Men In Occupational Therapy Podcast

Editor's note: This text-based course is a transcript of the Men In Occupational Therapy Podcast, presented by André Johnson, COTA/L, OTS; Dennis Cleary, MS, OTD, OTR/L, FAOTA.

**Please use the handout to complete the exam.

Learning Outcomes

• After this course, participants will be able to:
  • identify the prevalence of men within the occupational therapy profession.
  • recognize how the male occupational therapy practitioner deficit may affect patient care.
  • list innovative ways to address male faculty, student, and practitioner shortages in occupational therapy.

Podcast Discussion

Dennis: Mr. Andre Johnson, thank you for being on the podcast. I appreciate you being with us today. Could you tell us a little about yourself, your career as an occupational therapy practitioner to date, and what are some of your eventual goals?

André:
Sure. Good morning, Dennis. It is a pleasure to be here. I have been an occupational therapy assistant for 13 years. My clinical practice areas were pediatrics and orthopedics, and I've also had some academic experience. I aim to work in a community practice, likely in orthopedics or pediatrics. Additionally, potentially some part-time academic work as well. 

Dennis: You're currently an occupational therapy assistant but also in school to become an occupational therapist.

André: I'm currently at Florida A&M University getting my master's degree. I just completed my first level two rotation, which was in orthopedics. 

Dennis: We met at AOTA a few years ago. Anytime you meet another male OT, while there's not a secret handshake, there is definitely some affinity toward each other. I think you were doing a poster presentation. At the time, you said you were a "unicorn" in the occupational therapy profession. Do you want to explain a little about what a unicorn in the occupational therapy profession is?

André: I say that term in a loving way. I am rare in the profession as a six-foot-four black male who is an occupational therapy assistant becoming an occupational therapist. I tick many different boxes based on typical demographics for our profession. 

Dennis: Yes, we're both people of stature. Can you talk briefly about what it's like to be a black male in the occupational therapy profession?

André: I have had limited experience seeing others like me. However, I had the fortunate experience of working with another black occupational therapist on my last Level 2 fieldwork. I've become used to walking into a room and not seeing many that look like me. This is something we're going to talk about today and see how we can help this to change. I believe it's very important for us as a profession to have others who may look like us.

Dennis: Absolutely. Have you found that other black male occupational therapists can serve as mentors for you, or have you mentored others?

André: I'm at a crossroads with both. I'm still early in my career, and when I talk to occupational therapy assistants, most have 20 to 30 years of experience. I have sought out black male mentorship, and I have a few. This allowed me to see someone who went through a similar pathway. 

Dennis: Regarding intersectionality, you're a black man, an occupational therapy assistant, and a rising occupational therapist. What do you think is the most challenging: being a black occupational therapy assistant or a male occupational therapy assistant? 

André: Honestly, it's both in a way. For example, African Americans make up about 13% of the population, so there's already a day-to-day reality that I'm not going to see many that look just like me. That's fine. When it comes to my profession, though, there's another layer to that. There is even maybe more of an acute issue as it is not likely to see a minority in our profession. Again, we need to work on this to ensure our profession has the diversity of the general population.

Another example is the interaction of males and females in our profession. Additionally, my 6'4" stature may intimidate those shorter than me. I've got to be careful of appearing to hover over the person, as this changes the power dynamics and is not intentional. These are things that we need to have conversations about.

Mentorships can be beneficial to share ideas such as the above scenarios. You may feel, for example, that all eyes are on you in certain circumstances. Discussions with a mentor can show you that opportunities exist to diffuse these situations or are not as big of an issue. We can, for example, easily work together with all types in our profession.

Dennis: I agree.

André: You don't have to be a friend to everyone, but you do need to be able to work with others. Mentorship, for me, is most beneficial in understanding how certain words or actions may be perceived.

Dennis: How did you decide to become an occupational therapy assistant in the first place? Or how did you learn about the profession and decide to get a job?

André: That's a great question. Initially, I wanted to attend med school, but grades and other circumstances waylaid that decision. I then went to a local university to check out being an EMT. I am a physical guy who wanted to care for patients, so it made sense to me. Once there, the counselor talked to me about occupational therapy. They provided some literature and links to educate me on the profession. The EMT program was a four-month certificate program versus a 16-month occupational therapy assistant program. After some research, I saw that this career path was a viable option to sustain myself and my family. I am so glad I made this decision, as I love the profession and how we impact people's lives. 

Dennis: I think of my own story. I initially worked at an adult day program for those with intellectual disabilities. The OT asked if I had thought about this career. She said, "We need to get more men in the profession." Occupational therapy fits into my philosophy of life. I don't know if we're quite as blatant these days about recruiting men into the profession, but we certainly have talked a lot about diversifying. It almost seems like men are not talked about as one of the groups we need to recruit. What is your understanding of that?

André: We've had this conversation. In both stories, we had to have somebody bring it up to us. I do think that intentionality is something we need to work on as a profession.

Looking at demographics, worldwide, there are more males than females on this planet. In the United States, our population is 51% female to 49% male. If we're not intentionally looking at that 49% of the population, we're already reducing that potential candidate pool. 

Additionally, when I look at our communities of practice, there's a women's health section but not a men's. And men start having disabilities at a younger peak age of late 60s and early 70s. With a mainly female force, are we effectively meeting this clientele's occupational needs? They may have unique presentations like prostate cancer or high blood pressure and stroke risk (more prominent in males). Do we know how to train our male practitioners to address these specific areas?

Another difference in a male versus female perspective pertains to bodily functions. A male with a disability may be able to safely urinate sitting down, but there's also a pride issue with doing it while standing. There's also a psychosocial aspect of that male who's dealing with that loss of being able to stand up to urinate for himself and other topics as well. As a profession, if we're treating those patients, we may not be optimally primed to look at these unique factors.

Dennis: Sure.

André: Activities of daily living provide another unique component of treatment. A female may feel more comfortable with another female and men may feel the same way for particular topics unique to them.

Dennis: Speaking of that, have there been times in your profession when maybe a female has asked to have a different therapist work with them? If so, how do you handle that as a male occupational therapy assistant?

André: This has come up, particularly in a pediatric setting, and needs to be communicated with male practitioners. There can be a negative perception of a male treating a child. I understand that initial caution, and I don't take it personally. I say, "No problem," and proceed to treat whatever child is in front of me and who needs care. Things may change as the family sees you treating others and realizes you are competent. Trust can develop and evolve. Other examples occur with intimate ADLs like dressing and bathing with the opposite sexes. To be clear, this can happen with female professionals as well.

Dennis: As a funny aside, when I was filling it at a school for the blind, I helped an occupational therapist with a full caseload. She gave me all the teenage boys because she had two sons at home and needed a break. After I evaluated one of the clients, I came back with a diagnosis for her. She asked what it was, and I replied, "A 14-year-old boy." Teenage boys are interesting cases.

Continuing our conversation on diversity, I don't think we have great numbers to show what we're doing is working. One problem is that we may work with students too late. We need to do a better job of working with younger students.

When I first started attending the AOTA conference, there were signs in the men's room discussing where to meet to interact with other male professionals. It was like a secret group of male OTs but never officially recognized. There was a movement called BrOT, which started at Jefferson University. They have a website, but I don't know much about them or how proactive they are. There's also a group called BROTHAS that you're involved in for black, male registered occupational therapy professionals and students.

André: Yes.

Dennis: Can you talk a little bit about how this organization started?

André: The organization started in 2020, after the events of the George Floyd murder. A group of black males started to meet online to discuss our part in our profession and how we could mobilize to assist each other in the community. We talked about things we went through during our schooling unless we went to a historically black college or university (HBCU). Overwhelmingly, many of us felt a poor sense of belonging, leading to decreased accomplishments or a transition out of the profession.

One of the things that we were looking at was how we could promote and amplify our voices. I and six other great African-American males, OTs, and OTAs, created this group. Like BrOT, we wanted to ensure we were meeting a need. We got a lot of feedback from other African American males saying that this group was great for mentorship and support. They often did not see another black male OT or OTA during their entire time in school, leading to that poor sense of belonging. We started putting on events and have had good participation. Overall, the group's focus is to make sure that you feel supported, belong to this profession, and have a point of view. We're trying to spotlight the black male contribution to our profession. We also tap into African-American males working in healthcare systems, running departments, or are leaders in other areas, like CFOs of corporations. We are growing and look forward to continuing.

Overall, the advantages of promoting occupational therapy to attract male talent to the occupational therapy profession are:

• Greater reach to communities & and individuals we serve
• Diverse viewpoints
• Increased opportunities
• An increased sense of belonging 

Dennis: Would you say that your decision to return to school is related to this group, BROTHAS?

André: It might be in a way. It was a personal decision for me to go back to school to be an occupational therapist, but I also think going forward, I want to show other African-American males how they can succeed. I want to show them that there is a pathway for them as well.  

Dennis: If people are interested in getting more involved with BROTHAS, what's the best way for them to proceed?

André: We have a website in addition to Facebook and LinkedIn pages. This is how we typically communicate and link up. We also try to contribute to the AOTA conference in some capacity, either via short sessions or meetups. AOTA has been very supportive of this, and I want to give them kudos.

We also have had virtual meetings for a greater reach. We are trying to create an environment of community and coming together. The original mission is to reach out to African American males, males of the black diaspora, or the African diaspora. However, our events are completely open for anyone to attend.

Dennis: Let's throw a dart at the wall and imagine that many of our listeners are white, female occupational therapists. Would you suggest they contact the group if they have a student, an African-American male colleague, or a black male interested in OT?

André: Absolutely. If you don't think you can support a student and need an avenue, that's why we are here. We are very open to anyone reaching out to us. Sometimes, it's just a capacity issue. As a minority, we may have 50 students who need mentorship. This can create bottlenecks for us, but we're still open to new members. We can, if nothing else, provide support virtually.

In another scenario, you may find another brother inside the organization in your same state. Now, you can make plans to meet up face to face. Ultimately, we want to create a community virtually, but then extend it into in-person as much as possible.

Dennis: Yeah, absolutely. I'm a bit husky as a male. Anytime clients were of increased size, they were automatically placed on my caseload. I never resented that. Has this been your experience? Are you the "transfer expert" because of your larger size?

André: I think that's 100% true. As you said, I've never taken offense to it.

Dennis: I was actually the first man to teach at Ohio State. The program started in 1943 during World War II, and one of the students in that first class was a male. We think he was the first male to attend an occupational therapy program at a university. We even had a nun in the same class, so we started off diverse. They probably had interesting lunches with a male, a nun, and four others. When I started in 2004, the program was 61 years old. I was there for 10 minutes, and I was asked to help move a desk. Obviously, stereotypes can exist, like "transfer expert." Are there advantages to being a male within the profession?

André: I think at times. When applying for a job, you always try to show your unique perspective and use your differences as a strength.

Dennis: Do you think there are some disadvantages to being a male?

André: Again, my answer would be at times. It's not that there's not a desire to increase male input, but I think change can be difficult. People may feel that the profession will change too much. A male may be seen as a rival or a competitor. Prospective students may only see females and think there is no place for them. 

Dennis: Do you think there might be other advantages to having more males within the profession?

André: There are definitely advantages. As I said earlier, 49% of the population in the United States is male. If we do not have enough male representation, there could be conditions in our clients that are not being addressed appropriately. We need a 50-50 split to represent the population, but that's not the conversation. The conversation is an increase in males at this point.

Dennis: As a faculty member, I have gotten calls from students with issues with particular patients. For example, there may be an older male who had a stroke but was reluctant to participate in therapy. My question would be, "What occupations are you asking them to engage in?" Another example may be helping an African American woman with hair care. Our profession sometimes does not have the skills to meet the diverse needs of the clients that we're serving. I think the same is true for males.

In the past, if we had a male client, copper tooling was the treatment of choice. I don't know about you, but I have never done that. We have to dispel some of these stereotypes.

André: Another stereotype to dismiss is that plenty of males love to cook. While some patients may want to do copper tooling or leather working, we must ensure we do not have blind spots in our treatment and expand our viewpoints through diversity. 

Dennis: We can all work with different types of patients, regardless of our background, but working with someone who understands your needs may make sense. For example, if there's a transgender client, they may be more comfortable with having a transgender occupational therapy practitioner to work with them. If a woman has incontinence, they may prefer to have a female OTP for the assessment, and conversely, a male with a spinal cord injury may want a male to discuss treatment for sexual performance. One of my former female classmates has started a female pelvic health practice. Meanwhile, a male occupational therapist primarily works with males with spinal cord injuries for health issues and adaptive sports.

Again, we can work with all types of people, but sometimes, our own interests or personal histories can provide a richer treatment perspective.  I don't know if that's been your experience.

André: I think it is true. The typical occupational therapy practitioner has specific passions and niches. I would want a client to be treated by someone with the most skills and understanding. Clients can also respond to those who look like them or provide a sense of belonging. Another example is anxiety and how that may manifest in males differently than in females. Gender roles may also play a role. There are many different perspectives that we need to explore in our workforce.

Dennis: Do you see almost a reluctance among the profession to actively recruit males? 

André: I see it more as a lack of resources and exposure. Six out of 10 people end up residing 10 miles from where they grew up, and eight out of 10 usually live within 100 miles of where they grew up. This sets up some interesting dynamics. Our profession may be more well-known in big cities and not being addressed in rural communities. Some wonderful OTs are working with farmers, but we rarely hear about it. If we want to know more, we have to actively seek it. But I'm like, this is a huge area that I'm like, listen, I go to an agricultural and mechanical university. That's where they started the foundations of the rural community. Are universities in the less populated areas supporting the profession and our important role?

We must be intentional and provide resources to attract males and other minorities. We also require leadership to be on board with these types of incentives.

Dennis: I'm glad you're saying AOTA has supported BROTHAS.

André: It is important to have programs and pathways to support these initiatives. Nursing had this similar conversation and now has some diverse program components. It's still heavily female, and while nothing is wrong with that, they are increasing male contributions, which has been beneficial. We are a profession dedicated to people's lives and societal needs. I think we need to ensure that we're addressing as much as we can and not limiting ourselves in any way.

Dennis: Could you talk a little about some of those numbers of males, and African-American males in particular, in the profession?

André: There are approximately 7.8% of males in the profession. Looking at black males, both OTs and OTAs, it is tracking at less than 1%. The profession is mainly comprised of females or other identities at 91%. These numbers have not changed much in the last 15 years of workforce surveys. 

Dennis: It's actually gone down a little bit. 

André: As a profession, we seem to have gotten younger, too, which feeds into the college demographics. In most university settings, we get a 70 to 30 split female to male. Again, it's skewed towards females, and there's nothing wrong with it. It's important to understand those numbers to make intentional moves to increase diversity overall.

Dennis: The number of males is declining in colleges and universities, while we are growing the number of OT and OTA programs nationwide. These programs are having trouble filling their classes. So, it may be a good time to sneak more men into the profession if possible. 

André: I think that also goes back to where universities are located, like some areas have eight OT programs within a hundred-mile radius. This creates a lot of competition.

Dennis: Oh yeah.

André: We definitely don't need to close off access to 49% of the population. If we have opportunities to get male talent, I think that's where we need to head to have a stronger profession. We must be proactive and say, "We would love for you to be part of this profession because you're talented and could provide societal impact." 

Dennis: There's not a ton of research out there about male OTs. One thought is that men don't go into occupational therapy because it is a "helping profession," and men have other interests.

André: Oh boy, okay.

Dennis: Yes, this is a stereotype that exists. However, when you talk to male OTs, that isn't a deciding factor for them. They reported career satisfaction, and they felt good about the choices they made. In other helping professions, nursing and PT don't have that much higher percentage of males. Males make up about 30% of PTs. Male OTs are more likely to go into management positions. There is also a difference in salary between males and females. There are many reasons for that, including females starting families. Many female therapists move to part-time. I haven't delved into these statistics too much. What are your thoughts on some of the stereotypes in our profession?

André: I have not dealt with a lot of it personally. I'll just be very transparent about that. Have I dealt with it somewhat? Sure, of course, like questioning if, as a male, I am that empathetic. 

We are a doing profession. In my mind, helping is more of a nursing characteristic. Doing means that we need to know how a person is going to do things. A simple example is tying shoelaces. We all tie our shoelaces differently. Other examples that may differ by gender are taking care of your house or child caring; there are usually two sides to that equation. I feel we're not as strong as we could be if we're not addressing both sides.

It is 100% true that, unfortunately, females are making less than males. Why that is there, we also need to investigate. We need to find out the reasons behind it. 

We want to see females strive, but we also want to ensure males are in the profession.

Dennis: Absolutely. Much research has been done on small samples; we need much more. Do you have any other thoughts on what we can do or what the person listening today might do to help recruit more males to the profession?

André: We need intentional and open efforts towards diversity and inclusion in various professional fields, particularly in healthcare and occupational therapy. Here are some key points:

1. Top-Down Support

Initiatives for diversity and inclusion must be supported from the top down, indicating a clear commitment from program directors and leaders. This includes allocating resources and fostering a culture that values diversity.

2. Consideration of Males in Healthcare Professions:

There is a need for intentional efforts to encourage male participation in healthcare professions, particularly in areas where they are underrepresented. Marketing strategies should be crafted to attract males, considering specific interests such as sports or teaching.

3. Demographic Considerations in Recruiting:

Understanding the demographic composition of patient populations and tailoring recruitment strategies accordingly is crucial. Analyzing data related to patient demographics, especially in Medicaid populations in impoverished areas, can reveal disparities and inform strategies to address them.

4. Pathway Programs for Diversity:

Pathway programs should explicitly address diversity, including the underrepresentation of males. Acknowledging the diversity within various demographic groups is essential in promoting a comprehensive approach to diversity and inclusion.

5. Varied Marketing Approaches:

Acknowledging that occupational therapy may look different in various settings, the marketing of programs should be adaptable to cater to the interests and passions of diverse individuals. Recognizing that diversity comes in many forms ensures a more inclusive and welcoming approach.

Dennis: Could you talk about a pathway program or what a pathway program is?

André: A pathway program is an intentional initiative designed to address specific issues within a professional or academic context. For instance, if the focus is on increasing the representation of males, a pathway program could involve collaboration with institutions specifically catering to an all-male demographic. In this scenario, a strategic partnership might be formed with an all-male university, such as Morehouse, or from a partner institution, like Georgia State University.

Alternatively, pathway programs can leverage advisory boards, connecting with organizations possessing diverse pipelines. A foundational support system can be created by connecting with such entities. Additionally, there's the possibility of streamlining the transition of graduate and occupational therapy assistants aspiring to become occupational therapists. This involves developing programs that align seamlessly with their career goals.

The fundamental objective of pathway programs is to intentionally increase representation within a specific demographic group. This initiative does not involve displacing others; instead, it focuses on fostering diversity from the outset. To achieve this, the emphasis is on creating the necessary infrastructure within academic settings, grounding and supporting the initiative. As individuals transition into clinical practice, ongoing mentorship by practitioners becomes crucial to further nurture and sustain diversity within the profession.

It's essential to recognize that the effectiveness of pathway programs extends beyond the initial recruitment phase. While adept at attracting individuals, these programs should also prioritize ongoing support throughout a professional journey. This includes support within the academic program and as individuals transition into practice, ensuring optimal outcomes and addressing potential challenges that may arise. A comprehensive approach that spans the continuum of occupational therapy programs and professional practice is necessary to foster a diverse and supportive environment.

Dennis: Thank you so much. Good luck with your second level two clinical coming up, and I look forward to seeing you at AOTA again this year.

André: Thank you, Dennis, and looking forward to it. It's been great talking to you.

References

Please refer to the outline and handout.