more unfiltered conversations about the future of occupational therapy. >>>>>>Stay curious. Stay critical. Stay Outspoken.

    18 min

  8. 10/12/2025

    Episode 5: We Are Giving Our Own Profession Away

    Today’s episode dives deep into one of the biggest professional conversations happening right now — the ongoing tension between occupational therapy and physical therapy — and what it reveals about how we’ve been talking about ourselves for decades. We start From the Feed, where Chris Nahrwold’s viral post in the Practical Occupational Therapy Facebook group challenges the old phrases like “PT helps you walk, OT helps you do the things once you get there.” He asks the hard question: Are PTs limiting us, or are we limiting ourselves? Then in My Hard Take, Michelle breaks down some of the most repugnant, self-limiting catchphrases OTs keep repeating — from “We do the fun stuff” to “We’re like PT, but for your hands.” She explains how that kind of language quietly undermines the science, rigor, and value of the profession. Next, we take a look back to 1981, when AOTA President Mae D. Hightower Vandamm delivered her fiery presidential address “Flight Control.” Decades before social media debates, Vandamm called out the same pattern — warning that OTs were “too soft in defending our turf” and that “we freely give away our skills.” Her words still ring true today. Finally, Michelle closes with “What Now?” — four practical, actionable ways OTs can start changing the narrative right now: Don’t agree when others minimize OT. Keep growing — especially as a communicator. Guard scope with science and evidence. Stop giving away your expertise. Key Takeaway Occupational therapy doesn’t need rescuing — it needs reclaiming. When we speak with clarity, communicate with science, and stop handing away our identity, no one gets to define us but us. Resources Mentioned Practical Occupational Therapy Facebook Group Mae D. Hightower Vandamm, “Flight Control,” AJOT (1981) John Maxwell, The 16 Undeniable Laws of Communication

    21 min

  9. 10/07/2025

    Episode 4: What ACOTE’s 2023 Revisions Mean for the Future of OT Education

    In this episode of Outspoken OT, Michelle Eliason takes a candid, evidence-based look at the recently released ACOTE Interpretive Guide (2025) and how it reframes occupational therapy education—possibly for the worse. She unpacks ten critical changes that may weaken the scientific backbone of the profession, from diluted leadership qualifications and vague “generalist” definitions to the politicization of accreditation language and the quiet erasure of measurable competency standards. This episode isn’t about blame—it’s about foresight and accountability. Michelle calls attention to how these shifts could compromise clinical readiness, faculty credibility, and the neutrality of healthcare education. She also offers practical, actionable fixes for educators, practitioners, and students to uphold professional integrity until the next revision cycle in 2028. Listeners will learn: Why the “generalist” clause needs operational definition and measurable outcomes. How ideology has crept into accreditation—and why neutrality matters. What programs can do now to safeguard clinical rigor and transparency. Why documentation and dissent are vital tools for reform. Occupational therapy was never meant to be trendy—it was meant to be timeless, grounded in measurable skill and genuine care. If you care about the future of OT education, this episode is your record of professional concern—and a call to action.

    27 min

  10. 10/06/2025

    Episode 3: Growing in Number, Shrinking in Value

    In this episode of Outspoken OT, Michelle Eliason takes a hard look at the growing disconnect between occupational therapy’s rising employment numbers and its declining professional worth. According to the U.S. Bureau of Labor Statistics, OT employment is projected to increase from 160,000 to 182,100 jobs by 2034—a 13.8% jump that sounds promising on the surface. But when you compare those projections to federal reimbursement trends, a different story emerges: occupational therapists may be growing in number, but each position is worth less per unit of service than ever before. Michelle breaks down where this growth is happening and what it means for the profession. Skilled nursing facilities are projected to decline by 2.7%, which aligns with the 2024 Access to Care Report showing widespread closures and staffing shortages in long-term care. Hospitals are growing modestly at 10.8%, while the biggest jumps—outpatient practice (+25.1%), home health (+18.7%), and self-employment (+24.4%)—are occurring in sectors where reimbursement models have shifted risk and responsibility onto providers. These are the same settings where clinicians face the steepest documentation burdens, productivity demands, and payment reductions. From 2018 to 2025, the occupational therapy profession has weathered a series of financial blows. The OTA differential cut payments by 15% for assistant-delivered care, the Patient-Driven Groupings Model (PDGM) eliminated therapy visit thresholds in home health, and the Medicare conversion factor has fallen by nearly 10% in just four years. Add sequestration and the newly proposed 6.4% aggregate payment reduction for CY 2026, and it’s clear that OTs are being asked to do more for less. The system may tout growth, but its infrastructure continues to undervalue the labor and expertise that define occupational therapy practice. The implications are sobering: worth is decreasing as the payment pie shrinks, use of OT is at risk of reduction when therapy add-ons don’t increase reimbursement, yet the need for OT is rising as aging, cognitive decline, and functional deficits increase nationwide. Home health agencies still rely on OTs to improve discharge-to-community rates and prevent hospital readmissions, but their payment models now expect therapists to produce those outcomes in fewer visits and with less financial support. Michelle challenges listeners to move beyond frustration and toward action. If reimbursement systems won’t honor your worth, build one that does. Practitioners can shift into private or hybrid practice models, reform the profession from within through organized advocacy and education, and actively mentor new graduates who are entering a complex system unprepared for its realities. The future of occupational therapy depends on those willing to combine evidence with action—to speak up, show the data, and redefine value on their own terms. Occupational therapy isn’t disappearing, but its perceived worth is at risk if practitioners remain silent. Growth without respect is not progress—it’s erosion. It’s time to push for transparency, outcome-based valuation, and public recognition of what OTs truly bring to patient care: measurable, meaningful independence. Stay grounded, stay ethical, and keep saying what needs to be said. Connect with the Outspoken OT community at www.botportalceus.com or on Instagram @buffalo.ot .

    16 min

  11. 10/05/2025

    Episode 2: The Ethics No One Wants To Talk About

    In this episode of Outspoken OT, we dive into the uncomfortable truth behind ethical distress in occupational therapy. From productivity pressures in SNFs to federal whistle-blower cases and the global fight against healthcare fraud, Michelle unpacks how systemic incentives erode integrity—and why leadership accountability matters more than ever. Drawing from the AOTA Ethics Commission Advisory Opinion (2019) and the 2025 Global Scoping Review on Medical Fraud and Abuse (Najar et al.), this conversation connects real-world cases, data-driven fraud detection, and technology’s emerging role in protecting ethical clinicians. Whether you’re a new grad or a seasoned rehab leader, this episode challenges you to re-examine the culture of “minutes over meaning” and reclaim professional integrity in a profit-driven system. 🔗 Connect: www.botportalceus.com 📱 Instagram: @Buffalo.OT

    21 min

  12. 10/05/2025

    Episode 1: Scope Creep, Ego, and the OT Identity Crisis

    In this episode of Outspoken OT, Michelle Eliason dives into one of the most misunderstood topics in rehabilitation—scope of practice. What began as a debate about “who’s doing what” has turned into a culture of professional policing, leaving occupational therapy caught in the middle. Michelle challenges that mindset by reframing scope through the Occupational Therapy Practice Framework (OTPF), showing that our identity is rooted in reasoning and occupation—not task ownership. In This Episode You’ll Learn: 1. Why “scope creep” is misunderstood and how it distracts us from deeper issues 2. How the OTPF defines OT’s true identity as a science of human occupation 3. Where OT and PT intersect and how to collaborate without losing professional clarity 4. How activity analysis strengthens advocacy and professional credibility 5. Why defining our value through science and reasoning—not tasks—protects our future Key Takeaways: Scope isn’t a turf war—it’s a mindset. The OTPF is a guide, not a rulebook, designed to evolve with the profession. Collaboration works when we lead with curiosity instead of control. Administrators and insurers can’t value what we can’t clearly define. OT’s distinct power lies in how we think, not just what we do. Mentioned Resources: AOTA (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.) Youngstrom, M.J. (2022). Evolution of the OTPF and What It Means for Practice. American Journal of Occupational Therapy APTA Clinical Practice Guideline Manual WHO International Classification of Functioning, Disability, and Health (ICF) Listener Challenge: Take one activity you often document and analyze it through the OTPF lens—identify the structures, functions, and contexts involved, and determine where the true occupation lies. Bring that insight to your next team meeting and start the conversation about how OT adds depth, not duplication. Join the Conversation: Have you experienced scope confusion or blurred professional lines in your setting? Share your story or tag @Buffalo.OT with #OutspokenOT to keep saying what needs to be said.

    18 min
  • 12 Episodes

Ratings & Reviews

5
out of 5
3 Ratings

About

This podcast says what needs to be said in occupational therapy—conversations that impact practitioners far beyond the boundaries of “occupation.” When occupational therapy practitioners speak up and engage in the broader discussions of medicine, science, public health, and global wellness, we step into our rightful place as leaders. Topics include: Functional Cognition, Brain Health, OT Politics, AOTA Updates, Outpatient OT, Entrepreneurship, Private Practice, and unapologetically personal opinions.

Information

  • Creator
    Michelle Eliason, MS, OTR/L, ITOT
  • Years Active
    2025 - 2026
  • Episodes
    12
  • Rating
    Clean
  • Copyright
    © 2026 Michelle Eliason
  • Show Website
    Outspoken OT