Are we setting realistic expectations for early career OTs?

I’ve been hearing some concerning stories lately about the expectations being placed on early career Occupational Therapists. In particular, the billable targets they are expected to meet and the support they receive to achieve them.

I understand the commercial realities of running an OT practice. We need to generate enough income to cover our costs, support our teams and keep our businesses sustainable. But I also think we need to question whether some of the expectations being placed on therapists are reasonable, particularly when they are still developing their clinical skills and confidence.

Are we measuring everyone against the same expectations?

I remember speaking with a practice owner a few years ago who was frustrated that their team wasn’t meeting their billable targets. During our conversation, they explained that the amount of time therapists were allowed to bill for a Functional Capacity Assessment report was capped at five hours.

When I asked why, they explained that if they were writing the report, it would only take them five hours. Therefore, that was the maximum amount of time their team could charge. But how could they know that? They didn’t know whether that particular participant’s circumstances, assessment findings or reporting requirements might have taken them seven hours instead.

And even if they could complete the report in five hours, was it reasonable to expect every therapist in their team to work at exactly the same pace? We become more efficient through experience. Our clinical reasoning develops, we become more familiar with assessments and we learn how to communicate our findings more effectively. We also develop systems, templates and processes that help us work more efficiently.

Those skills take time to develop, and we cannot expect an early career OT to work with the same efficiency as someone who has been practising for 15 or 20 years. Equally, we cannot expect participants to fund all the additional time a new graduate might need while developing those skills. This is where good supervision, training and realistic expectations become so important.

What happens when the targets don’t reflect the work?

I heard another concerning example recently involving an early career OT who had become the only OT remaining in their organisation. They were expected to achieve 25 billable hours per week, but their travel time wasn’t being counted towards that target. This is where I start to question whether we are setting therapists up to succeed.

Travel is often a necessary part of delivering community-based Occupational Therapy services. Depending on the circumstances, that travel may also be billable. Yet in some practices, therapists are expected to complete additional billable work to compensate for time spent travelling.

I understand why businesses are looking closely at these things. Travel doesn’t generate the same income as direct clinical services, and practices need to remain financially sustainable. But consider an OT working in a regional area who spends two hours travelling to and from an appointment. If that travel contributes only partially, or not at all, towards their KPI, they may need to find additional billable hours elsewhere in their working week.

Finding that additional time can be difficult, particularly when therapists have limited control over their geographical caseload or appointment scheduling. I worry that expectations like these can contribute to burnout. Practice owners need to think carefully about how appointments are clustered, how caseloads are allocated and whether their productivity expectations reflect the actual work being undertaken.

Meeting billable targets is also a skill we need to teach

There is another side to this that I think is equally important. Sometimes therapists are completing billable work but aren’t accurately recording the time they’ve spent.

Report writing is a good example. You sit down to write a report, spend half an hour working on it and then the phone rings. You answer the call, deal with whatever has come up and eventually return to your report. But did you record when you stopped? Did you remember to restart your timer? These interruptions add up, and it becomes surprisingly easy to lose track of legitimate billable activity.

I’ve tried different approaches over the years, including time-tracking software and simple timekeeping sheets. I’ve also used a browser extension that hides incoming emails while allowing me to search my inbox. It helps prevent those moments when you open your emails looking for one thing and emerge half an hour later having completely forgotten what you were doing.

These might seem like small things, but they can make a real difference to how accurately we record our time and manage our workload. We shouldn’t assume therapists automatically know how to do these things simply because they’ve graduated. Accurately recording time, managing interruptions and developing efficient work practices are professional skills that need to be taught.

Productivity and professional development need to go together

I don’t believe the answer is to remove KPIs. Every private practice needs to understand how it generates income, what it costs to deliver services and what level of productivity is required to remain sustainable.

But I also don’t believe we can simply set a billable target and expect clinicians to work out how to achieve it, particularly when we’re employing new graduates. We need to help therapists understand what work can appropriately be billed, how to record their time, how to structure assessments and how to produce clear, clinically sound reports without spending unnecessary hours on them.

We also need to recognise that developing these skills requires supervision, feedback and opportunities to learn. For early career OTs, I think it’s equally important to understand the expectations of the organisation you’re working for. Ask questions about KPIs, travel, report writing, supervision and how productivity is measured. Understand what support will be provided to help you meet those expectations.

If you’ve never worked anywhere else, it can be difficult to know whether what you’re being asked to achieve is reasonable. And that’s something I think we need to be particularly mindful of when employing therapists who are new to the profession.

Ultimately, I think we need to stop treating productivity and professional development as separate conversations. Helping OTs become more efficient, confident and clinically capable is part of building a sustainable practice. If we’re serious about supporting our early career workforce, we need to make sure the expectations we’re setting are matched by the support we’re providing.