Should a New Grad Go Straight Into Pelvic Health?

Emily Lieberman graduated in August 2023 and accepted a full-time position in outpatient pelvic health as her first role practicing as an OT. Not a stepping stone. Not after a few years in another setting. Straight in.

She did it without a pelvic health fieldwork placement, in a job market where positions often aren't posted for OTs at all, while her classmates were taking more conventional routes.

"My life and my career are not an escape room. There's no single solution. There's no timer."

— Emily Lieberman

Lindsey: I know you had an interest in pelvic health even before you started school, and I can relate — I knew pelvic health was what I wanted, I just didn't know the vehicle. I didn't even know OT existed. I'd applied to PT school, and while I was getting my volunteer hours the director put me with an OT, because the PT I was supposed to follow called in sick. That discovery changed my world. I withdrew my applications and applied to OT school.

What advice would you give other students who've identified this interest and are considering pursuing pelvic health directly after graduation?

Emily: I could talk about this all day, but I'll try to boil it down.

Connect with other practitioners in pelvic health, and with people interested in adjacent topics you're passionate about.

Find people in your geographic area, even at the state level. There are people I've never met because they practice in far parts of my state, but just knowing there were other Michiganders doing this was really meaningful in the early stages. Some of them I've since met — one came to a conference presentation of mine and was my biggest cheerleader.

Over time, connect with adjacent professions too. Depending on your interests, that might be midwives, doulas or lactation consultants. And if there aren't other OTs in your city doing pelvic health, there are PTs doing that work. Meet them. Shadow them. Just connect.

Here's what I didn't appreciate early on: the barrier to entry for this is so low. As a student, almost everyone is happy to help. You can cold call or cold email and make whatever your ask is, and those people become your network later.

In my case, as a second career person, I was already not the typical student. In my program I was one of very few significantly out of undergrad, and that was okay. It had already got into my mind that there's more than one way to go about this.

But it still creeps in. If you have a few examples around you, that starts to create an archetype in your mind — that's how you do it. It starts to feel like a game you have to play, or a puzzle to solve.

I see people asking: which course should I take, this one or that one? As a student, should I do fieldwork in this area or that one? Like you have to make the one right decision.

This can sound contradictory, but I don't think it is.

On one hand, trust the process. There's real value in being trained as a generalist. On the other, take the initiative to feed the parts of you that are passionate about a particular population or approach. If you don't act to feed that hunger, it might not happen — not everything is served up to you at school, because we have such a wide scope of practice.

That's a great thing about our profession. It also means everyone has things they wish were covered more, or less. Give it time to unfold. Soak up the experience. There will be moments of frustration, and that's okay. You'll be glad you paid attention to everything when you're sitting your boards.

Emily: Rather than thinking of it as a game I'm playing, I came back to this idea:

An escape room

A single correct solution. A timer running. One wrong move and you've lost your chance.

A garden

Something you set up and that evolves over time. Maybe you put in one big rock now, plants later, gravel over here. In my case, as a second career person, there were already trees growing — and I don't have to uproot them, because they have value in what I bring from my previous experience.

Lindsey: Just picturing those two side by side — my nervous system has vastly different reactions to an escape room and a garden. And I'd much rather be in the garden. Recognizing we have a choice in how we perceive these situations is powerful.

It's also true for the entrepreneurs listening. Sometimes we get into this frenzy of: if I don't figure this out right now, my whole life takes a different trajectory.

Emily: For me it falls into three places.

In school

Programs vary. Mine had a lot of class projects and research projects, and often we didn't have much choice — you might pick a topic off a list. So I'd choose whatever gave me the most spark. Where I could pick freely, I went for depth. I did some fairly big projects on trauma, which is incredibly relevant to this work.

Outside school, during school

Continuing education, preparing a presentation for the state conference. I'm guilty of burning the candle at both ends here, and I don't regret any of it, but it did leave me feeling spread thin. Exercise moderation. Still, if there's something you want to learn that isn't being taught, it's probably within reach and not too expensive, especially with how much is online now.

Fieldwork

We had no choice in level one, but could rank preferences for level two. Being geographically dependent, I didn't have the world at my disposal. I would have loved pelvic health fieldwork, but there wasn't anyone within a reasonable drive who could have been my CI.

Emily: So I didn't have a pelvic health fieldwork — and obviously it worked out. I got a great job.

I did outpatient neuro and inpatient acute, and in both I got broad exposure that was genuinely enjoyable and informative. Pelvic health isn't the only thing in the world I care about. And within each of those placements there was plenty I could put on my resume and talk about in an interview that was highly applicable.

Be intentional with fieldwork. Think about what different sites could offer you. But don't feel everything is riding on one or two experiences.

Learn with me for free

Start where every pelvic health OT starts, with a free AOTA-approved CEU class. Take either one, or both.

Lindsey: Did going straight into pelvic health require you to step outside your comfort zone?

Emily: Honestly, it surprised me. Not that a job process would have some stress — there's always that — but how challenging it was at times. This was my second career. I felt like I'd done this before. So it was confusing that networking in my area and working on my resume were keying up my nervous system so much.

I was listening to your podcast, the episode about five things to recenter yourself after a setback, and I pulled the car over to take out my phone, rewind, and write down this line:

"Keep going until you achieve what it is that you're aching to achieve."

It was the word aching that connected. That's how I felt. I wanted this more than I'd wanted any job or opportunity before. It wasn't that I needed something to do with my time and a way to pay the bills. I really wanted to serve my community in this specific way I'd been working toward.

Which made it easy for that to cycle into a feeling that the stakes were enormously high, that I had to stick the landing, that this was the moment.

So I'd be writing an email to someone at a place I was thinking of applying — and I love connecting with people, that was my very first piece of advice — but in that high-stakes headspace I'd get stuck on the wording, re-editing, having to tell myself: this is good enough, Emily. Hit send.

Lindsey: What got you unstuck?

Emily: My first attempt was the boost-your-own-confidence strategy. Summon confidence, say the affirmations, get myself into a better place.

It wasn't really working. It took a lot of emotional energy, and it almost felt invalidating of my own experience — that for me, this genuinely was hard.

Everyone's on their own path, and everyone has their challenges. It just happened that I was trying to do something I didn't have many close examples of. My peers were finishing up, and in our group chat people were posting that they'd continue on where they did fieldwork, or that they'd made a profile on a job site and a recruiter had reached out. I was doing something that felt really different — applying for jobs that might not even be posted for OTs, in a specialty I hadn't always been encouraged toward as a new grad.

So eventually I started saying: it's hard to do hard things. Some of the time it came with a sense of ease. Some of the time I just did the thing even when it didn't feel good.

That's more of an acceptance and commitment therapy stance. There's a bigger picture to why I'm doing this, even when it isn't comfortable. I'm going to take these actions in service of moving toward something I really believe in.

And plenty of it was fun. I actually enjoy interviewing, and my interviews were all really fun. It was just some of those pieces that got sticky.

Emily: My first interview was a phone call, and then she invited me to come in person — and part of that was going to involve doing an internal assessment. The person interviewing me was the owner of the business.

So of course I said, great, great. And then after the call: okay. I can do this. I can do this.

There were things I could go back to on my own. I'd taken OT Pioneers, so I went back to my materials and rewatched some of the videos. Good confidence booster. I also rewatched the graduation celebration talk, because that was inspiring.

Then I posted in the Facebook group — I think there was a thread about what you have going on this week, or what you're celebrating — and I said, my gosh, I have my first interview and it involves doing an internal assessment. Probably with a funny emoji.

Lots of people commented, including you. Go for it, Emily. You're going to be great. I still would have gone and done it and been fine. But it was such a nice boost to have that cheering section. That's why we have fans at the game.

And you were so gracious and talked with me while I was preparing — mainly about what I was looking for and what I valued, and a bit about prepping for that interview. I also connected with that friend in Michigan and went more line by line: what was I thinking of doing during this assessment, I think I'll start with this. Bouncing ideas off her was so helpful.

Then because of circumstances that day, the internal assessment didn't end up happening at all. But by the time I went in, I was so excited for it that I was almost disappointed.

These are the little things you plant along the way. We don't know exactly how it's all going to play out, but things come back around. The more you've woven that network, the more those people are thrilled to show up for you in those moments.

And I'm hoping that after a while, I get to be that person for someone else.

Emily: I have a mini soapbox here. There's a bit of self-doubt talk within the pelvic health OT world that comes from a real place — the history of who's practicing, who's recognized, how jobs get posted. I benefit enormously from doing this in 2023 rather than 2013. The landscape has changed a lot, and I feel like I'm standing on the shoulders of people who did so much advocacy.

But my advice is: don't go in expecting it to be uphill both ways.

Lindsey: Every single thing you said had me on the edge of my seat. I'm in my mid-forties, and there's still so much in there that applies to every stage of the journey, not only to new grads.