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From the VA to OT Clinical Consulting: Meet Rafael Salazar, MS, OTR/L

by Dominic Lloyd-Randolfi, OTD, OTR/L

I was lucky enough to interview Rafael Salazar, a consulting OT in Georgia, Member of the State OT Board, and owner of Rehab U Practice Solutions. Here's a bit about him:

How did you decide to pursue occupational therapy?

I like to say that occupational therapy found me at the perfect time in my life. The summer before my senior year in high school, I was down at the river with a few classmates. We had hiked down to the rapids to do some fishing. While there, I slipped on a muddy rock, landing with both my hands in the shallow water. When I stood upright, I felt something funny in my left hand. Looking down, I saw a shard of glass sticking out of my palm (thenar eminence).

Long story short, I ended up undergoing surgery the next day to repair my flexor pollicis longus and median nerve. That landed me in an OT clinic 2 to 3 times a week for the balance of the summer. The therapist who treated me was knowledgeable and really took the time to explain to me what was going on, what to expect, and how I could best participate in my own rehabilitation. She took the time to ask me what was meaningful and what I wanted to get back to doing.

For me, it was guitar. She tailored my treatments to include getting back to playing guitar as quick as we could. Now, this was the summer before my senior year in high school, so I was running up to those big life decisions everyone needs to make. I was trying to make up my mind between chemical engineering or something in the medical field.

Well, after 12 weeks of OT, my mind was made up. I graduated high school, started undergrad, and graduated with my masters in health sciences and occupational therapy five years later.

Where did you go to school? When did you graduate?

I attended undergrad, with a major in kinesiology, at Augusta University — which was then called “Augusta State University.” I did three years there and was then accepted into the OT program at Augusta University — which was then called “The Medical College of Georgia” (name changes and university mergers resulted in one university that we now refer to as “AU”). I was graduated from the OT department of MCG in 2012.

How long have you been working? Have you always been interested in ortho/upper extremity?

I have been working since my graduation. Given my history and how I came to the profession, there was always a drive to specialize in upper extremity/orthopedic rehabilitation; although my first job out of school was working as the only OTR on staff at 2 different SNFs.

I did that for a while, and then ended up finding myself working in the outpatient specialty clinic at the Charlie Norwood VA Medical Center in Augusta, treating the patient from all the specialty services like orthopedics, plastic surgery, neurology, rheumatology, and the emergency department. I worked there for four and a half years (from early 2013 to late 2017).

During that time, I was able to treat and serve veterans undergoing all kinds of procedures and suffering all kinds of upper extremity conditions. The bulk of my casework involved post-operative shoulders and hands. I ended up being the lead clinician in that clinic and the clinical education coordinator for the OT department.

In late 2015, I ended up teaching the Evidence-Based Practice course for the AU OT department, and considered pursuing a career in academia, but decided that I wasn’t ready to go back to school and settle into a career that didn’t involve patient care or building my clinical skills.

In late 2017, I left the VA to work as a consultant for the State of GA DBHDD, as they transitioned individuals from state-run hospitals to residences in the local community. Right now, I work as a clinical consultant, but do spend a day or so at a private clinic treating upper extremity and orthopedic patients.

When did you decide you wanted to do consulting?

I knew very early on, as early as month one of OT school, that the most dangerous thing I could do for myself and my career was to pigeon-hole myself as “just an OT." So it was always something that I was cognizant of in every job I looked at applying to or opportunity that presented itself.

I always wanted jobs or positions that forced me to learn different and new skills. Building my human capital was always the top of my priority list. I wanted to be exposed to every aspect of the medical field, from ground-floor clinical work, to executive and management roles. When I was at the VA, I was part of their leadership development program and was exposed to data analytics, project management, and general department management, and really liked learning those skills.

I had not really considered consulting as a career or job prospect at all until late 2017. At that time, I was browsing LinkedIn (which is probably the single best platform for growing your career opportunities or prospects) and noticed a distant connection of mine had posted a job that was titled “OT consultant.” I reached out that person and pretty much just asked, “What the heck does an OT consultant do?”

Within an hour, I was on the phone with Derrick, the guy who posted the job and owner of CRA Consulting. He explained to me a little bit about the position and the situation and he asked if I was interested. I said sure. One thing led to another, and by the end of the week, they offered me a job with CRA working a few days a week as a core member for the Georgia project on the Integrated Clinical Support Team (ICST).

The project in Georgia itself was so interesting and intriguing, that it made me want to leave the comfort zone of the UE/ortho world and dive into mental health, psychosocial, and developmental disabilities; all the while growing in both my clinical capacity and overall professional skills and breadth of knowledge.

What advice do you have for others looking at alternative OT careers?

The first piece of advice that I would give anyone looking at alternative OT careers would be to never look at yourself as “just an OT.” And probably just as important: never frame yourself as a simple therapist. No matter who you are interviewing or networking with, you want to position yourself as a well-rounded professional with not just clinical skills, but other important skills such as analytical insight, program development, goal setting, etc.

The second piece of advice I would give is that pursuing any alternative OT career will likely require you to really invest in yourself and build your human capital. Human capital really just means your personal store of knowledge, skills, and personality attributes that make you valuable to the marketplace.

The reality is this: there is an entire world full of mediocre professionals out there that stop learning after graduation, go to work every day and punch a clock, and never think twice about what else could be out there. If you want something different, you are going to have to put in a lot of work up-front to gain the skills, experience, and knowledge that will set you apart from the crowd.

How much did you know about running a business before? Did you have to teach yourself some skills?

I did have a few friends that were self-employed and owned their own businesses, so I knew a little bit about it from a distance. One of my friends, who is an avid reader (a habit that I have tried to instill in my own life) once recommended me a book: Built to Last by Jim Collins. I read that, then burned through a few other books: Rich Dad Poor Dad, Start With Why, Made to Stick, The Power of Habit, a few Malcolm Gladwell Books, a few John Maxwell books, and The Millionaire Next Door, to name a few.

All of those books really peaked my interest in entrepreneurship and business ownership. So I was always trying to learn and build my business skills, in the event that I found myself running or starting a business down the line. However, when I started consulting, I really had to take the time to learn about the ins-and-outs of incorporating, tax structuring and the like.

Since I am an independent consultant, I ended up forming an LLC and running all of my professional work through that. The decision to do that really resulted from having conversations with an accountant and a lawyer, which is something I would recommend anyone looking at doing independent contracting do. There is so much to know and so many ways to make a mistake, you want to make sure that you have a competent and knowledgeable accountant and lawyer in your corner when navigating those murky waters.

I think the reality is I am always teaching myself new skills. This past year I was focused on understanding the consulting world, structuring my LLC, and handling the tax implications of all that. Now, I’m looking at growing my skills in marketing, copywriting, sales, etc. The reality is that, in the 21st century, if you have a computer, internet connection, and valuable knowledge or skills, you can earn a handsome living. But it requires learning how to develop and grow your business to do that. That’s the journey I am on right now.

What has changed the most transitioning from the clinic to consulting?

I think the biggest change that has had the largest effect on my daily life has been the freedom and flexibility that consulting has afforded me. I work out of my home office and can come and go as I need, which has allowed me to go to meetings, networking events, or work on building other side business or projects. In the short time that I left the clinic to do consulting, I have started a couple of side projects/businesses and have made new connections in my professional network that have the potential to provide valuable opportunities in the future.

It’s also given me some flexibility with work-life balance as well, and since I have 2 kids, that’s always a plus. Now that is a double-edged sword. While I don’t punch a clock every day or sit in a clinic from 9 to 5, I have to perform and I have to provide real and tangible results. This is definitely not the career path for anyone who has a time management or procrastination problem.

Sometimes I work 12-14 hour days because that’s what needs to be done. So that’s something to consider if you are planning on leaving the world of steady employment for independent contracting, consulting, or entrepreneurship.

Would you ever go back to working in a traditional OT setting/job?

Well, they always say “never say never”, so I won’t! And I still do work in a private clinic a couple of days a week. I enjoy seeing patients, building relationships with patients, having students, and helping people get better. I don’t think I will ever go back to being a staff therapist, at least not long-term.

I do think there is something very valuable in using a “traditional” OT job as a platform or launchpad to build the career you want, and I would encourage anyone looking at making the jump into a non-traditional OT career to make sure that they squeeze all the learning or professional development they can out of their current job until a good opportunity presents itself.

Does consulting still offer you the same lifestyle as you had before?

I think this a personal question that is relative to each individual. For my family and I, consulting has greatly expanded our lifestyle, and not in the financial sense (though it does pay pretty well). The flexibility and independence of consulting work has allowed us to do things that we wouldn’t have normally been able to do if I was punching my time card in a clinic.

As far as the financial compensation goes, I think that consulting can definitely provide a good lifestyle to someone. For me personally, my wife and I have never lived off of more than 45-47% of our income, which has allowed us to pay off all our student loans in just under 3 years, let my wife stay at home with the kids, and build up enough of a nest egg not to worry about emergencies or unexpected expenses; and that was before I began working in consulting.

Now, our lifestyle has not inflated financially, so any extra that I am making now working as a consultant is simply going to savings and investments. So I guess my answer to the question is that my lifestyle wasn’t lavish and extravagant to begin with, so the main motivation for taking the consulting job was purely for the opportunity to do the work itself, not so much for the financial compensation attached to it.

General pros vs cons of your new non-clinical career?

I touched on both a little bit in the last few questions, so I’ll try not to sound like a broken record.

The main pros of this new career are the flexibility and independence involved in this work. There is also the aspect of professional and personal fulfilment. The work I am doing now creates real value and is personally rewarding as well, which makes me excited to wake up to do it. It also keeps be motivated and encouraged on those longer days.

The main cons are that there is no one to fall back on. It’s me. If I don’t work, I don’t get paid. Some people may not like that and want their four weeks of vacation or their paid holidays. And to be honest, it was an adjustment, especially coming from the federal government, with 10 paid holidays, paid sick time, and an exorbitant amount of paid annual leave.

But the reality is that none of that stuff is worth it if you’re not happy or need a change. The other thing to consider is that personal and professional time management is very important in this job as well as maintaining work-life balance. I am one of those people who can very easily end up being “on the clock” 24/7, which is not healthy and will lead to burnout or personal/professional issues down the line. It’s very important to be able to manage your time to allow for personal time or down time in general.

Any advice for new grads?

My advice for new grads would be:


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