'It was hard getting a job in the US, getting a visa was the hardest'

Working Abroad Q&A: Each week, Irish Times Abroad meets an Irish person working in an interesting job overseas. Here, Bianca Doherty from Co Cork shares her experience of moving to San Diego to work as an occupational therapist.

What is occupational therapy?

The age-old question! Basically, we help people of all ages and abilities to do the meaningful everyday activities they need/want to do in their natural environments. We call those everyday activities that bring meaning to a person’s life “occupations”, hence the name. One of our core skills is “activity analysis” whereby we break an activity/occupation down into minute steps and assess where the challenge is happening - we then work to modify the task or the environment to increase the person’s chances of success. In a nutshell, OTs are creative problem-solvers.

When did you leave Ireland?

I got my BSc in Occupational Therapy from University College Cork. I left Ireland in 2016 to pursue my occupational therapy doctorate at the University of Southern California. I had always been interested in working in the United States and potentially teaching at a university one day. Then in 2015, I completed a summer programme in the OT Division at USC that really made me me to go for it. I also wanted to gain more clinical experience in paediatric mental health and I hadn't had an opportunity to do that in Ireland, so I thought the doctorate would help with that too. As part of that, I spent a year in a clinical residency working at an outpatient paediatric mental health clinic with children from low-income families from around Los Angeles.

What is occupational therapy? The age-old question! In a nutshell, OTs are creative problem-solvers

Have you done any training or studying anywhere else?

I got my Master's at Queen Margaret University in Edinburgh while working with a charity supporting autistic adults in the community. I also worked as an OT with the HSE in Ireland for two years. I completed training in sensory integration, which is an advanced intervention approach for people whose nervous systems have difficulty interpreting and organising sensory information coming in from their environment as part of my doctorate.

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I still need a visa, which is often the most difficult part, especially in these controversial political times

Tell us about your career there.

My previous role involved me working in LA with children and families who were experiencing mental health challenges. I also completed training at a more traditional paediatric clinic where I worked with children with sensory integration challenges. After finishing my doctorate, I moved to San Diego, which is where I am based now at the University of St Augustine for Health Sciences. I teach occupational therapy in our Master’s and Doctorate programmes.

What does your day-to-day work involve?

I teach full time at the University of St Augustine, and teach two foundational occupational therapy courses and a mental health course. I also have one day a week called a “release day”. Typically, faculty are encouraged to work clinically or pursue additional scholarship opportunities on that day. Because of some visa restrictions, I am finding it difficult to get a typical clinical OT job for one day a week, so instead I’m currently exploring options for collaborating with more non-traditional or “role-emerging” sites, such as a domestic violence centre, homeless shelter and an LGBT centre. I’m hoping to be able to set up an OT service at a site like this and give our students the opportunity to do a clinical placement there.

Was it hard to get a job teaching in the US?

It was hard getting a job in the US full stop - especially as an international OT. Although I got my doctorate in the US, passed the national board's exam in the US and have my license to practice in California, in order for me to work I still need a visa, which is often the most difficult part, especially in these controversial political times. I found very few clinical sites that were willing to sponsor a visa for me so when I found an opportunity that would cover the visa and was in teaching, I jumped at it.

Is the US health service different from the Irish health service? How?

Yes! This has probably been the biggest learning curve in my transition to the US. Especially those first few months of my doctoral residency, where I was expected to provide clinical services very quickly. My most frequent question was “wait, what does that mean?” In Ireland, the majority of jobs for OTs are within the HSE, which operates similarly to a system of socialised medicine. In the US, healthcare is driven by insurance and each insurance company has its own requirements for things such as documentation, billing, reimbursement etc. So as an OT you need to be familiar with some of those requirements going out into practice, and you (quickly) learn about others on the job. It definitely adds an extra layer of complication.

If you wanted to come and work in Ireland what are the opportunities like for an occupational therapist?

Working for the HSE requires an application to what is known as "the panel" and that has only happened every couple of years. I would have to get on that panel in order to be notified of permanent jobs in Ireland. Besides the HSE, there are also opportunities to work for agencies such as Enable Ireland, where you can just apply directly to the agency. I've loved all of the opportunities that working in the US has offered me and if I was to come back to Ireland, it would have to be for the right job and in the area of mental health I've started to specialise in.

How do salaries compare?

The pay in the US is far greater, although that the cost of living is also much higher. Starting salaries for a new-graduate OT in Ireland are about € 33,000. In California starting salary for an OT is anywhere between $70-90,000 (€61,600-€79,200). However, that is pretty proportionate to the difference in cost of living. For example in places such as LA or San Diego, you it would cost $1,000-1,500 a month rent for a shared apartment.

Do the Irish fit in well there?

Yes definitely - most people love the Irish. When people find out from Ireland, I typically get people telling me where they’ve visited in Ireland or where their ancestors come. This used to annoy me, but I’ve come to understand it a bit more since being here. The US is such a melting pot of cultures and there is no one “American” culture, so everyone is trying to hold onto the cultural backgrounds that their family belongs to.

There have been many perks to living in the States - spending my birthday at Disneyland, Will Ferrell delivering the speech at my graduation...

What is it like living in San Diego? Mention the climate if you must!

San Diego is great! It’s a very fun city to live in, and people are generally very relaxed - probably because the beach is never too far away. The weather is great, although it has forced my temperature gauge of what is defined as “cold” to change dramatically.

Do you think working abroad has offered you greater opportunities?

Yes, hands down. I think working abroad in any field would only help to widen a person’s horizons and offer different perspectives on the world. In OT specifically, it has given me the opportunity to pursue goals in new and emerging areas and has helped me to develop a great interest in policy and advocacy issues. I’ve become very interested in understanding how health policy drives the services we provide as OTs. Earlier this year I travelled to Sacramento with the Occupational Therapy Association of California to meet with legislators about three bills that were up for vote.

Besides the professional opportunities, there have been many personal perks to living in the States as well. Getting to spend my birthday at Disneyland, Will Ferrell delivering the speech at my graduation, and in true Irish fashion, finding a cousin over here, to name just a few.

What advice would you give to someone interested in pursuing a career abroad?

In OT specifically, there are a lot of lengthy and very expensive steps to get here - so I would say be prepared for that up front. But for me, I feel like it has definitely been worth it.

If you work in an interesting career overseas and would like to share your experience with Irish Times Abroad, email abroad@irishtimes.com with a little information about you and what you do.