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. 12/01/2025

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

    Episode 1: OT Started as Rebellion (1790–1899) In this first episode of the 8-part “Occupation Under Pressure” series, we go back to the days before occupational therapy had a name — when meaning, craft, community, and dignity shaped healing long before healthcare systems tried to reduce it to checkboxes and units. We explore the philosophical and sociopolitical roots of OT from 1790 to 1899, including the Moral Treatment Movement, settlement houses, the arts-and-crafts era, and the rise of graded activity in tuberculosis sanatoria. This episode reveals how occupation originally functioned as identity-building, purpose-restoring, skilled engagement — not “ADL practice.” Then we connect the past to today’s challenges: our profession’s confusion about what occupation actually is, the rise of ADL-only thinking, and how insurance systems now weaponize that misunderstanding against us. Finally, we close with a small but powerful action step to help practitioners reclaim occupation as meaningful work, not just functional task performance. If history has taught us anything…it’s to stay outspoken. 🔥 Key Topics The true origins of occupation-based healing Why early OT was built on craft, purpose, and contribution How medicine’s rise created the first battle between meaning and measurement Where the “ADL = skilled” myth really came from How modern documentation and AI auditing distort our roots What clinicians can do right now to reclaim authentic occupation ⚡️ Action Step Choose one client this week and document a meaningful, identity-building occupation — not an ADL — using the real historical logic of our profession. 📚 Series Source Occupation Under Pressure: A Sociopolitical History of Disability, Power, and the Occupational Therapy Profession

    17 min

  2. 11/23/2025

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

    “OT Left Off the List: What HR1 Just Exposed About Our Profession” In this extended, no-filter episode of Outspoken OT, Michelle breaks down exactly what is happening with federal student loan reforms — and why the “One Big Beautiful Bill Act (HR1)” is a turning point for occupational therapy. This isn’t just a financial update. This is a profession-wide reality check. You’ll learn: 🔹 What HR1 actually changed Grad PLUS loans eliminated New borrowing caps for graduate vs. professional programs OT placed in the lower-funded “graduate” category 🔹 Why OT was left off the “professional degree” list and how that outdated 1998 list still governs modern healthcare funding. 🔹 What this means for OT students and future practitioners Reduced access to federal loans Higher reliance on private lenders Major threats to diversity, access, and the workforce pipeline 🔹 Why other professions (including nursing, PT, PA, SLP, education, architecture, and more) are also affected and how their advocacy is bringing national attention to this crisis. 🔹 How this connects to the last decade of professional decline Michelle draws a straight line to: shrinking reimbursement exploding prior auth requirements rising tuition AI auditing OT’s internal identity battle and years of silence that left us vulnerable 🔹 Why HR1 is the wake-up call OT cannot ignore This bill didn’t break OT — it revealed the cracks we’ve been avoiding. 🔹 Concrete actions you can take today From AOTA advocacy to school accountability to supporting students and redefining OT’s identity. ⭐ Who this episode is for: OT students worried about paying for school Educators, faculty, and program directors Clinicians watching the profession shift under their feet Anyone who cares about the survival, sustainability, and visibility of OT 🗣️ In Michelle’s words: “This is not just about loans. This is about who we are as a profession — and whether we’re finally ready to be loud.”

    21 min

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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
  • 9 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
    2K
  • Episodes
    9
  • Rating
    Clean
  • Copyright
    © 2026 Michelle Eliason
  • Show Website
    Outspoken OT