Nobody talks about how isolating regional paediatric OT practice actually is

I’ve been thinking about this a lot lately.

Not because it’s a new problem — it isn’t. But because I keep hearing the same thing from the OTs I supervise, from practitioners who reach out after a LinkedIn post, from the questions that appear in Facebook groups at odd hours of the evening.

Is it just me?

It’s not just you.

I’ve worked in regional and outreach models before the NDIS existed. Back when allied health services meant a drive-in clinician once a term. Two days, a packed schedule, no room for anything unplanned, then back on the road. I’ve been the sole OT in a service centre as a new grad, carrying a caseload that probably needed four clinicians across three disciplines. And now, providing external clinical supervision to paediatric OTs across Australia, I hear versions of the same story over and over again.

Regional paediatric OT practice is hard in ways that don’t get named enough. This is my attempt to name them.

The pressure to know everything — and do everything

One of the things that shifts when you move from a metropolitan practice to a regional one is the breadth of what lands on your desk.

In a city, a child with complex seating needs might be referred to an AT specialist. A child post-acquired brain injury goes to a neurological rehab OT. A child with feeding difficulties might see a feeding-specific therapist. There’s a referral pathway. There’s a colleague down the hall.

In regional practice, that referral pathway often ends at you.

Families in regional areas have always deserved the same quality of care as families in metropolitan centres. The NDIS, for all its complexity, shifted something real here. Families no longer have to accept the once-a-term drive-in model. Choice and control gave them the ability to demand local, consistent, relationship-based care. That’s right. That’s what their children deserve.

But it also means those families are looking for metropolitan-level expertise from their local OT. The expectation of specialisation hasn’t gone away. It’s just been relocated to you.

You are now the AT specialist. The postural management lead. The sensory processing expert. The one who navigates the NDIS report, coordinates with the paediatrician, andknows the community supports available in a town with limited services.

That’s a lot of clinical territory to hold on your own.

The solo practice reality

Many regional paediatric OTs are working solo. Running their own small practice, contracting independently, or working as the only OT in an organisation whose leadership sits somewhere else entirely.

The autonomy that comes with that is real and valuable. I don’t want to dismiss it. But the clinical cost of working in isolation is also real.

When you’re the only OT in the room, there’s nobody to bounce a complex case off at the end of the day. No peer to say “I’ve seen that before, here’s what helped.” No team meeting where someone notices you’ve been carrying a heavy caseload for three months running.

You stay current by yourself. In a field moving as fast as paediatric AT and NDIS practice, that’s a significant ongoing commitment. You manage referral relationships yourself. You stay across community services yourself. And increasingly, you run a business yourself. The admin, billing, compliance, marketing. All of it landing on the same desk as the clinical work.

The siloing effect is real too. In solo regional practice, it’s harder to stay connected to what other professionals are doing for your shared clients. Building the collaborative relationships that make complex paediatric care work takes time and sustained effort. In a regional context, where those practitioners may also be solo and stretched, it can feel like just another job on the list.

The ethical complexity OT training doesn’t cover

There’s a particular kind of professional complexity that comes with working in a close-knit community. It doesn’t get talked about enough.

In a regional town, the boundaries that feel relatively clear in metropolitan practice become complicated fast. Your clients are also your neighbours. Their children are in the same class as yours. You run into families at the school fete, at the shops, at the footy.

This came up in an OT Facebook group just this week. A therapist asking: what do you do when your child and your client’s child are in the same class and year level?

That question tells you something. It’s not a question someone in a large city practice is likely to be asking. It’s the lived reality of regional clinical work. It surfaces dual relationship dilemmas that most ethical frameworks were written with metropolitan practice in mind.Managing those boundaries well takes active, ongoing effort. For your clients, for your own family, and for yourself. It requires space to think clearly with someone who understands both the clinical and human dimensions of what you’re navigating.

What I want you to know

If you’re a regional paediatric OT reading this, I want to say something directly: The difficulty you’re experiencing is not a reflection of your competence. It is a structural feature of the context you’re working in, and it deserves to be named as such.

The question “is it just me?” is one of the most common things I hear from OTs in supervision. It almost never is.

So what actually helps?

A few things have made a real difference for the regional OTs I work with.

1:1 Clinical Supervision — not the tick-a-box kind, but reflective supervision with someone who understands paediatric practice. Space to think through the cases sitting heavily, the ethical dilemmas you’re not sure how to navigate, and the professional questions you can’t ask your boss because you don’t have one.

Co.Consult is a telehealth joint session where, with your client’s consent, one of our senior clinicians joins you for the appointment. You get a second set of clinical eyes in real time.

Whether it’s a complex AT trial, a seating assessment you’re uncertain about, or a postural management question you’ve been sitting with. You’re not the only clinician in the room anymore.

Complex.Lab is our group supervision cohort for paediatric OTs working with children with complex disability. A small, consistent peer group. Four-weekly, online, led by Kacey. The kind of peer connection solo regional practice often strips away entirely. Low cost. High value. Less isolating.

None of these things solve the structural challenges of regional practice. But they change what you’re carrying, and how alone you feel carrying it.

If you’re sitting with the quiet question of whether you’re doing this right — reach out. That question is worth taking seriously.

Book a free discovery call →
Learn about Co.Consult →
Join Complex.Lab →

Kate is the director of Kids + Co.Lab, a paediatric allied health practice on the Sunshine Coast, QLD. She provides external clinical supervision to paediatric OTs across Australia and has worked in regional and outreach allied health models for over a decade. If this resonated, she’d love to hear from you.