Blog: If I Ran the Nevada Health Authority: The Real Housewives of Functional Medicine
Function is the new black, and occupational therapy is ready for its close-up.
By: Matt Brandenburg, OTD, OTR/L
Occupational therapy (OT) is the healthcare profession best poised to lead meaningful change; in people’s lives, in communities, and across our healthcare systems.
But for a profession built on function (i.e., what people need and want to do every day) we’re somehow left out of the “Big Picture” conversations.
Reimbursement rates stay flat. Tuition skyrockets. Connecting health to daily life gets skipped in care plans. Policymakers forget we exist. And our workforce burns out trying to prove its worth in a system that doesn’t always understand it.
That’s why we need more than good clinicians, we need strong, visionary organizations that aren’t afraid to claim space, reframe the narrative, and show how the entire healthcare system works better when OT leads.
And so, without further ado I present an unsolicited cover letter to a job that doesn’t exist but absolutely should.
Dear Hiring Committee for the Position of
Vice President of Making Occupational Therapy Cool Again (VPMOTCA):
Let me start with a compliment. I love NOTA and AOTA. I’ve been a member, a podcast producer, and a hype man in the comments section of every policy update they’ve ever posted. They work hard. Their webinars are solid. Their conference badge games? Flawless.
But we need to talk.
We’ve been playing small. We’ve been waiting on scraps. We’ve been asking permission to sit at tables we helped design.
Meanwhile, the Boston Celtics just posted a job, Director of Mind Health & Human Wellness, that reads like someone reverse-engineered the OT Practice Framework while binge-watching The Last Dance.
This job was shared by a prominent OT with the caption: “This would be a perfect position for an OT!” And they were right.
But here’s the plot twist: the Celtics didn’t list “OT” anywhere in the post.
Because we’re not in the room.
Because no one’s telling them what we do.
Because when it comes to health and human service policy and practice, we’re still acting like a polite guest in the house of healthcare, not the freaking architect of wellness.
Exhibit A: OTs Belong in Sports, Startups, and Spotify
Look around. Companies are spending millions on “performance coaching,” “behavioral optimization,” and “holistic resilience frameworks.” It’s all OT, but repackaged in sleeker fonts and with less licensure.
We need to go where the juice is. That means:
- Professional sports
- Functional medicine clinics
- Corporate wellness programs
- Mental performance consulting
- Lifestyle apps and wearables
- Digital health platforms
- Integrative pain clinics and brain health startups
It’s not just about branching out. It’s about staking our claim.
Exhibit B: Functional Medicine Is Basically OT in a Lab Coat
Functional medicine wants to get to the root cause of chronic conditions through client-centered routines, meaningful health behavior changes, and daily habit redesign.
Sound familiar?
It’s Lifestyle Redesign, just with a better Instagram filter.
We’ve been trained in:
- Root-cause thinking
- Systems-based intervention
- Personalized, occupation-centered plans
- Collaborative goal setting
- Client empowerment
- Preventative care
So why aren’t we the ones leading functional medicine teams?
Why aren’t we embedded in high-performance labs?
Why aren’t we the go-to professionals when someone says, “I just want to feel better again.”
Because no one’s making that case at scale.
My Proposal: Let’s Run State and National OT Associations Like a Union, Not a Courthouse
If I were the VPMOTCA, here’s what I’d do (Chat GPT Emoji List Incoming):
🔥 1. Launch an “OT Dream Job” Campaign
Let’s crowdsource it.
Ask OT practitioners everywhere: What’s your dream job?
Then analyze:
- Fit with our scope and competencies
- How to position the OT lens
- Barriers to entry or reimbursement
- Strategy to educate employers and legislators
Then we go to work.
Like a union.
Like a movement.
Like a profession that knows it’s the health and wellness authority.
🔥 2. Build a Strategic Partnerships Task Force
An internal team that’s not waiting for government scraps or CPT codes.
They’re talking to:
- Sports organizations
- Tech giants
- Functional medicine certification boards
- HR directors of major corporations
- CMPC trainers and IFM educators
And they’re saying: “We have licensed, credentialed, behavioral health experts ready to lead your programs.”
Because here’s the truth:
Strategic partnerships with high-visibility, high-revenue organizations translate to political recognition.
And political recognition translates to influence.
And influence brings the one thing advocacy needs to scale: funding.
Funding for state-level lobbying.
Funding for public health campaigns.
Funding for community programs led by OTPs, not as guests, but as anchors.
This isn’t about selling out. It’s about making sure the next big health initiative doesn’t forget to invite the people who know how to make life work.
🔥 3. Create the OT Career Matchmaking Service
- Want to work in nutrition? Here’s your roadmap.
- Dream of working in esports? Let’s talk attention and fine motor fatigue.
- Want to be a sleep coach for touring musicians? I’ve got circadian rhythm assessments and backstage passes (DM me if you know a band).
We match passion to possibility. No gatekeeping. No guilt trips. Just pathways and community.
🔥 4. Develop a Functional Medicine & OT Integration Toolkit
Because guess what? Casey Means was appointed as the Surgeon General (If that means nothing to you, buy a copy of her book Good Energy and get ready for a new era of healthcare standards).
We’re already doing this work.
We just need the narrative, the billing guidance, and the community support to scale it.
Give us:
- Sample documentation
- Scope alignment guide
- Language translation for job applications
- Advocacy templates for reimbursement
- Case studies of OTs already doing it
🔥 5. Start Telling Better Stories
We’ve got enough PDFs to sink a kayak.
What we need now are:
- Short-form video case studies
- Punchy podcast episodes
- Blog series from OTPs in emerging roles
- State and National Org-backed social content that slaps (that’s Gen Z for “good enough to share without cringing,” in case your last meme was a Minion in a lab coat)
Occupational therapy is sexy! We just forgot how to sell it.
In Closing:
We are not the waterboys of rehab.
We are not sidekicks to “real doctors.”
We are not just post-surgical dressing trainers.
We are experts in daily living.
We are agents of health transformation.
We are the backbone of behavior change.
So if you ever open up that role, Vice President of Making OT Cool Again, just know my inbox is open, my elevator pitch is memorized, and my sock aid is ready for battle.
Let’s take the profession where it belongs:
Front and center in the future of health
.Sincerely,
Matt Brandenburg, OTD, OTR/L
Functional Medicine Fanboy. Sports Enthusiast. VPMOTCA in waiting.
(P.S. I make a mean podcast too).
This Is Not About “Hating ABA.” It’s About Power.
This is not an attack on individual clinicians trying to do their best within a constrained system. It is not a condemnation of families seeking support. And it is certainly not an indictment of autistic children receiving services.
This is about power.
Specifically, who holds the power to decide:
- how much therapy a child is said to “need,”
- which outcomes count as success,
- when treatment continues or ends,
- and who benefits financially from those decisions.
Right now, too often, those decisions are not being driven by children or families. They are being shaped:
- by corporations with fiduciary duties to investors,
- through a therapy model that rewards volume and endurance,
- within a system that offers limited transparency about long-term outcomes.
That’s not healthcare.
That’s extraction.
And yes, this pattern is familiar to my fellow Mob Museum friends. Systems of extraction tend to follow the same playbook:
- enter spaces where people are desperate for help,
- control access to scarce resources,
- normalize overuse as “necessary care,”
- make themselves indispensable,
- and quietly collect while everyone else absorbs the cost.
Which brings us back to Nevada.
Nevada’s children should not be revenue streams.
Autistic kids should not be growth markets.
Disability services should not be acquisition opportunities.
Public insurance should not be a private equity playground.
What Nevada needs are autism care models that are:
- developmentally informed,
- evidence-informed and outcome-driven,
- trauma-aware,
- neurodiversity-affirming,
- interdisciplinary by design,
- shaped and evaluated with meaningful input from the autistic community,
- and led by licensed professionals with deep clinical training.
That means elevating occupational therapy, not as an add-on, but as a core component of care.
Occupational therapy providers are trained to ask different questions:
- What is this child communicating through their behavior?
- What is this child’s nervous system telling us?
- What sensory, emotional, or environmental factors are shaping participation?
- What supports create regulation rather than suppression?
- How do we build capacity without erasing identity?
- How does this family function in real life, not just in a clinic room?
We don’t sell stillness.
We support participation.
We don’t demand compliance.
We build capacity.
A Broader Coalition Is Raising the Same Concerns
These concerns are not mine alone.
The Nevada Therapy Alliance, a statewide coalition representing licensed occupational, physical, and speech-language therapy providers, penned a formal letter to the U.S. Department of Health and Human Services calling for a federal reassessment of Applied Behavior Analysis (ABA) funding and a redirection of autism care toward evidence-informed, developmentally grounded interventions.
The Alliance’s letter outlines:
- the escalating financial burden of ABA on Medicaid and public systems,
- concerns about limited oversight and minimal training requirements,
- the expansion of ABA into complex medical and developmental conditions beyond its scope,
- and the downstream consequences for children, families, schools, and long-term independence when skilled therapies are underfunded or delayed.
The letter advocates for better care. Care delivered by licensed clinicians with medical training in development, communication, motor systems, sensory regulation, and functional participation.
It echoes the same conclusion reached throughout this piece: when reimbursement incentives prioritize volume and compliance over outcomes and development, children and taxpayers lose.
Read the full Nevada Therapy Alliance letter here
If I Ran the NVHA…
I wouldn’t wait ten years for outcome studies while children are over-treated and mis-treated today.
I would restore accountability, realign incentives, and center children over capital:
1. Restore Oversight and Public Accountability
- Pause approval of new private equity acquisitions in pediatric therapy and review acquisitions from the past decade.
- Require full ownership and financial transparency for all pediatric therapy providers receiving public funds.
- Establish a Citizens with Disabilities Advisory Council with formal representation in NVHA leadership and governance.
- Set statewide interdisciplinary standards of care and supervision in pediatric therapy.
2. Realign Funding With Evidence and Outcomes
- End preferential reimbursement and automatic authorization of high-intensity ABA services without interdisciplinary justification.
- Conduct a formal, transparent review of ABA outcomes, costs, and long-term impact, including autistic lived experience.
- Redirect cost savings toward licensed, evidence-informed therapies such as occupational, physical, and speech therapy.
- Increase reimbursement rates and reduce network exclusions for therapies that demonstrate functional, developmental impact.
3. Redefine What “Success” Means in Autism Care
If I ran the Nevada Health Authority, we would stop measuring autism therapy success by quiet compliance and start measuring it by meaningful participation, emotional regulation, and engagement in daily life.
We would shift the question from “How do we control this child?” to “How do we support this nervous system?”
And we would finally align the care model with what children and families actually need:
- ✅Occupational therapy integrated under physician oversight
- ✅Behavior technicians appropriately supervised within interdisciplinary teams
- ✅People over protocols
- ✅Function over obedience
- ✅Clinical decision-making insulated from corporate and investor pressure
- ✅Autistic lived experience guiding every level of care
Because the truth is this: not all “therapies” are created equal. And not all “evidence” is ethically neutral.
Our shared objective should be clear: to ensure that children with autism receive interventions that respect their dignity, support their developmental needs, and demonstrate measurable, meaningful progress in daily life.
Nevada has been here before.
We know how rackets operate.
We know who gets hurt when oversight disappears.
If we can spot exploitation on the Strip, we can recognize it in healthcare.
And if I ran the Nevada Health Authority, I wouldn’t stand for it.
Neither should you.
