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Finding Your Niche As A New Grad OT

by Brittany Ferri


For many reading this, the hard times of occupational therapy school are finally over. No more exams or practicals sounds great, but – here comes the dreaded question — what now? Which occupational therapy specialty should you choose? With so many practice areas in existence and AOTA adding still more, it can be a daunting task to figure out which area calls to you the most. Maybe you’ve always known you wanted to work as a pediatric therapist but, after that, the details get a little fuzzy. Or maybe you’ve had a level II fieldwork at a hand therapy clinic where the patient population really appealed to you, but you don’t know if you can pass the complex certification test.

If these are your worries, the good news is you’re not alone. Many times, it is hard to think ahead when you’re just trying to finish your program or even the current semester. The area you initially preferred during OT school may change once you begin applying for jobs. Fear not: there are resources for this exact problem.

Identifying your interests

So maybe you’ve narrowed your ideal setting down to pediatrics, but don’t know where to go from there. Start by identifying which type of pediatric setting you may like: Clinic-based sensory therapy? Neonatal intensive care unit? School-based therapy? Even if you have not had in-person fieldwork experience in some of these areas, you likely have learned a bit about them and can gain a general sense of whether it would fit your work style.

Maybe you volunteered in a hospital during high school and would be interested in a larger facility. Or maybe you have been in a smaller clinic setting and value individual time spent providing care to patients and their families.

Just because you are a newly licensed therapist, that doesn’t exclude you from getting observational experience in a setting that is new to you. Many therapists are willing to have students or new therapists shadow and answer questions to get a taste of that practice arena before settling into a job. This can be a good way to identify interests quickly, with minimal commitment (e.g. signing on for a job and realizing it’s not at all what you thought).

Don’t panic if you are now realizing you don’t yet have a population of interest. You can work on the step before that, by pinpointing positive aspects of your personality that may translate to success in a certain setting.

Identifying your strengths and weaknesses

I’m sure if most of you dig deep in the pile of your long-term memories (or maybe even boxes of old papers in the attic), you will find the career test you were made to take in junior high. It was a well-intentioned test that gauged your answers to certain case scenarios, determined your style of thinking, and suggested a career path for you. Fortunately, we weren’t obligated to sign a contract right then and there following their advice.

A lot of the leg work has been done for you at this point — you are an occupational therapist already, or are very close! While this opens a lot of doors for you, it also gives you a lot of decisions to make. Thankfully, the process of completing an OT program tells you a lot about what you are good at and what you could improve upon.

Have you enjoyed the words ‘group project’ or are you better at working alone?

If you do value being independent and autonomous, home health care or travel therapy may be the right area for you. However, it is important to note that many experienced therapists recommend waiting until you have some experience before diving into such independent roles.

If you enjoy working with groups and being part of a team, a facility with a large rehab department (such as inpatient rehab or outpatient therapy) where each discipline is in direct contact may be the place for you.

I have worked as part of larger therapy departments before and, while I enjoy the unity in that, I have found myself considering travel therapy at several points in my still-new career. However, I have decided each time it would be best to wait a couple of years. I currently have two years of experience (and counting) under my belt and now feel as if I would be comfortable with joining a travel company in the coming year. The appeal of travel has not worn off in the time since I first discovered it and, as such, I feel much more equipped in taking on such an independent role as my next step.

Do you prefer working at a slower pace, valuing quality over quantity, or are you comfortable working in a fast environment and keeping up with strict productivity standards?

If you thrive in work settings with a slower pace, mental health may be appealing to you. Many mental health facilities do not have productivity standards, allowing for group interactions and numerous individual interactions, as needed by patient interest and acuity. A setting without productivity standards may also be ideal if you like to engage in time-consuming projects, as you would have more time to develop new treatment ideas, develop resources for staff education, and research new assessment tools.

Faster-paced work environments are common in skilled nursing facilities, with a short length of stay and high productivity standards expected. If this type of work is something you are used to and you have good time management skills, you may enjoy the pace of one of these facilities.

Would you prefer a wide variety of diagnoses and presenting problems or do you enjoy working with primarily the same diagnoses?

Stand-alone orthopedic clinics will typically give you the same injuries, with many fractures, sprains, and cumulative overuse across different patients. However, acute inpatient rehab and hospital-based outpatient clinics may give more diversity in diagnoses, including major multi-trauma, complex neurological diagnoses, along with multiple comorbidities.

Do you consider yourself to be creative with your work (in decorating, personal projects, or patient treatments), or is coming up with original ideas more in your comfort zone?

If you tend to the creative side, pediatrics might be your forte. There are plenty of opportunities to bring new games or activities to the table without fear of retribution from older patients. I will personally admit to being the least creative or crafty therapist in existence. This doesn’t mean you can’t be an OT (thankfully!). However, you may want to opt for facilities with well-developed departments and ample treatment supplies, so there isn’t a need for many creative decisions to be made.

Are you a self-starter, spearheading new projects and looking for new work experiences, or are you more comfortable with a set schedule, with little room for change?

If you enjoy the structure of a pre-made day with scheduled patients, you may thrive in school-based therapy where their class schedule is consistent and you can expect children most always to be in class when you reach them for therapy. If you do enjoy being a trailblazer of sorts, you can ask for smaller leadership opportunities within any role, in potential preparation for a management or supervisory position. This can be a way to increase responsibility and productivity in a role that may have limited structure for time not spent with patients.

Finding Mentorship

Another important aspect of finding your niche is having appropriate support. Whether this is your academic advisor (who you can often rely on after graduation), a fieldwork supervisor who has remained a reference, or a more experienced occupational therapist you have worked with, mentors can help define paths for their mentees. By listing some of your interests to them, they can provide constructive feedback about your performance and comfort level in certain areas of practice, which may make some strengths and weaknesses clear for you. They can assist with networking and introduce you to contacts in certain practice areas they are familiar with, possibly leading to observation hours, email exchanges about day-to-day work in that setting, and articles to read up on.

Mentors can also speak to their previous experience, and explain the clinic world outside of the sometimes idealistic view created by OT school, by explaining how to actually meet productivity standards, what states pay the most, and what continuing education can help sharpen certain areas of your generalist skillset.

Continuing education

Speaking of generalist skill sets: continuing education is another important piece to finding an area you love. We all know continuing education is required to renew and maintain our licenses each year. But what they don’t tell you is it’s a great opportunity to give yourself an edge on certain skills. Especially with hands-on pieces of training, trying out certain modalities is a great way to test whether it’s something you’d like doing for eight hours a day.

For example, kinesio taping seminars may be a big part of working in an outpatient orthopedic clinic, and it is also a certification you can receive after two hands-on pieces of training. This is also the case for Lee Silverman Voice Training (LSVT-BIG) for clients with Parkinson’s. These pieces of training can give more concentrated information on modalities for certain diagnoses aside from work experience.

I would consider myself to be on a bit of a continuing education kick! I have become very dedicated to finding not-so-common certifications to enhance my resume and provide me with tangible skills, rather than simply taking online webinars. In finding so many of these hidden gems, I have a running list of information regarding certifications (e.g. costs, how often and which areas they are offered, if there is a certification exam if it needs renewal every couple of years). This is also a good way to map out a professional plan of sorts, to keep track of which courses you have been generally considering, which you can register for and take now, which you would like to take within a year, and which you’d like to take within three to five years, if they are more time-consuming or expensive, such as board certifications through AOTA.

Update your social media frequently

What to do once you’ve received some of these certifications and special pieces of training? Add them to your résumé, of course. By ensuring your online presence (e.g. LinkedIn, or other job profiles) is as up-to-date as possible, you will open yourself up to being contacted by recruiters and companies who are hiring or possibly just looking to network. Using the summary at the top of your profile is a great way to showcase your interests within the field of OT or your intent to gain more experience in a certain area. This will stand out to your mentors, recruiters, and your peers, by highlighting your accomplishments and passion for exploration of your niche and the wonderful field of occupational therapy.

Do you have any tips for new therapists attempting to find their niche? Tell us in the comments!

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