If you’re interested in a healthcare career where you have meaning, high satisfaction rate and portability, then you’ll probably be happy to be an occupational therapist. What is occupational therapy? How is it different from physical therapy? What does an OT do and why is their work important? How do you become one? Joining Dr. Richard Marn to explain these is Todd Bryson, an OT working at Mount Sinai Hospital in New York City. Like many others in the profession, Todd didn’t go straight from high school into occupational therapy. Find out what attracted him to this specialization and why it could be something you might want to consider for yourself as well.

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Many years from now, I can honestly say that I would do everything exactly the way I did it. This is a great career choice. There’s a lot of flexibility. The work-life balance is great. It’s meaningful what we do every day. Most therapists are happy with what they do. You get to go to work every day with people that are happy and enjoy what they do.

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That was Todd Bryson, an occupational therapist here in New York City working at Mount Sinai Hospital. This is a terrific interview with Todd. Not only does he know, his career very well and the study of Occupational Therapy but he is also very passionate about his career and taking care of patients. You’re going to sense that as you continue to read this episode. I was also fortunate that this episode follows after the two episodes with Dr. Nate Enoki, a hand surgeon. Why is that? Hand surgeons and occupational therapists, especially someone like Todd who specializes in the hand and the upper extremity, professionally work together very closely with regard to their patient management. Of course, after surgery, the patient will usually get rehabilitation therapy with an occupational therapist like Todd. I was very fortunate that both guests were available around the same time and I got to interview him around the same time and put their episodes right after each other.

If you’re interested in a career where you have meaning, high satisfaction rate and portability, as Todd will explain, then you should continue reading as Todd will highlight those benefits. Not only that, the backstory with Todd and how he got into Occupational Therapy, it’s interesting. He didn’t necessarily go straight from high school into Occupational Therapy. That story could be very relatable to a number of people. Let’s get the rest of this episode going.

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Our guest is Todd Bryson, an Occupational Therapist. He got his Bachelor of Science degree in Occupational Therapy at SUNY Buffalo. He went to NYU for a Master’s degree in Occupational Therapy and also went to Drexel University in Philadelphia for upper quadrant and hand rehabilitation training. He is a course director and instructor of Kinesiology at Columbia University. He develops and teaches seminars nationally on clinical management of shorter pathologies for Vyne Education. He is the Founder and Course Director for Practical Rehab Seminars. He works with and for Mount Sinai Medical Center as a senior advanced clinician where he helps supervise staff members as well as provide mentoring, along with taking care of patients. For part of his career, he was also in private practice serving as a clinical director of Hand Therapy NYC where he helped manage and supervise clinical and non-clinical staff. Let’s meet Todd. Todd, welcome. How are you?

Thank you, Dr. Marn. I’m happy to be here.

It’s great that you’re here. As some people know and as you know, I had a thumb problem before and I swear, I thought I was going to need surgery or some intervention. As Dr. J. Kim at Mount Sinai, he’s a hand surgeon. He recommended me to you. I was a little doubtful because I thought I needed something more invasive. I got to tell you, you taught me some nice exercises. You custom made this brace for me and it did wonders. It wasn’t just the brace. It was the care, the thoughtfulness and the confidence that this would work and it did and I was amazed and I want to say thank you. I appreciate that.

You’re welcome. I’m happy to help.

As I may have mentioned, I had actually interviewed a friend of mine not too long ago, Dr. Nate Enoki out in Oregon, who is a hand surgeon. He is on a podcast and I thought it’d be a great segue and perfect timing that you, as an occupational therapist specializing in hand would be this follow-up episode. Thank you for coming on board. Todd, in your own words, what exactly is your career? What do you do? What are your responsibilities?

I’m trained as an occupational therapist, that’s the degree tract or the degree program that you have to complete in order to become an occupational therapist. I’ve been practicing for many years. I graduated in 1998. A lot of people don’t know what occupational therapy is. It’s great that we’re doing this. The profession is over 100 years old. Originally the profession started out in the mental health area. It was started by a psychiatrist and a nurse. It was basically based on observations of people with mental illnesses withering away, being totally disconnected, disengaged and getting worse and worse.

They started engaging people in simple activities, like arts and crafts or anything like that. They noticed that these patients started perking up and becoming more engaged with the world. They actually started formalizing that type of treatment with these people. That gave rise to the profession of occupational therapy. The word occupation, I get this all the time. Patients get referred to me and they’re confused because they didn’t get hurt at work or they don’t have any problem with their work. The word occupational historically means occupations were considered any activity or any type of tasks that was purposeful, meaningful or functional to somebody.

The profession has changed and evolved a lot over the last 100 years. There are a lot of different specialty areas in occupational therapy. It’s started out of the mental health area. There’s a huge mental health component to it. After World War II, like when soldiers were surviving battlefield injuries, it shifted over a new paradigm into more of like the medical model, the physical disabilities model and taking care of that aspect of people.

 

How is occupational therapy different than other therapies like physical therapy and what are the other type of services similar professions in your area that you work with?

Physical therapy and occupational therapy are definitely the two that are closest. Speech therapy or speech and language pathology doesn’t have a physical component to it. It’s more of literally the speech and the language part of it. Physical and occupational therapy are similar and historically, apparently right around that time again, around World War II, the two professions, in some ways came together to care for fit the physical rehabilitation aspect of taking care of people who survived battlefield injuries. They’re similar in the sense that they’re both like rehabilitation professions in terms of helping people recover physical traits or physical attributes after an injury, a disease, a disability. Those are some similarities. Some of the differences are if you think of regionally the body, occupational therapists tend to focus more and be more specialized in treating injuries involving the upper extremity or the arms. Physical therapists get a lot more extensive training in treating injuries to the spine and to the lower extremities, the legs knee injuries, hip injuries, back injuries.

Physical therapists do get training and treating the arm as well. From a specialty point of view, occupational therapists get a lot more extensive training under there. Professionally, they tend to go into those areas and specialize in those areas. Another huge difference between occupational and physical therapy is occupational therapy, because of its roots in the mental health area, it gets a lot of training on cognitive remediation, cognitive rehabilitation. For example, if someone has a neurologic incident like a stroke or a CVA, the occupational therapist, in addition to working on the arm and the upper extremity, will also help to work on rehabilitation and restoration of some of the cognitive functions like visual issues or perceptual issues, issues around judgments, safety. Some of those cognitive neurological processes where physical therapists don’t directly deal with those types of things. They would be more involved in walking and ambulation.

Is there a particular case that you can think of that would represent occupational therapy or that even left an impression on you in your career that you can share?

Do you mean as it distinguishes from physical therapy or in general?

Maybe one that distinguishes it from physical therapy but even one in general.

Just to wrap up the OT-PT connection, if you take for example, a patient who had a stroke, a cerebrovascular accident and you’re looking at an inpatient hospital setting. The physical therapists would work on standing with the patient, looking at the leg, addressing any deficits related to that to improve your ability to stand and to walk. Whereas the occupational therapist would work on trying to regain function in the arm and as well as any cognitive disabilities the patient might have, whether it’s a neglect or a visual perceptual issue. Also, another big thing that I mentioned is that OTs are particularly concerned with function and not movement for the sake of movement but can the patient dress themselves, feed themselves, get themselves in and out of the bathroom or the kitchen? All this function, daily activities of daily living, the OT will be heavily focused on figuring out ways. Whether it’s restorative and rehabilitative or compensatory ways to try to get the first person to regain the highest level of independence possible to get back to those daily functions.

In general, I have been practicing for many years. I’ve seen a lot of things earlier on in my career. My first job at Mount Sinai where I work was on the acute spinal cord injury unit. That was such a profoundly life-altering experience and working with people that have come up against these devastating injuries. Whether it’s someone who’s a paraplegic, meaning they’re paralyzed from the waist down, a quad or a tetraplegia person who’s paralyzed from the neck down. My first patient who I always remember was a 25-year-old girl who was going to be a nurse and she was at a party with her friends in the summer. They’re running around the pool and there was some drinking involved. She didn’t realize what end of the pool she was on, she dove in the pool, landed in the shallow end and landed on top of her head. She broke her neck and she was a high-level quadriplegic, meaning she was on the higher end of the cervical spine. She had a very limited function in her arm.

I remember my first day at work looking through the doors in the gym and seeing her sitting in a wheelchair and being overwhelmed by the fact of this is a 25-year-old person that was about my age when I first started my career. She’s in a wheelchair paralyzed from the neck down for the rest of her life and I was like, “This is what I’m going to do every day. I’m going to come to work and try to help people that are dealing with these awful, devastating things in life,” and dealing with the families as well. Coming up against that every day is a big thing and makes you realize that you have a lot of things to be thankful in life if you’re not in that situation. You get a lot of perspective from things like that.

How did it feel taken care of her?

It was overwhelming at first. Emotionally, it was very difficult. Also, very inspiring in the sense that one of the things that stuck out for me right away, I would come home from work every day and I would say, “How do these patients get out of bed every day and try to get better knowing that the best-case scenario for them is not that good in terms of what their potential is for recovery in a setting like that?” That was the thing that was the most profound and inspiring to me. These people get up every day, they try hard, they work hard, they do what we asked them to do and they have hope that there’s something out there for them. There’s a way that they can come find a new reality or a new life for themselves out of all this.

The old saying, 'You don’t know what you have until it’s gone,' becomes highlighted when you’re working with people who have disabilities. Click To Tweet

That’s an awesome story. It definitely left an impression on you since it’s many years ago.

It’s changed my life. It’s shaped my life, the way I view things and the things that I don’t take for granted and the appreciation for literally being able to put one foot in front of the other or to breathe on my own without a ventilator.

Would you say some of the things that occupational therapists do is things that we who are not injured or have a problem from a disease take for granted in daily activities? What you do is you help them out with those activities.

That old saying, “You don’t know what you have until it’s gone,” it’s true. It’s highlighted when you’re working with people who have disabilities or dysfunctions.

Todd, you specialize in hand in occupational therapy. Before we even get into that, what are the other specialties in occupational therapy that you can go into and why did you choose hand?

Occupational therapy is a very broad profession, the whole mental health aspect of it. Some of the general specialty areas are a very small percentage of occupational therapists are still working in mental health. Pediatrics is a huge specialty area in occupational therapy beginning literally at the neonatal level, focusing on developing reflexes and feeding in neonates, premature babies. School-based occupational therapy is big helping kids with sensory disorders, autism, developmental disorders, physical disabilities, whether it’s handwriting or low tone. Pediatrics is a big area that’s definitely has become more popular over the years with increased awareness of pediatric disabilities especially autism.

The majority of OTs, the bread and butter, and the natural pathways to go work in a hospital setting where you’re working in an inpatient rehab setting where someone had a stroke, a spinal cord injury or some other type of an accident that required hospitalization. They need certain rehab services, usually OT, PT and perhaps speech to recover to the point where they can either go home or perhaps maybe have to be transferred to a long-term care facility, nursing home or something like that. Those are the general specialty areas in terms of inpatient hospitalizations. What I do is I’ve spent pretty much the bulk of my career working in the inpatient rehab setting for about a year and a half.

I started working in an outpatient setting working with pretty much exclusively with patients who have had orthopedic injuries. Broken bones, fractures, dislocations, tendon injuries, things of that nature. I have pretty much been doing that for the bulk of my career. That actually is a big specialty area that’s not entirely exclusive but for most people that have the advanced certification that I have in the treatment of upper extremity injuries, about 90% of those people are occupational therapists by training. I am considered or I am a certified hand therapist but it’s a bit of a misnomer because it involves the entire upper extremity so shoulder, elbow, wrist and hand.

It’s not from the wrist down?

No, it’s not. Certified hand therapist is probably not the most inclusive name. It should be certified upper extremity rehab specialists or something like that.

Was there a reason why you chose occupational therapy specialty versus the other specialties you mentioned?

A little bit of background is I got into occupational therapy because I can call myself a little bit of a knucklehead when I was young and I was a classic slacker underachiever. I didn’t put a lot of effort into high school and little somewhat directionless. I didn’t go to college for four years after high school. I worked as an auto mechanic because I was always very mechanically inclined and I was good at taking things apart and putting them back together. I worked as an auto mechanic for four years. I was into cars, race cars and everything. I had that mechanical inclination and I hurt my back. I actually went to physical therapy and I was in that setting, I said, “This beats you know slaving away under the hood of a car. Maybe I’ll go to college and try this whole college thing out.”

 

Long story short, I decided on occupational therapy. I’ve always had this mechanical mindset and enjoyed like working with my hands, fixing things and building things. When I got into occupational therapy, orthopedics is very mechanically oriented. Understanding how muscles work, how joints connect, stress, strain and biomechanics. It naturally led me into structure and function, so anatomy and biomechanics. The area of OT that requires the most advanced or working knowledge of those things happens to be orthopedics and working in the area that I work in. That was one part of it that seemed like a natural fit for me based on the way that my mind works and the way I see things.

The other component probably equally important and irrelevant was, to be honest, I found the heaviness and the emotional impact of working in the spinal cord area was a lot for me. I was having dreams about my patients walking again. It was profound, it impacted me and it still does to this day. I also felt to a degree that I couldn’t help these patients in the way that I wish that I could. Whereas in an orthopedic setting, which if we use your case, for example, I fabricated a splint for you out of plastic so it’s mechanical and tactile. I was able to give you guidance and give you direction and educate you about your injury and what you can do to manage it and it worked. That is very appealing to me to be able to directly impact somebody’s recovery on that level.

I know you mentioned the specialties but are there different venues that occupational therapists can work in? For example, the hospital setting versus an outpatient setting. Can you describe some of that? Also, are there other settings that OTs can work in?

Maybe there’s a lot of great things about being an occupational therapist and I absolutely love what I do. I can honestly say I would not change my career path if I could go back to do it again. One of the amazing things about occupational therapy is there are so many different areas of specialty that you can go in. Even within the specialties, there are so many different avenues or different venues. For example, you could work in a school, you can work for the Board of Ed and literally have a teacher schedule. You can have the summers off, you can have the holidays off. For parents who want to be home and their kids are home, you can be an OT and you can go work for the Board of Ed and you’ll be off with their off.

You can work in a private practice in a pediatric setting and only work with kids with autism, for example, or you can work in neonatology and work with neonates who are premature and you’re helping them develop feeding reflexes. You can work in an acute care setting in the hospital where patients have been admitted emergently after a surgery, after some type of a stroke, an injury or a disability like that. You can work in the inpatient rehab side where they’re medically stable. Now they’ve moved to the next level of recovery where they need to be progressed to the point where they can be discharged either home or to a long-term care setting. A lot of OTs work in nursing homes, for example.

On the outpatient side, which is where I’ve spent pretty much most of my career, there are two areas where you can work in a hospital setting like I do now or you can work in a private practice setting where it’s a privately owned practice, whether it’s an independently owned or for a larger group. I had a brief two and a half year stint in the world of private practice. There’s a lot of differences between the two. The nature of the work is the same. It’s different because one’s a private for-profit model and the other in being in a hospital. You’re a part of a larger health system, so it’s a little bit different.

Can you walk us through a typical day for yourself? When you come in, maybe the patients you see, I know every occupational therapist is a little different, especially in the type of venue that they’re working at their specialty. For you, what is your day like when you leave? Can you walk us through that so someone can have a better feeling of what that experience is like?

In the outpatient setting, one of the big advantages of working in an outpatient setting over an inpatient setting is clinics tend to be open from let’s say, 7:00 AM, sometimes even a little bit earlier, all the way up to 8:00 PM. There’s a lot of flexibility in scheduling. You can work early in the morning to remember later at night. In my case, I usually get in the office at about 6:30, 6:45 in the morning. I open up the computer look at my schedule for the day and review my patients. I review any operating report I might need to look at, review any imaging studies, X-rays, MRIs that might be relevant to the patient’s care. I start treating patients at 7:00. I see one patient every 30 minutes to 1 hour or so. My last patient is at 2:30. I usually finish up treating around 3:00 and then I wrap up for the day, so I leave around 3:30 or 4:00. In my job at Mount Sinai, I get a full hour lunch which is great. It’s a very manageable workflow.

Todd, we talked about before we started, you actually do more than work as occupational therapists. You do some lecturing as well.

My love of teaching actually started when I first went to college. As I mentioned before, I was a bit of a slacker. I barely made it out of high school through the skin of my teeth. When I decided that I wanted to go to college, I never took PSATs or I never did anything like that. I signed up at a local community college in Philadelphia where I’m from. I started from the ground up and I had some incredible teachers who were very supportive and professors who encouraged me to not quit, to keep going and to keep at it. The value of a good educator, beyond teaching the X’s and O’s of the subject but connecting with students and inspiring them in the way that they were teaching and making a higher-level connection. I remember thinking to myself like, “I want to do that for somebody else.” While I was in that community college, I worked as a peer tutor in the learning center. That was my first exposure to teaching and education.

I continued that. I transferred from the community college to the University of Buffalo where I got my Bachelor’s degree in Occupational Therapy and then it later on, went to NYU for my Master’s. That’s where my love for teaching and education started. Once I began working as an occupational therapist, I started by being a teaching assistant or a lab assistant in the Occupational Health Program at NYU and Columbia. That developed into me teaching my own classes and develop our own classes for graduate students who are in the occupational therapy program. Outside of that, I began doing a lot of peer teaching to my colleagues, occupational physical therapists.

Do you mean one-on-one or in a large group?

Occupational therapy is a great career choice. There’s a lot of flexibility and you get to do meaningful things every day. Click To Tweet

In a large group, in a seminar format. I briefly launched my own continuing education company and did a few initiatives of that which were successful but the business side of it was a little bit too much for me. I decided to join out with a very large continuing education company that took care of all of the travel arrangements and all the marketing. It was fun, it was enjoyable. I got to travel to eighteen different cities all over the country teaching seminars mostly about shoulder rehabilitation. That’s another great thing. It’s another outlet for occupational therapists or physical therapists to get into teaching or education, which not only supplements your income but also breaks up, I don’t want to say the monotony of being in the clinic but it’s a nice break from actually the clinical side of it. I can say for sure, for me, that being an educator has made me a better clinician and being a clinician has definitely made me a better educator.

In high school, you did not have any vision have even been in healthcare. You’ve graduated high school, you’re working as a mechanic. You talked about it briefly but you started going to community college. Is that what it was?

The turnaround started, I mentioned I was interested in race cars and I had a race car. My friend was driving a car at the racetrack on that particular run and he crashed it going about 130 miles an hour. It was an ugly scene, the cars flipping over on there’s smoke everywhere. He was fine, thankfully, but that experience for some reason shook me up a little bit. The last job I had working as an auto mechanic was a rough place in the sense that and along the way of being a mechanic, I enjoyed it. I’m not disparaging the profession but most of the mechanics that I worked with were constantly telling me like, “Get out while you can, kid. I can see you’re a smart kid and you have some skills. You don’t want to be doing this and not be able to get out of it.”

That was in my mind. The last job I had was it was a miserable job and I woke up one day and I said, “I got to do something different.” I literally signed up for a class at a community college it was called Psychology of Career Development. It was a noncredit class. Being in the classroom setting and being in that environment fits in my personality. I came home one day and I said, “I’m quitting my job and I’m going to college full-time.” That’s the person I am. Once I decide to do something, I’m going to do it.

When did the idea of occupational therapy come about?

One of my classmates at the time was trying to pursue a career in OT and I said, “What’s that?” I literally went to the Career Center at Montgomery County Community College where I went and I started asking around and doing some reading on it and it turns out that one of the counselors there, her niece was going to occupational therapy school. She conducted me with her. The more I learned about the profession, it sounds appealing to me. I did some observation hours with an occupational therapist who was fantastic, dynamic and creative. I thought this would be a great fit for me.

I was also always very interested in psychology, human behavior and what motivates people. It was a good fit for me and I liked that psychological component to it, which differentiates it a little bit from physical therapy. It was that combination of things of meeting the right people at the right time, so I chose that profession. Once I got into that program, I gravitated towards anatomy and kinesiology, the study of movement, which is what I teach now and that whole biomechanical aspect of it, which I found interesting and appealing to me. That led me into the area that I specialize in as a clinician.

Todd, what type of schooling is required to become an occupational therapist? It may have been different when you were in school.

When I graduated, which was in ‘98, most of the programs were Bachelor’s degrees. Right around the time when I graduated in ‘98, they started transitioning into entry-level Master’s programs. You have to get a Master’s degree, that’s the minimum degree. There’s a big push in the profession to transition into entry-level clinical doctorates. Not a PhD. It’s not mandated. Physical therapy is mandated, you have to get a doctorate. In OT, you still can get a Master’s. There are many programs that do offer a doctorate and there are some programs that only offer the doctorate because it’s only an extra semester two at the most to get the doctorate over the Master’s. It’s an entry-level master’s program typically, but there are some that are doctoral programs.

You can have any undergraduate degree. It could be Biology, it could be History, it could be Psychology. A lot of OT students tend to major in Psychology as an undergrad. Different programs have different requirements in terms of prerequisites. Some programs are a little bit heavier on the science prerequisites. Typical standard prerequisites have like a year of Biology, usually a year of Anatomy and Physiology, maybe a semester of Chemistry, maybe a semester of Physics but every program is different. Some programs don’t require Chemistry or Physics but there’s definitely some science component involved for prerequisites to get into the program.

Todd, reflecting back, is there anything that you would do differently for yourself?

I had this conversation with somebody. Along the way, I’ve had some I wouldn’t say career crisis but I’ve had moments along the way where I thought maybe I should have like, “Should I have pushed it a little bit more? Should I have maybe gone into medicine?” I had times where I thought about maybe nursing along the way but many years in now, I can honestly say that, no, I wouldn’t. I would do everything exactly the way I did it. This is a great career choice. There’s a lot of flexibility. The work-life balance is great. It’s meaningful what we do every day. Most therapists are happy with what they do. You get to go to work every day with people that are happy and enjoy what they do. The best part of the job is meeting people. That’s how I met you and we’re reconnecting all these years later. You make an impact, the patients make an impact on me and I make an impact on the patient. That’s a great career and it’s a great profession. I enjoy it.

 

It sounds like a high satisfaction rate. Not just you but even amongst your peers.

You don’t see a lot of people changing careers going from OT into other careers. Most people tend to stay in that profession, which I guess in some ways, some people might look at that as a limitation. If you’re trained as an occupational therapist, you’re probably going to be working in the area of occupational therapists, whether it’s a clinician, as an administrator or something like that.

Do you have any parting thoughts for anybody interested in your career?

I hope my passion and enthusiasm for the profession comes across during this episode. It’s a great career option. It’s flexible, it’s a portable skill. An occupational therapist does the same thing whether you’re in Philadelphia, California, New Mexico or whatever. It has a very high level of satisfaction for everyone involved. It’s a great lifestyle and it’s very rewarding.

Todd, this has been fantastic.

I appreciate the opportunity to talk about it. It’s great to reconnect with you and thanks for reaching out.

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That was Todd Bryson. I am very happy that he was able to join us on this episode. If you’d like to reach out to him, he can be reached through his LinkedIn account. Our next guest is a friend of mine for several years. He is an ENT doctor, ear, nose and throat. He has some very interesting stories and perspective on life that you’ll enjoy. Stay tuned for our next episode. I appreciate you guys reading. If you like what you’re reading, please hit that subscribe button. It elevates the recognition of the show but also it makes me feel good, so it makes me know that I’m doing something for someone that’s useful. Of course, if you think that this show could be improved or you think there’s a guest that we should maybe get on this show, please let me know. Is there a career that you think should be on this show? We’d love to hear from you and I will help find that career for you and we’ll hear from them. Thank you. I appreciate you. I’ll see you in the next episode.

Important Links:

• Todd Bryson – LinkedIn
• Dr. Nate Enoki – Previous episode

About Todd Bryson

Upper Extremity Orthopedic Rehabilitation Specialist, Adjunct Professor,, Seminar/Course Presenter