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OT Across America: New York, NY with Tara Rudkoski, OTR/L

For our OT Across America: New York interview, we got to chat with Tara Rudkoski, OTR/L over the phone about her experiences working as an OT in both pediatrics and adults in New York, NY as well as Seattle, WA. Tara just moved to Phoenix, AZ and was on the job hunt during our call (she has since landed a position in Phoenix!).

Big thanks to Tara for taking the time to speak with us about her varied occupational therapy experiences!

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

I started figuring out what I wanted to do in 2006 when I graduated from high school. I heard about OT and had someone tell me, “You’d be great as an occupational therapist.” I knew I was interested in OT, PT, and nursing so I chose schools that had all 3 of them.

I decided to pursue the occupational therapy major at the University of Buffalo. So I started the program and I ended up really loving it. I loved the theory and I loved where we came from. I just stuck with it. I don’t have any extravagant story about how this person was an OT and was involved in my life. I just really liked it in school.

What setting are you in and how long have you been practicing?

I’ve been an occupational therapist for 7 years. After college in 2011 I moved to Seattle and started as an OT in Washington School District and was there for 4 years. While I was working in the school district I also worked for a staffing company. The staffing company placed me in different placements like subacute rehab for geriatrics.

I was also doing geriatrics on the side whenever we had a long break, so I was at a million different places. Then I took a placement for home health and that involved a lot of different things outside of Seattle where it was pretty rural. I was going to people’s farms sometimes to work with them. From there I moved back to New York and I was applying for jobs in New York, which is pretty saturated.

It was much harder to get an interview for a job. I then took a home health position working for a company that was owned by an OT. It was a good job, but it was still owned by a bigger company. It was an experience that I learned from but there aren’t many OT positions for home care and in nursing facilities. This was right outside of the border of New York City. I did worked there for 3 years.

What does your typical day look like now?

I’m looking for jobs now in Phoenix – going on Indeed.com in the morning. I updated my resume so I am sending that out to a bunch of people and getting a lot of phone calls and figuring out which jobs are worth me applying to.

It depends on who you want to work for and where you want to work. Do you want to work for the hospital system? In New York, there are very minimal jobs in the hospital system. All the recruiters will tell you to go outside of the city, but inside the city it is really hard to find those types of jobs. Someone I talked to had an interview for an acute care position but she didn’t get the job.

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What was your productivity like in your different jobs?

At the school we were on the lower end because all the OTs that were there were district employees. As a district employee they had a pretty good ratio. I had to have at least 37 kids on my caseload which was across many schools. Sometimes it would be lower and sometimes it would be up to 45. That is on the lower end. In California or Illinois it would be 60’s and above. And a lot of the time it was “consults” which is what they liked to call them.

You would talk to the teacher or observe them in the classroom and see if there’s anything additional they would need. We didn’t do consults as much. At the time I was there, it was a very gray area as far as what counted towards my caseload. We were constantly having conversations about how do we treat kids that are in school and need OT but they don’t really need direct treatment all the time – sometimes they do but sometimes they don’t. The ones that were straight forward were individual direct treatment, or group direct treatment, or group indirect treatment.

It was difficult to know how exactly to track what we were doing. It was hard in the school district I was at because I was employed directly by the school district. Sometimes it was unclear if I should travel to another school when there was only one student I needed to see. The evaluations were not reflected as much – they only counted if they were on your caseload. I think it very much has changed since I’ve been there.

In home health, we did units. I can’t exactly remember what it was when I lived outside of Seattle. Mostly I’ve had a pretty good experience with it and never felt too overwhelmed. I was salaried and not a lot of people I know are paid that way. Usually it’s paid per visit. I liked the salary model better especially in the beginning when I wasn’t seeing as many people. At least you were making a standard amount.

But, by the time I was leaving I was usually doing more work than I was getting paid for. They would take into consideration if you were driving a lot. Each of the types of visits were worth a certain amount. It was based on the OASIS outcomes assessment which is very standard. If you’re doing an evaluation as an OT now, you’re probably not doing “start-of cares” which takes a really long time because it’s a snapshot of the entire person and takes into account their entire body. Nurses typically do that and physical therapists sometimes will too. With Medicare, occupational therapists are not allowed to. But on other private insurance plans OTs can do them. So OTs don’t usually get trained on them since they don’t usually administer them.

The other job I did out in Seattle, that was for a very big home health company. They would have everybody that was taking regular insurance too as well as Medicaid. In a typical day in home health, I was seeing around 5 patients.

By the time I was finishing, I was pretty proficient at it and the company was growing so I was seeing anywhere from 7-8 [a day] maximum and I was getting paid overtime and working a lot. It also depended on how much you’re driving. If I had people that were all in the same place, it would be doable but often it was spread out. Sometimes there were in the same assisted living facility where I would see 2-3 people there, which makes it doable.

What were the most common diagnoses you were seeing in both settings?

In home health, I saw everything. We would see people with knee and hip replacements. They would leave the hospital and they’d go home after 2-3 days and I’d be seeing them. A lot of people had Parkinson’s and sometimes multiple fractures from falling. Plus there were comorbidities with diabetes, stroke, spinal cord injury, etc. It usually was more than just one thing.

In the schools, it was mostly autism, ADHD, and then there would be some random things like muscular dystrophy. There would be other uncommon syndromes that kids were diagnosed with. It was predominately autism in the schools.

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What do you like most about being an occupational therapist?

I like that there are so many different placements and there’s so many different ways to be an OT, if you can dream it you can somehow figure out how to do it as an occupational therapist. There was a TED Talk about someone who had their handle in many different things professionally. I think OT is like that. It’s also great if you specialize too.

But I like that you can be flexible in this profession. I think that as an OT it wasn’t hard to translate my skills from one setting to the next, because that’s how it should be. We’re an overarching practice that assists in many different settings. I’m trying to find what peoples’ meaningful occupations are whether they’re 2 or 60 or 70.

What would you say have been the biggest challenges?

I think the productivity is always a challenge. In a lot of the settings I’ve been in, the isolation is hard. I see a lot of people that are in isolating settings. So if anybody out there wants to go into any of these settings, they’re very isolating which is hard. Anybody I know who does home health, I was calling them all the time when I was working so I could be in contact with them.

We were calling each other every day to stay in touch. We would talk about what we were doing. We would always bounce ideas off each other, and so that was the hardest thing. It was great to have other OTs I could at least call and talk to. I had another friend that I graduated with that was doing home health in Indiana and we would talk on the phone too.

What is the job market like?

With New York it’s hard for new grads and seasoned therapists to find jobs. You’re going to find more jobs in home care for adults and schools for pediatrics. There’s a lot of 1099 positions, which means nobody will pay you for anything besides hourly. They don’t give you CEU money. They don’t give you benefits so you have to go on the market and find benefits.

Do your research before you move to a city. If a city is really booming, there will be jobs. But if it’s a city that’s more stagnant without a lot of growth, it’s going to be a lot of home care. You’ll be driving a lot, but it’s hard because for that time you’re not doing therapy. If I’m seeing people in a condensed area, I’m really working during that time. But if you’re driving you have to try to find a way to feel productive by either talking to people or listening to educational podcasts.

Is there anything unique about occupational therapy in the New York region?

I can say that the one thing I noticed when I started doing home care in Seattle [after being in New York]. I thought I was going to go into the homes and be a little aggressive, and so I was kicked out of a lot of people’s homes. I realized I didn’t really sugar coat things and people there didn’t like that. I had to be with people that were not taking my recommendations. I had to talk to people carefully and compliment them and tell them that they’re wonderful.

But in New York I don’t have to do that at all. I had to find a way to be able to do that. Complimenting people goes a long way. I read the Dale Carnegie book How To Win Friends And Influence People. So I was reading up on how I could change my charisma to fit to those people to make sure they are listening to what I’m saying.

When I came back to New York, I was able to be more direct with my patients without any problems.

Would you say OT is appropriately represented in home health?

I feel like in any type of isolating setting, you need to advocate for OT. You have to advocate for OT a lot so it’s really hard to fake it if you don’t like doing OT. There were many times I would go into evaluations and nobody knew what OT was. And I also went in and would have to educate them and they would get confused because they were already seeing PT. I had to do a lot of educating and calling the patients.

What I ended up doing was talking to my supervisor, and they sent an email out to the nurses to have them also advocate for us. That would really help when we went in so patients would be more receptive.

I had to do a lot of advocating especially for older patients. I would have to explain to them that they probably need both [OT and PT]. You have to make sure your patients understand what OT is. There are some great resources on AOTA that help you explain what you do. That was always really important for me to be able to get my foot in the door. And the other important thing is being able to explain how you’re different from PT.

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How would you rate the compensation in New York?

The cost of living in New York is a lot more. When I moved back, I was living with my parents again. It was helping me save money but everything costs more there. I like making more money as a home care therapist compared to someone doing the same job in Indiana. But the cost of living out there is so much lower, that they’re probably better off overall.

In Phoenix, the reimbursement rate is a lot higher so my salary could end up being similar to what it was in New York but the cost of living is so much lower. I have a few friends in Las Vegas and they also have a really high reimbursement rate. If people are looking to travel and you don’t have anywhere set that you want to go, look at the reimbursement. It really depends on what you want and where your family is. Coming from Buffalo, their reimbursement was really low but the cost of living was also really low.

What are your plans for your career in OT?

I think right now I am probably going to go back to pediatrics. I’m trying to think about it logically. If I go back to pediatrics, I feel like it will be a little more specialized. If I wanted to go back to home care, there’s always going to be a home care job. I think right now as we’re moving to Phoenix I’m trying to get a job in outpatient pediatrics, even though I applied for that acute care position. I think that’s what I’m going to be moving towards.

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