Hi! Im working on AOTA applications, I was wondering if you have any tips or advice or anything you wish someone had said to you before entering the field?
I kinda went overboard on answering your question because I wanted to provide an honest overview of the degree requirements, training, opportunities, as well as the stuff I wish people had told me. I’d be happy to answer further questions or clarify anything.
OT Schools and Areas of Practice
Currently, COTAs are required to complete an associate degree. OTs are currently required to complete a master’s degree. The mandate to increase in entry level degrees has not yet gone through (originally anticipated for 2027), but it’s expected that at some point COTAs will need a bachelor’s and OTs a doctorate for entry-level practice. Anyone completing their COTA or OT degree now is likely to be grandfathered in, just as other OTs were before when OT when from bachelor’s to Masters. I have taken ODT level classes and, while they were fantastic, I don’t think the additional debt is worth it for an entry-level generalist practitioner.
An OTD is a “professional” doctorate. It’s possible to get a PhD in OT, but that’s the research branch. It’s also possible to get a dual masters in public health or another specialty, depends on what the school offers, but it’ll be a heavier course load and/or take longer to complete both degrees.
Each OT school has a slightly different approach or philosophy on OT. For example, some continue to incorporate the older mental health aspects, while others are more focused on bio-medical aspects of rehab. I recommend looking for a school whose approach and course structure best matches your interests and feels like a good fit.
Attend the open houses (whether virtual or in-person with PPE) and make yourself known. Applying to OT school can be quite competitive. I’m not sure at all what the schools are doing about the volunteer hours requirements due to COVID, but if they’re still asking for volunteer hours then do more than the minimum.
I’ve had talented students from “weak” schools and I’ve had incompetent students from “strong” schools. Mostly you get out of school what you put into it. However, if you’re able to go to a higher ranked school you will typically encounter more ambitious peers and may be taught by leaders in the field.
You will most likely be trained as a generalist across the lifespan (pediatrics to geriatrics). There will be A LOT more theory and less hands-on training than anyone would think. While theory is very important for OT, more so than PT or SLP, I think the heavy theoretical work an antiquated approach and training/education in occupational therapy needs serious modernization.
There are many specializations within the field, and if you know what area you want to work in then you’ll be able to direct your professional development towards that. However, if you don’t know yet or change your mind you’ll have opportunities to explore the many areas that OTs work in.
Diagnostically, rehab specializations can include oncology, burns, stroke and traumatic brain injury.
OTs also work in Ergonomics and durable medical equipment sales – it’s worth searching for non-clinical therapy jobs.
While new grads can train towards the following specializations, addition post-grad experience, training, and/or certification is required for practice: NICU, Early Intervention (pediatrics), Seating and mobility (wheelchairs), Certified Hand Therapy (CHT), Vocational/Work Hardening, Aging in Place (home modifications), Driver Rehabilitation.
The mental health jobs in OT are harder to find, but OTs also work in behavioral health and psych units for life skills. PTs and Recreational Therapists are more prevalent in adaptive sports programs.
Understanding Occupational Therapy
Make sure you have a solid grasp on what occupational therapy is and whether it’s the area of rehabilitation you want to go into. Other rehab fields include Physical Therapy, Speech Language Pathology, Recreational Therapy, Music Therapy, and Art Therapy.
Occupational Therapy is not “upper body physical therapy”. I tell clients OT is the “taking care of yourself therapy” for activities of daily living. At its most essential, occupational therapy addresses the interactions between person-task-environment and how those interactions influence client performance.
In addressing difficulties with activities of daily living it’s essential to be able to identify the underlying performance factors impacting their function. Example: the client cannot get up/down from their toilet due to seat height. An OT will make a plan with the client to work on the client’s strength/balance with sitting to standing, adding equipment like a raised toilet seat to compensate, train a caregiver on how to assist the client on toilet transfers, or any combination of the 3.
There’s a professional document called the “The Occupational Therapy Practice Framework”, which is now on its 4th edition The previous 3rd edition should be available free online, I believe copies of the 4th Ed. are still paywalled at the moment. It’s worth looking at because it gives an overview of the profession and how OTs analyze client factors and performance skills
Things I wish people had told me before entering the field
Do the OT advocacy day in Washington DC if you can. I really enjoyed meeting my representative (also good for the resume). Join the student organizations and go to the AOTA Conference if you can – lots of presentations and learning opportunities.
Your career may plateau quickly. Most of the jobs postings will be for schools, skilled-nursing, home-care, hospitals, and some out-patient. Also, a lot of the jobs I’m seeing lately are Per-diem. It may take a while to find a full-time position with a set schedule when you first graduate. A lot of therapists work at least two jobs if part-time/per-diem and many still work two jobs even if they have a full-time position. Management roles can be limited and competitive.
In a lot of areas OTs are harder to find than PTs, however, in some areas the market is saturated with OTs. You may be lucky with recruiters, but they’ll also try to low ball you. Look up the local salary ranges and talk to as many people as you feel comfortable about typical salaries and pay rates in your area so you can negotiate. If you’re working 1099 you need to pay taxes quarterly and a whole bunch of other stuff, some therapists working 1099 set-up LLCs for managing their income and business expenses.
Work in this field is largely a young person’s game. While it varies a bit by practice area, you need to be prepared for the physical labor involved and also need to have a plan for aging in this field. Hospitals and Skilled Nursing are a lot of heavy lifting. Out-patient and home-care can be, but not as much as hospitals and skilled nursing. Pediatrics can be very physical, especially in a sensory gym or if you’re running groups in a school. If you get injured there may not be a “light duty” option - and therapists do get injured.
Protect your back from day one. Medical staff get injured. Learn the body mechanics for transfers, don’t be a hero, and protect your back.
Do not work home-care as a new graduate. You need to be able to be very independent in your ability to practice, so home-care jobs are better for experienced therapists. If a home-care agency is willing to hire you as a new grad take it as interview practice and ask a million questions about their ability to support you in the field. Any home-care agency looking for new grads is either desperate or has an absolute unicorn of an employee training model.
I think the training approach for occupational therapy is antiquated and the field needs to modernize its approach to practice across all levels of care. I think it’s important that patients can choose a therapist who has specialized in stroke or cardiac or Parkinson’s rehab (etc) instead of being assigned to whoever is on the schedule that day.
Take an NDT course that requires hands-on practice of the mobilization skills. I learned a lot more than I expected from taking just such an NDT course a few years after I graduated. It changed so much of my practice. If I had that course in conjunction with the kinesiology course and Bobath chapter it would have been the perfect marriage of theory and practice and I would have had skills I now consider essential much sooner.
Insurance is a fucking nightmare and the US healthcare system is structurally psychotic. You will have more paperwork than you can possibly imagine and enough bullshit to make the entire Sahara fertile for farming ten times over. Learning the policies, procedures, and expectations of your area of practice takes time and effort, and once you know it well everything will be updated to new standards.
Be very careful about student loans and have a plan in place for payments after graduating. The interest accrues in school and capitalizes (basically adds on to your original loan and becomes part of the principle) when you start paying them back. Scholarships are hard to come by, but there may still be incentive programs that will pay for some or all of school in return for working in a specific part of the field for a certain number of years. The student loan payments may be with you for 10-25 years. You need to make a plan, and you need to be realistic about your ability to pay both for the loan and for living expenses. Additionally, there are many for-profit entities in healthcare and so if you’re on a loan forgiveness program that requires you to work for a non-profit you may find your options more limited. You will be paying back far more money than you think and I strongly suggest running the loans numbers through debt repayment calculators to see exactly how much that degree is really going to cost.
Burn out in healthcare is very real, and in OT in particular due to the dual physical and emotional labor requirements. Take care of yourself early, pace yourself, and look for support.
