OT Across America: Phoenix, AZ with Phyllis Khao, OTR/L

For our “OT Across America: Phoenix, AZ” edition, we got to interview new-ish OTR grad Phyllis Khao, OTR/L about her experiences as a new grad who just moved to Phoenix. In our interview, she discusses her experiences working in both inpatient rehab and skilled nursing facilities.

Since our interview, Phyllis has taken a full-time position in a research-based acute care position, so we’ll have to do a follow-up interview once she gets in the groove there! Huge thanks to Phyllis for taking the time to meet with us at North Italia where we had a lot of carbs and great conversation.

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

IMG_3808My name is Phyllis Khao, and I’m a new grad. Prior to becoming an occupational therapist I worked in marketing in New York City. I did marketing for Broadway shows, performing arts, and work for non-profits. But I decided I wanted to become an occupational therapist because I needed a more fulfilling career. Being a marketing professional I felt like I was constantly lying to people and trying to make people spend money and I didn’t find it fulfilling.

So I did something really old school. I went to the library, and and wrote down a list of qualities I’m looking for in a job. I saw the book of occupations and looked for keywords for jobs with these qualities that I’m looking for. And then I found 5 or 10 jobs, so I contacted people that I knew to ask them, “Do you know anybody in this profession? I really want an informational interview to get to learn more about the profession.”

And my co-worker’s wife was an OT, she was one for 17 years and she said, “Come over for dinner and I’ll tell you all about it.” And she was telling me all about the different settings she worked in. She invited me to shadow her and her friends.

I didn’t even go check out those other careers after I shadowed her. I thought, “This is so much fun.” Who knew it existed? She was a COTA professor and she was working at a SNF, and worked PRN at a pediatric clinic. Prior to getting into OT school, I volunteered at six or seven different settings. And it started off with her and her friends and it just kept going on.

Where are you working now? What school did you go to?

I went to Bay Path University in Massachusetts. I currently work PRN in inpatient rehab and full-time at a SNF in Phoenix. I do long term care, short term, outpatient, and assisted living. I’ve only been at the SNF for three months. It actually became three months yesterday. Before that I lived in Tucson and I worked at an inpatient rehab hospital.

How long have you been working in total?

As an occupational therapist, officially I’ve been working for eight months.

What does your typical day look like with how many different settings you’re working at?

So I work at the SNF from Sunday through Thursday. And then I’m PRN at the inpatient rehab hospital two to three times a month on the weekends. And my typical day at the nursing home varies depending on how many patients we have – that I have to evaluate or how many progress notes or discharges. But every day I always feel like I’m rushing because I’m trying to meet this whole productivity thing, and I’m still adjusting to it. But I would say I’m not a fan of it right now.

But what I do like is my favorite setting, the inpatient rehab hospital. I’ve done it for six months. What I love about it is that you see six to seven patients a day, there’s a set schedule where you see them each for an hour and they know the expectation. And I love how everybody on staff respects that time.

I feel like while at my full time job in the nursing home, nobody respects that time. They’re like, “No. They cannot participate. They’re going to activities, or nursing is doing something, or paperwork needs to be filled out.” But every day I feel like I’m racing against the clock when I’m at a nursing home and I’m trying to do so much in so little time just because of billable hours.

What is productivity like in the SNF and inpatient rehab?

In the SNF, it’s a 3% difference between and evaluating therapist and an assistant. So for my productivity it’s 87%, but for my assistant it’s 90%. It’s kind of awkward to say, but when I agreed to the job I was told it was 80% and then they changed it on me. I nearly had a heart attack! So, that was a little tough on me. But for inpatient rehab they said I had to see a minimum of six people a day. Which I really like because it’s scheduled and you’ll actually see them.

Whereas in the nursing home, I have to worry about the productivity but I also have to worry about moving myself around the patient’s schedule because you don’t have a set schedule. You just show up and then they will tell you if they want to go or not. I did it for my fieldwork too but the productivity was 80%. And that’s much more doable.

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So in inpatient rehab, you see six to seven patients a day. Do you ever see concurrent therapy?

In my nursing home right now, we haven’t started yet because the company just bought it in April. So I don’t have to see that in my nursing home. But at my inpatient rehab job we do have concurrent and we also have group. The thing is, what I do like about the group is we have special groups just for ADLs, a special group for lower body dressing, for balance, for functional transfers, life skills, and money management. But I feel like it’s such a good experience because I usually have like four or five people. But they can talk about their experiences and I don’t feel like it’s work.

I like that in inpatient rehab they actually have a set template curriculum designed for those already. We have something called the Amazing Race. And the Amazing Race is where we have all these obstacle courses and we assign patients by their abilities to do these obstacle courses, but it goes out throughout the whole hospital. It’s very functional. And people participate in The Amazing Race when they’re preparing to go home, probably a few days before discharge. So all those people might have a day where it’s all wheelchair for Amazing Race or all ambulatory.

It’s just really good cause you get to have them do real functional activities. We have a supermarket obstacle course, pet care, there’s even golf. But patients don’t even realize that they’re participating in therapy. They think that it’s a fun day, like an activity day or something. We try to incorporate all three disciplines: speech, physical therapy, and occupational therapy for The Amazing Race.

In the SNF, how many patients do you typically see in a day?

Sometimes I see from 4 to 8 depending on the day. Sometimes on a weird day where I only see someone for 30 minutes, I may have a bunch of those and I can see up to 10.

What are the most common diagnoses that you see?

Mostly in the SNF I usually see orthopedic, a few neurological like strokes and Parkinson’s, dementia, and then I would have a lot of people that have fallen. But in the inpatient rehab I see the traumatic brain injuries, strokes, all the neurological spinal cord injury, multi-trauma, cancer, or mysterious diseases that no one knows about.

So it’s exciting. That’s why I like that one because I feel like I can be a real therapist. I’m always learning something new every day. It’s like, “Oh, a mystery disease. No one knows much about it. One in 30 people in the world gets it.” But it only shows up once in ten years and you’ll learn about it.

What do you like most about your jobs?

I think in general what I love about my job is working with the patients and actually building that relationship with them. Even though I’m part of their life for a small period of time, I love seeing them progressing, seeing how they change in the few days, being able to be part of their recovery, and seeing them doing things they love again. In the nursing home, sometimes you don’t see the people recover. Sometimes they decline or they pass away.

What are the biggest challenges you face?

I would say that not seeing the nursing patients progress is a big challenge for me because I always feel bad. Sometimes I have to tell myself I can’t do anything for them anymore. And it’s not my fault, it’s just that they’re very sick and it doesn’t help when they’re old or when their body just won’t fight anymore.

But what I love when I’m at the inpatient rehab hospital are stroke patients. And I just love seeing someone come in – they can’t walk, they can’t do anything. And then it might be a month or a month and a half later and all of a sudden they’re walking with assistance or they’re finally putting on their shirt for the first time or they’re they’re finally stating their first word and it brings so much excitement to me.

I got so excited just because someone can finally move their hand for the first time and the look on their face just makes you think, “Wow, they’re recovering.” It might be a finger wiggle or being able to poke themselves but it’s something exciting. It’s like, “Oh my God! Their fingers wiggling!” And then I come home and I tell my boyfriend about it and he goes, “OK. They did what? They poked you?” It’s exciting!

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Are there any other challenges you face?

Aside from that, I feel like there’s a lot of ethical dilemmas. When census is low, I dislike when my rehab director would ask me to pick up people from long term care that don’t need services. They’ve been dependent the whole time. Why would I pick them up? Or when they try to push me to extend taking care of a patient longer than they need to be. They’re at their prior level. Why are we keeping them on? Or when I have outpatient, they’re not really outpatient. They’re people in assisted living.

And they would push me saying essentially, “Let’s go searching for people that we think need OT.” And I’m thinking, “They live in assisted living. If they have assisted living, what am I there to assist them with?” And they would tell me, “They were independent before.” And I’ll say, “But there’s a reason why they moved to assisted living. I don’t need to help them.” Or they would say, “Maybe you need to do balancing. They could do everything themselves, but maybe balance to use the toilet and the shower.” And I’m thinking, “That’s duplicating. They don’t need it. PT is working on balance with them. I bring them to the bathroom and they can undress themselves, they can wipe themselves,and they can do everything. But they have poor balance? If they’re independent, they’re independent.

And I dislike it when every time I evaluate a new patient, the rehab director automatically puts them at the highest level. That person’s not appropriate. They can’t tolerate that long for therapy. And then they might say, “You’re going to see this person for 60 minutes” and they’re only able to tolerate 30 or 45. And then they get mad and say, “We’re losing money. You have to make it work. Be creative.” And I feel like it’s unethical. They can’t do it.

And I feel like because I am a new therapist everybody thinks that they can push me around. They’re like, “You don’t know anything. This is the way it is. You just do it.” It’s uncomfortable. For example, I had a patient that was getting osteomyelitis, and she was at the rehab facility getting IV treatments. Then the rehab director kept telling me, “She broke her hand, so now she doesn’t have any supination, pronation, or flexion extensions so we need to do modalities.” But I kept telling them you can’t use modalities on osteomyelitis.

They didn’t believe me until I contacted the modalities company and asked, “Isn’t it a contraindication to use modalities on osteomyelitis?” And they said, “Yeah it is.” I had them talk to the rehab director and provided proof to my assistants so they would believe me. 

What is the job market like here in Phoenix and Tucson?

I noticed that in Tucson there aren’t as many OT jobs. What I don’t like about it is that there’s more school based OT jobs. There’s not really any other type of pediatric job except for school systems, and a lot of them are nursing home jobs. There’s not really hospital jobs, or there’s very few. And then when I moved to Phoenix, there are a lot of pediatrics jobs and a lot of home health jobs.

But hospitals it seems there’s very few. I think the reason why is because when people like their job, they don’t want to get rid of it. Especially when a lot of therapists don’t like nursing homes. There’s a lot of nursing home jobs, but they all demand crazy productivity. There’s snowbirds here especially in the wintertime, but in the summertime there are not a lot of patients. And that’s when – if you work at a nursing home or hospital – they go searching for patients in assisted living, or long term care, or wherever they can find them.

What are the demographics like here?

There’s a lot of geriatrics snowbirds and college students. The reason there’s a lot of college age students is because there’s a bunch of universities here like ASU, University of Arizona, Midwestern University, and all these other for-profit colleges. So it’s a big college town. I’ve only been here three months but it’s a very young and old vibe at the same time depending on where you live. I’ve heard the family-friendly towns are outside of the metropolitan area.

Do you feel like OT is appropriately represented where you work?

I feel like nobody knows what occupational therapy is and I always have to advocate because everybody’s always like, “Oh are you here for physical therapy?” Every time I meet a new patient I have to tell them what occupational therapy is, and they’ll be, “I don’t think I need that. I know how to get dressed.” The most typical one we hear is, “I already have a job” or “I’m retired” or “I don’t really need that. I have caregivers to do it for me. I don’t care about dressing myself. I haven’t done it in 30 years.” I feel like a lot of people don’t know a lot about the profession. And the few people that do, it’s great because they would actually tell me they appreciate it.

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How would you rate the compensation in this area?

The cost of living in Phoenix is lower than most parts of the country. And there’s only two or three OT schools in Arizona. There’s more demand for OTs. When I was in Tucson there weren’t even that many OTs around. It’s hard to find an OT to get a full time job, whereas in Phoenix you have more because all the schools are up here.

I talked to my peers who are all new grads too, and we would talk about negotiating and our compensation. I feel – maybe it’s me – I know that for some my pay average and for some they make more than me. But it depends on the setting too. So far for nursing homes, I feel like I make more than my peers. And they live in big cities like Boston, Chicago, Los Angeles, and Miami. But I think the reason they make less is because it’s flooded there. It’s harder for them to get a job so they have to accept the lower pay if they want to live in the big city.

I like that I have low cost of living and I make more than them. I am from California. I lived in New Jersey. I worked in New York City. And I lived in Massachusetts and now I live in Arizona. And I’ve seen the cost of living in each state and Arizona is the cheapest.

Just like the apartment that I get, the housing is amazing. And that’s one of the reasons why I don’t want to return home to California because of the higher costs of living. I am an LA girl. $3,000 you can get just a one bedroom in some places [in California and New York] depending on where you want to live.

What are you future plans for your OT career?

My goal as an OT is to work in a role advocating and lobbying for OT and healthcare to ensure every patient that needs services receives them. I also want to work and research neurological disorders and eventually get a stroke certification through the National Stroke Association. I recently became a certified lymphedema therapist through the Casley-Smith International Method. 

And currently I also do Car-fit with AARP. So I’m am OT adviser and car technician where I recommend adaptive equipment for driving for older adults and provide training on like how to use the adaptive equipment and host events where you might host an event at a nursing home or assisted living facility so that you can get older adults safely driving.

And I’m looking forward to trying other settings. And I’m most interested in trying outpatient and acute care. I want to try it all in my lifetime. I’m still young. So why not!

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We want to give Phyllis a huge thanks for taking part in our OT Across America: Phoenix edition, and hope you enjoyed learning her perspective about being an OT in Phoenix!

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