Occupational Therapy Practice and the History of the Medical Model: A Case for Why OT is Awesome

Recent movements on social media have made claims that occupational therapy as a profession is moving away from the medical model. However, occupational therapy has begun moving away from this model for a long time now. It is not something new.

So as a healthcare profession, why did occupational therapy move away from the medical model? This well-researched video explains the early history of occupational therapy and how it was influenced by the medical model in the first place.

In early OT history, the profession worked with the American Medical Association (AMA) to help improve schooling and standardization, having seen success from the Flexner Report. AOTA’s collaboration with the AMA helped the profession of OT to be recognized by the medical community. To this day, occupational therapy practitioners work in many medical settings such as hospitals and skilled nursing facilities. And they will continue to do so.

This is why membership in associations such as AOTA and your state is so important. By not becoming a member and making your voice heard and providing resources for lobbying and advocating for OT, we would potentially lose our practice in such settings. It’s the opposite…funny isn’t it?

So does that mean a move away from the medical model will threaten occupational therapy practice and its scope in these traditional settings? The answer is more nuanced than but it is also a no. So you should not be worried about it or even angry about it or start a social media tirade about it. Here’s why not:

Occupational therapy was actually influenced by another model very early, the biopsychosocial model. This is believed to be one of the current models (which has many strengths over a purely reductionistic medical model) that OT practices in. Another term is occupation-based (as mentioned in the video). It’s even in the name of the profession: occupational therapy.

The medical model has many benefits on its own such as being founded in science, research, statistics, and randomized control trials. However, it primarily sees clients in terms of their deficits and their symptoms. Not their strengths. Furthermore, they are typically seen as passive recipients of healthcare during their treatment by the team. The medical model has its strengths for being able to predict problems and solve them, reduce disability, and improve quality of life through functioning. However, it is seen as a “bottom-up approach” and is not holistic.

In contrast, the biopsychosocial model factors in also the psychological and social-cultural factors. To treat an individual, one need also consider these additional factors, contexts, and so on (as described in detail in the Occupational Therapy Practice Framework). The biopsychosocial model shares many parallels with occupation-based treatment. Theoretical OT models such as MOHO, PEO, EHP are all considered to be top-down and have elements of the biopsychosocial in their diagrams. Based on this, one can say that these OT models are more biopsychosocial than biomedical. Many experts also believe that being occupation-based by nature means that one is not biomedical and they are actually in conflict.

Like anything in life, having a balanced approach is best. I have seen some concerns and criticisms about what is being taught by OT schools and if it is preparing them for the real world, all the way down to how they approach and have experienced occupation-based practice or not. This is also setting dependent as well. But this does not mean that a traditionally medical model setting like the hospital cannot have influences of other models. In my opinion, it needs to. Why?

One argument against a purely biomedical approach is that of the US healthcare system such as in the hospital. The US spends significant amounts of money, time, and resources in healthcare, yet we have very poor outcomes when compared to other similar countries.

If OT were to conform to the medical model along with the physicians, nurses, technicians, and other therapists, the profession would not bring their strengths into the mix. Occupational therapy and its philosophy and emphasis on occupation using a more holistic approach should be seen as a strength, not a weakness.

People (even among OT circles) often say that “no one gets what OTs do”. Or knows what occupation is. Or that the term occupation should be renamed.

But people naturally get how the medical model works. It’s easy to understand. If there’s something wrong, try to identify the symptom and use the best evidence to fix it with an intervention, surgery, or whatever. Due to the complex nature of human beings and subsequently, attempts to help them using a model like BSP or occupation philosophies, it is much harder for people who don’t do OT to understand occupation. Or remember to emphasize the biopsychosocial model.

So reflect on this again: how are we doing in terms of healthcare outcomes in the US? Not so well. So I would argue that advocacy for occupational therapy is vital for the profession and also for the benefit of society.

We need OT.

Without it, we would be left with an overemphasis on the medical model, which while very effective at some things, does not fix everything like chronic pain, mental health issues, substance abuse issues, social issues like homelessness, and the list goes on and on, even for very “physical ailments”.


Kielhofner G. Conceptual foundations of occupational therapy practice. Philadelphia (PA): FA Davis; 2009.

Lohman, H., & Peyton, C. (1997). The influence of conceptual models on work in occupational therapy history. Work, 9(3), 209-219.

Murray, A., Di Tommaso, A., Molineux, M., Young, A., & Power, P. (2021). Contemporary occupational therapy philosophy and practice in hospital settings. Scandinavian journal of occupational therapy, 28(3), 213-224.

Prislin, M., Saultz, J., & Geyman, J. (2010). The generalist disciplines in American medicine one hundred years following the Flexner Report: A case study of unintended consequences and some proposals for post-Flexnerian reform. Academic Medicine, 85, 228–235.

Yerxa EJ. Some implications of occupational therapy’s history for its epistemology, values, and relation to medicine. Am J Occup Ther. 1992;46:79–83.