Tea Time with Certified Hand Therapist (CHT) Rebecca Walsh

Q: Please tell us a little bit about yourself! What’s your favorite food? Favorite season? Do you have pets? Best place you’ve ever visited? Tell us what makes you sparkle!

A: I love sushi! I think I could eat it every day and never get tired of it! I also have a huge sweet tooth. I’m a yoga enthusiast and have had a regular practice for 11 years. I have 2 pets, one cat and one dog. My dog is a retired racing greyhound. I worked at an animal hospital as a teenager where we always had greyhounds because they are universal blood donors. I fell in love with the breed. They are gentle, goofy, couch potatoes.

My husband and I love to travel. My favorite place so far was Budapest, Hungary. It felt like home almost immediately, and it was easy to imagine what day to day life is like there, which is a rare feeling as a tourist.

Q: What degree(s) do you hold and what made you interested in pursuing OT, what have you been up to since graduation?

A: I am a certified hand therapist. I graduated with my bachelors in Psychology. I considered getting a graduate degree in psychology but quickly realized I did not want to spend 5 years doing research. I took a job as a therapy facilitator for a child with developmental disabilities. During this job I was able to work very closely with her OT, PT, and SLP. I loved OT because of how creative it is. Then when I was in OT school I had surgery on my hand for a benign sheath growth on my median nerve. This furthered my interest in hand therapy.

Q: What practice setting are you sharing about today?

A: I work in a hospital owned outpatient clinic with mostly orthopedic patients.

Q: What was the process like to earn your CHT?

A: You need 3 years of experience as an OT or PT, and 4,000 hours of direct practice experience with upper extremity conditions to sit for the exam. It is a computer based exam with 200 questions and you are given 4 hours to take it.

My first job out of school was at a physician owned upper extremity clinic. I worked very closely with 4 other occupational therapists, all CHTs, and 6 physicians. This provided me with amazing mentorship and lots of hands-on experience.

I took the CHT exam 3.5 years after graduating from OT school. Preparing for the CHT exam took a lot of hard work. I began studying a year before taking the exam. At first I only studied for an hour or two every couple of weeks, then a few hours every weekend, and about 3 months out I was studying every Saturday for 6-8hrs. I read the Rehab of the hand textbooks, attended the ASHT hand therapy review course, and made countless flashcards. I also made copies of the upper extremity diagrams from Atlas of Human Anatomy and labeled them over and over.

When I arrived at the testing site I drew out the brachial plexus and order of innervation for each nerve prior to starting the exam. I was very nervous the day of the exam, but I left feeling okay about it, which I took as a good sign. I also made a point to take a nice long vacation immediately following the exam so I wouldn't stress out while waiting for the results!

- Study Resource 1

-Study Resource 2

-Study Resource 3

Q: How long have you worked in this practice setting?

A: I’ve worked in orthopedics for 6 years now and have worked with both pediatrics and adults.

Q: Can you please describe a typical day day?

A: I typically work from 8-5 treating patients. I have a lot of flexibility and often shift my hours if I have patients that need to be seen earlier or later. I’m very lucky to work somewhere that allows me to treat patients one-on-one and schedule 1 patient per hour. This is rare in hand therapy, most places schedule patients on the half hour.

I have an hour scheduled for lunch. However, I often get walkover (unscheduled) patients sent over from the hand surgeons that need to be worked into the schedule. I typically see 8-10 patients a day.

I am hourly and clock in and out on the computer. My previous jobs were all salaried so this can vary.

Some common diagnoses I see: All types of fractures (distal radius, olecranon, radial head, metacarpal, P1, humerus), flexor/extensor tendon repairs, nerve repairs, arthritis, ligament/soft tissue sprains. I also get some patients with neurological diagnoses (CVA, MS, ALS).

The majority of my patients are post operative so I tend to address edema, adhesions, ROM, strength, and fine motor dexterity in preparation for functional tasks. I try to ask patients about their functional gains and struggles at the beginning of each session and incorporate these tasks into treatment and/or provide strategies for modifying these activities.

I don’t have many meetings, usually just one outpatient meeting a month for the entire staff (management, office staff, OTs, PTs, and PTAs)

Q: What type of documentation do you complete? (i.e. how long does it take, how frequent are your notes due, etc.)

A: I use epic for documentation. The daily notes are fairly quick so I try to do these while treating. Evaluations take me about 30min to document, give or take, based on complexity.

Q: What does a typical evaluation look like? How long does it take? What assessment tools do you use?

A: I use the QuickDASH, 9 hole peg, goniometry for ROM, pain scale, and dynamometry for strength (if appropriate based on precautions). I interview the patient on what ADLs they are having difficulty completing, their job responsibilities, and leisure activities they want to get back to.

I often make orthoses during the initial evaluation for protection (thumb spicas, ulnar/radial gutters, dorsal blocking). I instruct the patient in a HEP and review their precautions. It takes 45 minutes to an hour for the entire evaluation.

Q: What is a ball-park range of what an OT can expect to earn in your practice area (please also include approximate geographical location - rural South Carolina, suburb in Connecticut, etc.) Please also include if this rate is for per diem, with benefits, per visit, etc.

A: This can vary greatly based on location and years of experience. On average, CHTs earn between $35-50/hr. If you are an OT looking to get a job in hands/orthopedics to gain experience towards earning your CHT expect to make less. Most places will offer you a raise after earning your CHT. Ask potential employers if they will cover the cost of taking the exam. The Hand Therapy Certification Commision does a very in-depth salary survey every 2 years which is free to CHTs and can help you negotiate future salaries.

I also think it’s important to point out that OTs, the majority of which are females, don’t often negotiate their salaries. You absolutely should!

Q: How did you get your “foot in the door” to work in this setting?

A: I was offered a job at the facility where I completed my second fieldwork rotation immediately after graduating. Because of this I was lucky enough to get my first job out of school in hand therapy.

Q: What is your favorite part of this practice setting? Can you provide a favorite memory of a patient/client that you know OT positively impacted their life?

A: I like that patients typically make progress quickly in this setting, which is rewarding for both me and my patients, and most are happy to come to therapy because of this. I love that I get to work so closely with physicians. This can be intimidating but it’s such a great way to learn. I treated a patient with a brachial plexus injury with co-morbid mental health diagnoses. She fell asleep on her arm and when she woke up she was unable to move it. Many other therapists were weary about treating her due to her co-morbidities. When I first started treating her she was approximately 3 months out from her injury and had no active elbow flexion. By the time I discharged her she had full range of motion of her entire extremity. I also felt that I was able to treat her as a whole person and support her mental and emotional needs even in a physical disabilities setting.

Q: What advice do you have for new grads/therapists hoping to transition into one of both of these settings?

A: I recommend requesting a level 2 fieldwork placement in hand therapy if it is a setting you are seriously considering. Know your anatomy and common diagnoses before your fieldwork starts. Ask lots of questions and learn common protocols when your fieldwork educator introduces them to you during fieldwork. Also remember that even though you deal with physical disabilities in this setting OT started out in mental health. Always be empathetic and holistic.

Q: Do you have any stories (can be funny, sad, real, neutral) or a “big mistake” you’ve made on the job? What happened? How did you correct this mistake (if possible) or what did you learn from it?

A: Approximately 3 months after passing my boards and starting my job one of the physicians I worked with sent over 2 unscheduled walkovers for dynamic extension orthoses, on top of an already full schedule. These typically take about an hour, just to fabricate the orthotic. My colleagues and I knocked out the first one and then realized we were out of the metal parts needed to make the second splint. I ended up fabricating the outrigger out of thermoplastic. Needless to say it wasn’t my best work. The MD wasn’t super happy with it and we ended up making her a new one the next week when the parts came in. But it got the job done. I can still remember how stressed out I was in that moment. But I stayed calm and one step at a time, I figured it out. It also gave me a better understanding of the mechanics behind dynamic orthoses and helped me further my splinting skills. You’re not going to be an expert right out of school, but sometimes stressful situations help you learn and grow.

Q: How do you personally prioritize your self-care and prevent/manage burnout?

A: I make time for activities that I enjoy. I try to take at least one big vacation a year. I do my best to finish all of my notes at work and not bring work home with me. Still, mentally detaching from work during off hours is something I struggle with.

Q: If you’re comfortable sharing, approximately how much money did your OT program(s) cost (including tuition, fees, books, housing if applicable)?

A: My graduate program cost me approximately $120,000 (including cost of living while I was in school).

I was lucky enough not to have any debt from undergrad thanks to scholarships and instate tuition. I definitely recommend getting your undergraduate degree locally and as cheaply as possible.

I then used graduate school as an excuse to travel. I moved cross country for my graduate program and traveled for my level 2 fieldworks. Although this made things more expensive for me, it helped me grow a lot as a person and I’m glad I did it this way.

Q: What’s next for you? Where do you see yourself in the next 5 years?

A: I do not see a lot changing for me in the next 5 years. I’d like to continue developing my skill set and further my knowledge and proficiency with complicated diagnoses. I plan to continue being a clinician and can’t see myself moving into management or teaching. I really feel that working so closely with people is the most rewarding part of my job.

Q: What changes would you like to see in the OT profession in the next 5-10 years?

A: I’d like to see continued advocacy and more mainstream media about occupational therapy. Most people still do not know what OT is and call me a physical therapist. I’d also like to see more collaboration between different types of occupational therapists. I feel it’s important to be able to serve all people, even if it’s not a diagnosis you commonly work with or it’s outside your primary setting of practice. In order to do this I feel it’s important to collaborate with therapists in other areas and have a broad network of therapists you can reach out to for guidance.

Q: If you could go back in time, what advice would you give yourself when deciding on OT and more specifically becoming a CHT?

A: I would tell myself not to stress about the little stuff and reassure myself that I’m doing a great job. I would tell myself to be more present and spend more time enjoying the day to day.

Q: If you could do it all again would you pursue your same degree and become an OT?

A: Yes, I really enjoy my job. It keeps me intellectually stimulated and I get to connect with and positively impact so many people on a daily basis! It is a very rewarding career. Having said that, It is also a stressful career. I often find it hard to shut my brain off when I leave work and not take things home with me. I stress about decisions and treatments and protocols. I’m always trying to make sure I am doing the right thing for my patients. And not every patient will have a great outcome. But for me it’s worth it and I would do it all again.


Rebecca Walsh is a Occupational Therapist and Certified Hand Therapist currently practicing at Houston Methodist in Houston, TX. She is originally from Atlanta, Georgia and received her Masters of Occupational Therapy degree from the University of Southern California.

- Instagram: rebecca___walsh

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