OT Across America: Tucson, AZ with Heidi Carpenter, OTR/L

For our OT Across America: Tucson, AZ edition, we had the great pleasure of interviewing Heidi Carpenter, OTR/L about her varied experiences in OT and about starting her own private practice, Embody Occupational Therapy.

We had such an inspiring conversation about her varied practices and moving OT forward as a profession at the historic (and very cool) Hotel Congress.

If you’re ever traveling through the Southwest, definitely be sure to visit Tucson. It is such a neat town and was probably our favorite city through our journey throughout the West and Southwest.

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Tell us a little bit about your background and what drew you to occupational therapy.

I have a background working with kids and kids with special needs. So ever since I was in junior high and high school, I started babysitting. My mom is a special education preschool teacher, so when I was growing up I was always in her classroom seeing the kids with special needs and the therapies that were working with them. That exposed me really early on to school based practice for early childhood education.

And then, my mom has multiple sclerosis and so seeing her go through that as I was getting older and getting ready to choose which profession I wanted to go into, that was a huge motivator for me to learn more about how to help people. I have a undergraduate Bachelors of Science in Psychology which was a great foundation for then going into occupational therapy school to learn the clinical aspects of helping people.

What setting are you currently in?

Currently I work in home health for a full time position and then I also work part time in an adaptive gymnastics program coaching. And I also just recently started my own private practice, Embody Occupational Therapy, which I focus on yoga-based interventions more from a wellness model.

What does your typical day look like?

I also work as a contractor for in-home pediatric practice here in the state. So my typical day will include 4-6 clients, and I drive to their homes. And for home health, my typical intervention or eval session is between 50 minutes to an hour and 15 minutes.

And I cover all of Tucson as the only occupational therapist. So I drive typically 150 miles a week, so that gets me around town. Usually I’ll see my first client at 9:00 or 10:00, and I’m seeing my last client at 3:00 or 4:00. And I typically work straight through the day and eat in my car.

Do you have to do any paperwork in the evenings?

I use online documentation for all of my positions and I attempt to do as much point of service documentation as possible. For actual treatment sessions I do pretty well. I am pretty consistent with finishing my point of service documentation when it’s an intervention session. And I’m signing the note when I’m in my car and I’m finished with that documentation for that person.

When it comes to evaluations, I take notes during the evaluation. But the way the system is set up I have to go back and tweak a lot of stuff that just takes time. And when I do it in the session, the client is like, “What is she doing?” So I just do it afterward. Evals usually take me 20 to 30 minutes per eval after. I do it in the evening or sometimes I’ll roll it over the next day. And so I’ll just get it finished that way. I usually have 4-5 evals a week.

What does your productivity look like?

We have a documentation productivity – so to speak. So my goal is to finish 80% of my documentation by midnight of the same day. And my productivity for seeing patients with my full time home health job is 20 points a week. So an evaluation is 1.5 points and a treatment or intervention session is 1 point. So it just has to equal up to 20 points.

They’ve been pretty lenient with me because I’m their first full-time OT hire since they started home health down here a year ago. So I’ve been averaging like 17 – 18 points a week. I’m almost getting up to that full time 20 point minimum. But I mean they don’t have the caseload, so they can’t expect me to be meeting it yet.

How many hours a week are you working?

So it is 30 hour equivalent and I end up working about 30 hours a week.

What are the most common diagnoses that you see?

With kids in that contract job, I just do evals and then I supervise occupational therapy assistants. So with them I see the myriad of childhood conditions like cerebral palsy and some really rare genetic disorders actually. I saw a kid with PANDAS, kids with autism, and kids with Down Syndrome.

So with home health, I see a lot of people with chronic conditions like COPD, CHF, people who have had strokes, heart attacks, M.S., Parkinson’s, and people who have cancer.

One of the things I like most most about my job is just the ability to work with people, hear their stories, and be the OT on the team who is finding out their whole story. Somebody with chronic diabetes, COPD, and living alone who wasn’t always like that.

There’s always a reason and motivation to why people are where they’re at in life and what they want to do better. I love finding that out about my patients and helping them meet whatever goals are important to them at the time, and so that is really fulfilling.

When I work with kids, my main goals are really to help that family and answer questions because it’s so new to them to be having their first occupational therapy eval when their kid is three and has autism. I just really enjoy getting to meet people from all walks of life.

What are your biggest challenges?

So the biggest challenges are definitely that I feel like I’m always racing against time. Especially now in home health where I’m driving around to different neighborhoods and it takes me forever. I’m terrible. I try to squeeze in as many people as I can and I’m like, “Oh I can make this 30 minute drive in 15 minutes.” No…it never works out like that. So I feel like my days just go so fast because there’s so much to do.

And then there’s also the challenge that I don’t feel like I’m using my training to the fullest at all. I’m not practicing at the edge of my license. I’m not pushing the boundaries or pushing the profession forward. I feel like there there are limited resources to do so because the system has to be set up to support that. Especially in home health, there’s limited time, there’s limited episodes of care, and so you have to do a lot in a very short period of time with limited resources.

The job that I work at right now – yeah they’ll give me all the Thera-band and Thera-putty I need, but they won’t buy me a dynamometer. I’m limited by resources and supplies that I feel like could help people or gather data so I could look at my cases retroactively and be a clinician researcher. It’s better with the nonprofits. Like you were saying with the for-profit hospitals, they don’t care about looking back and doing case studies or supporting their clinicians to go speak at conferences or do any professional development stuff that I’ve seen personally.

People want to but it’s not coming from the companies supporting them doing it. I really appreciate academic medical centers for that aspect. They do support more professional development. But it’s hard and the clinician really has to drive it.

And then of course like the documentation – I would just love to have a documentation system that really truly keeps track of the progress. So you could just automatically look into it and see like, “Hey… this is what your patient has done.” Like a snapshot. My documentation system right now does not have a snapshot. There are some that do.

Do you feel like OT is appropriately represented in your home health job?

I feel like I definitely am appreciated and I feel like people generally understand what I do. I feel like we could be having more referrals to occupational therapy. My team really does support me very well and my manager does. Right now we’re having a PT shortage and they feel confident sending me in. I’m working with a lady right now who fractured her ankle – both medial and lateral – so she is non-weight bearing and ordinarily that would only be a PT referral in a lot of places. But we don’t have the PT help, and they feel competent sending me in there to do it.

So I’m going to get to be doing those bad exercises that PT always hog. And there’s no reason why an OT cannot do those. It’s kind of cool – it challenges me a little bit to be like, “No Heidi, you can do this.” Because when you do work with physical therapists all the time, I feel like there’s certain stuff that definitely gets turfed to them 100% of the time, but there’s no reason why we can’t do it too. There’s no reason why I can’t be teaching some bed exercises. I learned that anatomy and I went through that kinesiology too.

Is there anything unique about OT in this region? What is the job market like in Tucson?

As an occupational therapist, you can write your ticket here because there is a scarcity of occupational therapists down here. There’s plenty in Phoenix. There are three schools and there’s going to be four: two OTDs and two masters entry level programs.

But I get the job searches and there are consistently 14 or 15 open full time OTR positions down here. So you can set what you want to do. You know this is rural health. Tucson is a city of over a million, but it’s very easy to go up to Marana or out to Vail or down to Green Valley. It has a very rural feel to it. Which is good.

It also means that you’re constantly educating. My team right now might know what I can do, but there is still so much education. A lot of the docs have old school ways of thought, like how they’ll do surgeries or how they’ll write in order. For neuro rehab, there’s not a huge emphasis on neuroplasticity or more of the motor learning for neuro rehab after a stroke. So there’s a lot of education, and occupational therapists that are here tend to be older and they tend to be the ones who came in with the bachelor’s.

So there’s also that crossing in education both ways that happens. In one sense you’ll get a lot of how OT was done and that historical context is really interesting. But I come from Omaha, Nebraska where they’re very forward thinking and they have rehab centers that are state of the art with Madonna to QLI. They’re just really thinking out of the box there in terms of OT and so I feel like it’s a little behind the times down here a little bit.

As much as you’re willing to share, how would you rate the compensation in your area?

There are sign-on bonuses since OTRs are in such high demand here. Nationally, I think it’s pretty middle of the road. But cost of living is is pretty low. With the payer systems here in this state, there are certain areas of practice that can be pretty lucrative. Like DDD for Arizona specifically, for in-home pediatric services, three years old and up, for people with disabilities, who are on long-term care.

That payer source can be really lucrative. It’s no secret, you can look this up on the internet, but if you’re a provider with them for an OTR to do an eval it’s $165. And a treatment is $75. An hour is the expected time. But yeah, you’re going to spend time documenting. Generally, you’re looking in the $40s per hour as an OTR here. PRN here would be more in the mid to high $40s for new grads under five years of experience.

What are your future plans for your career in OT?

I launched Embody OT and I’m focusing on wellness based services. I’m finishing a nutrition coaching course right now. Obviously I bring the OT lens to that, but I did feel like I needed a little bit of a boost credential-wise to talk about nutrition. I’ve been studying yoga since I was in high school and I managed to do an in-service about yoga in every single one of my field work placements. I was really excited about it. I’m doing yoga-based interventions.

I’m just going to focus on that, and I’m going to keep doing my other gigs until I can really do Embody OT full time. I want to continue be forward-thinking and pushing things forward. I was involved with AOTA when Amy Lamb was vice president and then president, so that distinct value she talks about resonates with me. And I got that education with her really early on. So I really want to help do that.

When I was applying to OT school, I found books at the library that were published in the 70’s and 80’s. It was not appealing to me to want to be an occupational therapist. And now I look at how educated we are coming out of school, and it doesn’t translate to what we’re doing in practice – it really doesn’t. There are some level one trauma centers like one my fieldworks at St. Joe’s in Phoenix. You are practicing at the top of your license when you’re in a setting like that.

And in Omaha, QLI is this really cool no-productivity place where if somebody was working on motorcycles before they had a stroke and that’s what their passion is, they bring in a motorcycle and that’s what they work on.

I love working with students. I want to teach someday. But I want to figure out a way to keep practicing at the top my license and figure out how to help other practitioners do the same. Figure out a way to track it better so we can talk about it more. Because that’s what physicians have done since the beginning of time. They’ve written case study after case study after case study about these really cool cases. And that’s how they have progressed medicine.

We’re needed now more than ever. And I learned that more now than ever being in home health and seeing all these people with diabetes, COPD, anxiety and conditions that are so debilitating. I’m just going to keep meeting people and talking about OT and how great it is!