Job Security
While doing some research, I came upon a
forum dedicated to posts from COTAs. I was pretty shocked to see that many of the comments there were related to job security and pay. COTA job security is a topic I planned to address in the future; however, after finding these comments I decided to change gears and relate my thoughts regarding the topic now.
Even though I didn't read all 500+ posts in the forum, I must have counted ten or twelve COTA's who had reported losing their job recently. Some blame the system, some blame the lower salaries accepted by OTRs, while others report that the contract companies are at fault. Having been in the same situation several times, I can really relate with many of these comments.
Have you ever been in a position where the facility decides to change contractors? It's usually a shock because no one sees the change coming. Management is very good at keeping their discussions with competing therapy contractors secret. No matter what initiates the change, I find it is just as hard on the patients as well as the staff. Thinking about the reasons a facility may change therapy contractors makes me come to several conclusions. The first is financial reasons. Did another contractor approach them and offer a bigger cut of the profits? Or have they searched out another contractor for other reasons? Companies that hire OTs for reduced salaries may be able to offer a wider profit margin. Companies with higher productivity guidelines can also offer a better return rate on the therapy dollars we generate.
This change can also occur from the top. Upper management might develop an agreement with a large therapy contractor to cover all their facilities. They may see it as a decrease in paperwork tracking as they turn over all their business to one contractor.
Personal relationships can be another reason for change. In one facility I worked where the administrator was let go, the new administrator came in and almost immediately contracted with his close friend to be the new therapy provider. The worst part of this situation was that the new contractor did not have the staff to cover the contract. Temps were used while full time staff was hired. The humorous part of this is that I was recruited by the new contractor, and was working my old position two weeks later. The sad part though is I saw first hand that many of my patients had regressed in their rehabilitation process. I also noted that all patients had been discharged from therapy, and then re-evaluated by the new therapists. Is that a waste of therapy dollars or what?
Another reason may be disagreements and/or tension between management of the facility and the contractor. A change of administration in the facility or the contractor can create a difference of opinion, and ultimately a change in the contractor serving the facility.
The current salary base may also be another factor that affects job security. If there is an OTR who is willing to accept a salary that is less or close to a COTA's, no company is going to think twice about hiring them. This is a pretty cut and dried fact, why use a COTA who needs not only a supervisor but also someone to do the evaluations when one person can do it all?
However any of these changes occur, it can be upsetting for our patients, as well as us. Most patients tend to develop a trust relationship with their therapist. A sudden change with this relationship can directly affect the progress of a patient. Having been involved in this situation several times, I've seen patients cry, lose their initiative, stop eating, and just totally give up.
We feel helpless because we know there is nothing that can be done to remedy the situation. Once that trust relationship is developed with a patient, it's hard to just say good-bye without knowing the patient has succeeded in their rehabilitation. Along with the fact that now we are back in the job market again, and our income and lifestyle have become jeopardized.
The worst part of all this is that I find these changes affects my ethical viewpoint. It's hard to remain ethical in our every day practice when the people who control our jobs resort to undercutting salaries and fees, raising productivity standards, and favoring specific contractors. I know they have a business to operate, and revenues that have to be made. However, first and foremost this is a business of treating people. The notion that a therapist is a therapist and we are only out there to generate dollars is definitely not why I became a COTA.
Hope all your thoughts are good,
Tim