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From New Grad OT to Upper Extremity Specialist in 3 Simple Steps

by Rafael Salazar II


So maybe you went into Occupational Therapy knowing that you wanted to be a hand therapist. Maybe you went into OT thinking that you’d like to end up treating complex post-surgical diagnoses of the upper extremity (UE). Heck, maybe you went into OT thinking you wanted to go into pediatrics, but then became enamored with the idea of UE orthopedic rehabilitation on fieldwork (it’s happened before).

Regardless of how you came to the decision to pursue a specialty practice in UE orthopedics, one question remains fairly common among new grads entering the field: How do I go from a new grad to a UE specialist?

What does it mean to be a UE Specialist?

Before we go about answering the how-tos, we’ve got to take a step back and get a big picture idea of what it actually looks like to be a clinician who specializes in UE rehabilitation.

When we talk about specializing in UE rehabilitation, we are focused on becoming an expert in the diagnosis, treatment, and management of UE disorders and dysfunctions. However, specialization can take many forms.

For example, you could go out, buy some books, study, and take an exam to get credentialed as a “specialist”. You could immerse yourself in your daily practice in treating and managing UE disorders, building up a reputation as a specialist, and developing relationships within the industry to establish yourself as an expert. And you could also get involved in academic or clinical research in UE disorders. Specializing also opens doors to non-clinical OT careers. At the end of the day, a specialist is someone who is recognized as a subject matter expert and is able to demonstrate that expertise, either through actual hands-on treatment or through education and research.

Regardless of which avenue you pursue to become “a specialist,” the basic path is the same. Many clinicians who are certified in a specialty have developed a reputation as being an expert, and some of them go on to participate in clinical or academic research in the area of UE rehabilitation.

So now that we have defined what a UE Specialist is, how do we go from a new grad or a “generalist” to a specialist?

The Three Simple Steps to get from “Generalist” to “Specialist”

Now, this is called the three simple steps, as opposed to the three easy steps. As with many things in life, the simple things make the most difference, and yet are seldom the easiest things to do. Becoming an expert or authority figure in a given niche, UE rehabilitation included, requires discipline, perseverance, and massive goal-oriented action. The majority of any profession will always be content with a mediocre career. Becoming a specialist requires making the conscious decision to go above and beyond. Simply making that decision and acting on it places you above the vast throng of mediocre therapists out there.

Step One: Work on Your Professional Development (Increasing Your Human Capital)

The first step on your way from new grad to specialist involves the basics: developing the knowledge and skills you need to work at that higher level we all expect of specialists. How many times did you hear your professors in OT school say, “A career in OT requires lifelong learning”? Many students roll their eyes at these types of statements and, in reality, lifelong learning or “continuing competence” has boiled down to nothing more than making sure you have enough CEUs to renew your license or NBCOT certification when it comes due.

If, however, you wish to become a specialist, you must make the choice to intentionally study and learn more than those around you. Remember, the vast majority of professionals are happy to float in the river of mediocrity. You have chosen to rise above that.

As I mentioned in my interview with Dominic Lloyd-Randolfi, you should make it a point to prioritize building your human capital with every professional decision or move you make. This includes your choice of CEU courses and seminars. Instead of looking at these classes as just a box to check off to keep your license up, focus on attending those that are focused on UE rehabilitation. Many of the practical hands-on skills that I have now were originally learned in a course that was taught by great instructors on topics that related to UE rehabilitation. After you take those courses, go back to your clinic and practice those skills. Actually doing what you’ve learned in hands-on courses is the only way to build real skill and expertise, especially when it comes to manual techniques.

Along with pursuing education opportunities to grow your knowledge of and skills in UE rehabilitation, you should also actively seek out current research, literature, and evidence-based resources to inform your practice. Staple books such as Diagnosis and Treatment Manual for Physicians & Therapists, Rehabilitation of the Hand & Upper Extremity (Volumes I & II), Fundamentals of Hand Therapy, and Myofascial Pain and Dysfunction, Vol. 1 Upper Half of the Body provide a plethora of solid information and practical protocols for treating everything from strains and pains to complicated post-surgical diagnoses. Plenty of resources also exists out in the interwebs that provide practical, evidence-based resources for therapists focusing on UE rehabilitation. One of my personal favorites is physio-pedia.

It’s also a good idea to begin gathering and collecting copies of the resources that you find most helpful and useful. For example, I have been using the Core-4 exercise program when treating all kinds of shoulder dysfunction for years, with good results. Having a solid set of “go-to” exercise program and treatment protocols make life a lot easier and give your patients some assurance that you know what you are talking about.

One last piece of advice I give to any student or new grad on entering the UE rehabilitation world is to seek out mentorship and/or learning groups. When I started on my own journey in UE rehabilitation, I was blessed enough to form relationships with therapists who had been treating me for decades. Over the years, I learned as much as I could from them, asking questions, learning manual techniques, and discussing research, methods, and protocols related to the diagnoses I was treating. I think most people who are considered experts or specialists would agree that it’s not something you do on your own. For the most part, everyone gets helped, taught, and mentored along the way.

Step Two: Get Recognized (Building Your Personal Brand and Authority)

After you’ve begun building your clinical knowledge and skills, gathering clinical resources, and forming relationships with mentors and expert practitioners in the field, what’s next?

Getting recognized and building your reputation as a UE expert becomes the next step on your path from new grad to UE specialist. Now I’ll admit that this can be easier said than done, especially in the medical/rehab field, where everyone tends to know everyone. Nevertheless, you want to not only have the knowledge and skills of a clinical expert, but you want to be viewed as an expert.

Building your personal brand or authority in your field opens the door to opportunities and possibilities not available to clinicians who are “just” occupational therapists. To do this, you need to understand a little bit about psychology, human behavior, and influence. Robert Cialdini’s book Influence: The Psychology of Persuasion provides immense insights into the psychology behind human perception and the role that plays in establishing credibility and authority.

At the end of the day, being viewed as an expert or authority in any field — UE rehabilitation included — boils down to the amount of credibility and influence you have within your niche. In our case, we are looking at UE rehabilitation. Regardless of whether you are a practice owner or a staff therapist, the ability to influence your patients or clients builds your reputation as an expert. Think of it this way: Imagine a patient walks into your clinic, in a lot of shoulder pain. Through the way you communicate with that patient and the clinical skills you apply during that session, that patient leaves your clinic in less pain and feeling that their therapist knows their stuff! What do you think this patient does? He or she tells their friends, neighbors, and, more importantly, the doctor that sent them to you how wonderful you are. Now that doctor thinks of you as an expert clinician and will likely refer more patients to your clinic.

When I was at the VA, there were times when patients would come into my clinic for their first appointment with me and say something along the lines of, “My doctor told me he was sending me to the shoulder expert and said you were the guy to see.” Why did those doctors feel that way about me and the services I was providing to my patients? Because not only did I have the practical knowledge and hands-on skill necessary to do the job, I built myself a reputation as an expert. I built up my reputation in a variety of ways.

First, I made it a point to network, dialogue, and frequently interface with the physicians that referred patients to our clinic. Second, I looked for opportunities to gain exposure through extracurriculars. I became a board member on the GA State Board of OT. I taught the Evidence-Based Practice course at the university that I was graduated from. I also began volunteering as a subject matter expert for several NBCOT committees and meetings. All of these activities did two things for me. First, they provided me with networking opportunities and allowed me to build relationships with other influential people in the field, both locally and nationally. Second, it built up my resume and provided me credibility when I presented myself as an expert or authority figure in UE rehabilitation.

It all comes down to taking your knowledge and skills and then communicating them in a way that creates and builds influence and authority. Books have been written on this subject, but it requires being deliberate in everything that you put on your resume, LinkedIn profile, bios, and anything else you put out about yourself, your clinical expertise, and the way you communicate it to the world. You’re building your brand. Focus on that.

Step Three: Pursue Certification (Making it “Official”)

The final step in becoming a UE specialist involves certification. Especially in the medical field, a lot of significance and emphasis continues to be placed on official certifications in advanced practice. Certifications are a good way to solidify credibility and authority in UE rehabilitation practice as well as provide some concrete assurance that you truly know what you are doing.

The CHT (certified hand therapist) certification by HTCC is probably the most popular chosen by therapists who focus on UE rehabilitation, specifically hands. The requirements for the exam are fairly stringent. To sit for the exam, you must practice as a licensed therapist, treating diagnoses involving c-spine to fingertips (pretty much the whole UE) for approximately 4,000 hours, which are certified by an employer. The International Academy of Orthopedic Medicine (IAOM) also offers certification as a Certified Manual Therapist (CMT) with a specialization in UE and LE. Another source of CEU and certification courses is Evidence in Motion (EIM). Whichever you choose, you are guaranteed to learn a whole lot, and probably study even more.

That being said, the internet has created enormous opportunities for practitioners who do not have a specialty certification to establish themselves as experts in their field. With your clinical knowledge & skills, the internet, and a laptop, you can easily create content and provide services or products that build your credibility and authority in UE rehabilitation. That’s not to say that anybody can throw up a blog post and be considered an expert. You still need to provide quality, evidence-based content that exemplifies best practices in order to truly build your reputation as a specialist.

At the end of the day, one thing is certain: going from new grad to UE specialist is hard work! It takes time, dedication, constant study and practice, and a willingness to go above and beyond what the majority of professionals are willing to do.

Have you considered specializing in UE rehabilitation? What do you think are the biggest hurdles to getting where you want to be? 

Are you wondering which OT setting may help you best reach your personal and professional career goals? Get started by clicking the link below and taking our short quiz.

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