*This article was originally published at Rehab U Practice Solutions on 6/11/2026.
We graduate knowing how to treat patients. Most of us graduate knowing almost nothing about the business that makes treating patients possible.
I was recently invited to speak with OT students and faculty at Bowling Green State University, and one of the questions that came up — the one I keep getting asked no matter the audience — was some version of this: What do you wish you had known coming out of school? My answer is always the same: business literacy. Not coding. Not research methodology. Not even a deeper clinical specialty. The single biggest gap between where most OT graduates land and where they want to go is a basic understanding of how the business of healthcare actually works.
And before anyone emails me — I’m not saying OT programs are failing their students. They’re not. They’re designed to produce excellent clinicians, and by and large they do exactly that. But there’s a difference between being a great clinician and being able to sustain, grow, or lead a practice. That second set of skills? Nobody handed them to me. I had to go find them.
Here’s what I find telling: PT has an entire chapter within APTA dedicated specifically to practice owners. There are resources, communities, business development support. OT doesn’t have anything equivalent — not yet, anyway. That’s not a criticism, it’s just an observation about where our profession is relative to where it’s going.
Because here’s the reality: even if you never plan to own a practice, understanding how the finances of your organization work changes everything. It changes how you advocate for resources. It changes how you negotiate a raise. It changes how you read a staffing decision that doesn’t make sense to you clinically but suddenly makes sense when you understand the margin pressure behind it.
The clinicians I’ve seen advance — in private practice, in hospital systems, in consulting — almost universally had one thing in common: they weren’t just good at their jobs. They understood the business they were operating inside of.
“Even if you never plan to own a practice, understanding how the finances of your organization work changes everything — how you advocate, how you negotiate, how you lead.”
I’m not suggesting you go get an MBA. I’m suggesting you spend a few hours getting comfortable with a handful of concepts that will pay dividends for the rest of your career.
Start with the P&L — the profit and loss statement. Know how to read one. Know what revenue, expenses, and margin actually mean in the context of a healthcare practice. Then get a handle on cash flow, specifically how healthcare cash flow works. We operate in a cash-flow-negative business: we deliver services first and get reimbursed later. That dynamic shapes every business decision a practice owner makes, and it’s something most clinicians never think about until they’re the one making those decisions.
From there, start paying attention to where reimbursement is heading. Accountable care organizations, value-based care, shared-risk models — these aren’t abstract policy concepts. They’re the structures that are going to determine how our services are bought and sold over the next decade. The practices that are going to thrive aren’t the ones that react to those shifts. They’re the ones that saw them coming.
Follow the money. It will tell you more about the future of this profession than any continuing education course.
I think there’s something deeper here, too. When we limit our professional identity to being an OT — just an OT — we inadvertently narrow our own thinking. We filter the courses we take, the connections we pursue, the opportunities we’re willing to raise our hand for.
I’ve worked alongside OTs who are CEOs of hospital systems. I’ve watched colleagues leave clinical practice and build management consulting careers at the highest levels. None of that happened because they were better OTs than everyone else. It happened because they stopped thinking of OT as a ceiling and started thinking of it as a foundation.
The business knowledge isn’t a distraction from being a good clinician. It’s what lets you protect your patients, sustain your practice, and build something that lasts.
The full interview is waiting for you. This article draws from a longer conversation I had with a group at BGSU — covering burnout, mentorship, the future of OT, and a lot more. Paid members get the complete Q&A and the full video.
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