I have been in the profession of occupational therapy (OT) for over 20 years. I have owned and sold an occupational therapy practice. I studied occupational therapy and leadership at a doctorate level. Today, I have an axe to grind.

The profession of occupational therapy continues to be left behind. While I am not going to dive into the areas of this truth, I will say with absolute conviction that business is one of them. While occupational therapists generally seem to be very business-adverse, they also receive little (if any) training here.

Even if the training-in-business gap is solved, there exists a massive miss in literature, resources, and even conversations about the occupational therapist business owner. Where I noticed this recently was in a draft practice resource on leadership. I was asked to edit this and consider it’s aim to highlight the many leadership elements of occupational therapy practice. It was well done, with the exception that business ownership was never mentioned as a leadership role.

The document outlined historic leadership roles some occupational therapists assume, such as academia, student precepting, work-related advancement, mentors, directors and managers in the public sector.

But what continues to be absent from the language and culture of occupational therapy is the reality that occupational therapists also build enterprises, corporations, and run massive ventures. Yet, we don’t talk about this, let alone celebrate it.

OT Ownership IS Leadership

It might be easy to see the relationship between ownership and leadership, but I would argue that leadership scholars won’t look at this correctly or completely. Sure, business owners lead, teach, and train, but here are some continuously undervalued roles these owners play.

OT Owners Pay People

Unless you have directly experienced the responsibility of managing cash flow and paying other people’s salaries, you may struggle to understand how to relate this to leadership. Leading others to perform and be competent is huge, it is, but even bigger is not messing up the business side of paying them. Making sure these professionals bill for their time is far more complicated than it should be. “Don’t they want to get paid?” is a common question occupational therapist owners ask me about their people. Occupational therapists can be notoriously bad billers. Most are women, many with families, so their income is often “gravy.” It doesn’t keep their own lights on or feed their families, so billing is secondary to service. This is no joke. It’s a colossal and common problem in the private sector.

Yet, there are (albeit disproportionately few) occupational therapists that go to sleep at night worrying about being able to send invoices, collect payment, and make payroll. These OTs pay others first. Some don’t get a regular pay themselves. For those experiencing this, I argue that is the epitome of leadership. And still, I read documents and resources that don’t talk about them, their commitments, or their steadfast dedication to the people they employ.

OT Owners Sell the Profession to Customers and Clients

No one sells the value of occupational therapy better than a business owner. There is a misconception that owners do this to make money. Insert that controversial big-bad P word (profit)! But I have yet to meet an occupational therapy owner who isn’t first and foremost interested in filling the capacity of their team so the profession can continue to provide value to others. These owners aren’t just selling for the sake of selling. They are selling to build the profession’s reputation and to create social awareness of how occupational therapy can help.

OT Owners Put Occupational Therapy Online

Back in 2010 I realized that the biggest threat to the sustainability and scalability of my business was that people haven’t the slightest clue what occupational therapy is and does. So, I started blogging about this. I wrote a blog a week for almost 10 years. These blogs were about how occupational therapists saw the world and worked to solve both simple and complex human-environment problems. Then I did an OT-V video series that ran for a few years. I had over a hundred thousand views on both.

I was a business owner; I was not an academic or public servant. I was not running a non-profit or promoted into management. I was not being paid to do any of this. I was a self-employed occupational therapist who dedicated hours and personal costs to get the value of the profession out into the ether. While that may have looked like personal or business promotion, it was leadership. I truly didn’t get a single referral from a “great blog or video,” but I certainly lead and brought conversations about the profession online.

OT Owners Make Really Hard Decisions

Owners of businesses have the most complicated job that involves a ton of tough choices. From promotions, to negotiating salaries and benefits, staff changes, to pricing and chasing receivables. Owners decide which markets to pursue and how to get there. They create vision and operationalize. They manage quality and relationships. No one is telling them what to do, or even worse, how to do it, and yet they do it all. Day after day.

OT Owners Succession Plan

When an OT owner is thinking about the future of their business, they usually look internally at the others they have led and developed as take-over options. These owners are thinking three to five years ahead and keep a close lens on the top performers and how they can help make the business continually better. OT owners often sell to OT owners. We trust each other and get the struggles of being an owner in the OT space. Succession planning for an OT owner is far more complicated than just replacing yourself in a leadership role. When you build a business you are attached to it, and want it to survive even in your absence. You build your leadership team to support this.

Business is about instinct, gut, and grit. Leadership in entrepreneurship is about taking those skills and turning them into something sellable and ideally profitable.

As a profession I urge us all to “see” the OTpreneur in our documents, resources, and conversations. Include them in leadership research and circulations. I would think (unconfirmed) that other professions are including their business owner-professionals in the efforts to expand and drive professional change. These other professions are doing this better and have been for decades. Many remain worlds ahead of us.

Ownership is the highest form of leadership. Occupational therapy owners – I see you, I know your struggles and I applaud you for your tenacity. I have been where you are. It’s lonely at the top and many days it may be hard to see the “wins” in your efforts. Thank you for your innovation, dedication, and yes, leadership.

Reach out if you ever want to chat.