7 Things I Wish I Knew Before Becoming an Occupational Therapist

Are you interested in becoming an occupational therapist?

After being an occupational therapist for over seven years now and having worked in multiple adult-based rehab settings, I want to share with you 7 things I really wish I knew before becoming an occupational therapist.

This list is not meant to scare you away from becoming an OT!

That being said, I do want to share some of the realities of occupational therapy for you to consider so you’re well prepared. These are based on my experiences working in the United States. So without further ado:

1. Being an occupational therapist can be stressful.

Occupational therapy is not always the “sunshine and rainbows” that you read about in the countless news articles touting its frequent rating in the top 10 happiest and least stressful jobs.

Almost every occupational therapy setting has productivity requirements, with some settings having less strict standards than others. So while you do get to provide meaningful treatments and help people achieve their goals, you will likely have to deal with the struggle of meeting your productivity on a daily basis.

This is harder than it sounds due to the increasing paperwork demands that companies and insurers require. Because of this, any time that you aren’t treating patients (or even when you are treating) you’re doing a lot of paperwork.

Unrealistic productivity demands and some unethical companies and managers can be the biggest factors for burnout, so after graduation, I advise you to do your due diligence with the job you’re interviewing for on these factors before you accept the offer.

2. Becoming an occupational therapist is expensive.


If you’re going for the OTR (Master’s or Doctorate) route, you can expect to pay anywhere from $40,000 to well over $100,000 for your degree.

Less expensive state schools are harder to get into, so you may have to choose a private school and pay an average of $80,000+ for your Master’s degree, and over $100,000 for your Doctorate.

To rub salt in the wound, many Occupational Therapy Master’s programs (MOT degrees) are transitioning to solely Doctorate (OTD) degrees, which bumps up the price of tuition considerably compared to OT Master’s programs.

If you’re thinking about becoming a Certified Occupational Therapist Assistant (COTA) you will pay much less in tuition as it is now an Associate’s degree, but keep in mind this may be transitioned to a Bachelor’s degree in the near future. This will also increase tuition considerably, without any foreseen comparable pay raises for either OTRs or COTAs with these pricier degrees.

While the Bureau of Labor Statistics states that the average salary for OTR’s is $85,570, the average for new grads is quite a bit less (tens of thousands of dollars less). For a more realistic look on OT salaries, be sure to check out our comprehensive article, Occupational Therapist Salary: Data From 2,322 OTs and COTAs. Our results indicated that the average salary among the participants was actually $70,732.

This is important to consider when your student loans from OT graduate programs alone might be well over $100,000, not including interest.

3. Some big cities are already saturated with OTs and COTAs.

Because more people are wanting to become occupational therapists and occupational therapy assistants, schools in bigger cities are creating more programs and pumping out more and more new grads every year.

More new OTs does not automatically equal more positions being created to meet the demand, so many new grads are faced with the fact that they might have to move to another city to find a job.

Fortunately, most rural parts of the country have a desperate need for occupational therapists. You can certainly find a position, whether permanent or travel, but you might have to make the choice to leave a bigger city.

If you’re wondering if your city is saturated, check Indeed.com regularly and see if new job postings are listed, in addition to seeing how many OT and OTA programs exist in the city.

4. Getting into occupational therapy school is HARD.


I can’t speak for occupational therapy assistant (OTA) programs. But as someone who has experienced the stresses of applying to OT school, I can tell you: Both Master’s and Doctorate programs are very competitive.

Cohorts typically have 20-40 students per program, and OT schools are getting 300-500+ applicants each cycle.

Because of this, your application has to be really strong to stand out among the massive number of applicants. Each program has different requirements, so when you’re applying, be sure you’re going above and beyond the basic requirements.

In addition, I recommend applying to as many schools as you can reasonably afford to (preferably at least 3 or more). This is will improve your odds of getting into a program.

5. After graduating, you might not get to work in your dream setting right away.

Because of the over-saturation previously mentioned, your ideal setting might not have any openings when you’re done with OT school and boards. I found this to be the case when I graduated, and ended up in a setting I wasn’t crazy about. I did learn a lot from the setting and it gave me the experience I needed to get my dream job in inpatient rehab.

If you’re open to other types of settings after graduation, this won’t be a huge downside. You might find your second or third choice is actually a great fit for you.

6. You are always explaining what you do as an OT.

Almost daily I’m rehearsing my OT elevator pitch, educating someone (patients, caregivers, doctors, nurses, even my own family!) what rehab occupational therapists do. No, we actually don’t work on getting people jobs. That’s vocational rehab!

I don’t mind educating the general population on what we do at all, but I imagine after doing this for your entire career it could get tiring.

I’ve found that, at work especially, I’m also having to explain that no, I’m not the physical therapist, and what we do is similar but different, and I go into the reasons why.

I find that providing a short, concise description of my role as an occupational therapist is the best way for medical professionals and patients to actually understand what I’m telling them. This quick PDF from AOTA is a great educational handout you can also give to patients and medical professionals when you’re in this predicament.

7. Many occupational therapy settings are physically demanding.


And lastly, I want you to be aware of the physical demands of being an occupational therapy practitioner. Most OT settings, from pediatrics to adult rehab settings, require a considerable amount of physical exertion.

With rehab-based occupational therapists and COTAs, a big focus with your patients is transfer training. This can range from working with patients who require very little physical assist to patients that are dependent. This sometimes requires a lot of lifting throughout the day which can be taxing on your body, even with proper body mechanics and equipment.

Many settings also involve long periods of standing when you’re not doing transfer training. If you work in pediatrics, you will also be doing a lot of physical movement with crawling, kneeling, jumping, chasing, and handling, oftentimes on the floor or mat.

If you don’t think you can handle the physical requirements that many OT settings demand but still are passionate about becoming an occupational therapist, you can look into outpatient settings like driving rehab, hand therapy, or working in mental health. These settings will typically have considerably less physical demands.


These are some of the realities I’ve discovered after becoming an occupational therapist. Would I personally change my career choice? Absolutely not!

Every career has its ups and downs. As an occupational therapy practitioner, you’re helping people achieve their goals and increase their independence and life satisfaction, which far outweighs the downsides.

I can’t imagine doing anything else. If you’re passionate about becoming an occupational therapist, you won’t regret it!

The job flexibility and variety of job options combined with knowing you are truly making a difference in peoples’ lives makes it a great career choice as long as you’re prepared and you know the potential drawbacks you might encounter.

For even more on the realities of being an occupational therapist, be sure to also check out these informative blog posts:

5 Things to Consider When Deciding on a Career in Occupational Therapy (Mama OT Blog)

Is Occupational Therapy Stressful? (My OT Spot)

Is Occupational Therapy a Good Career? (St. Catherine University)

This post was originally published on May 24, 2018 and updated on May 2, 2023.

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  • JF January 24, 2019   Reply →

    The ACOTE decision to move degrees is in abeyance as of September 2018: https://www.aota.org/Education-Careers/Accreditation/acote-doctoral-mandate-2027.aspx

  • Carolyn Boersma December 26, 2020   Reply →

    I just retired after 40 years as an OTR. I found myself agreeing with 100% of what you said. Add in
    A) You should expect to need to do Con Ed every year to keep your license and certification. Fewer and fewer settings are paying for this, so expect to pay for the courses. Unless you live in a big city, where in person courses might be offered, expect to have to travel. Or do a lot of on-line con Ed.

    B) Depending on your setting, you may be the only OT in the department. (Especially if you are in a small rural setting) so try to network with any other OTs in your area. Especially important if you are a new grad.

    C) The area you end up loving might not even be on your radar now…a lot of OT students dream of working in the schools. Or inpatient rehab. Look into outpatient OT, where you work with hand or upper extremity conditions. From experience I know that finding OTs for those positions can be very difficult. Ditto with home health. Mental health. Cast a wide net when you are looking for jobs. One of the joys of OT is that there are so many areas to work in. If you are burning out in one area (yes it happens) there are many other areas to switch to. Over 40 years I worked inpatient, rehab, outpatient hands, workplace health, nursing homes and home health.

    In my 40 years I never regretted my career choice. Loved every minute.


    • Sarah Stromsdorfer, OTR/L December 30, 2020   Reply →

      Thanks so much for adding this, Carolyn! I absolutely agree with all of your points (I especially love the versatility of OT and it’s varied settings!)

      • Julie June 21, 2022   Reply →

        Hello! This article has been incredibly helpful. Thank you so much! I am working through my BA at the age of 34. Looking to eventually get a Doctorate in OT and become a SI specialist. I love feeding therapy. For 12 years I have been a special needs paraprofessional and have worked so closely with OT’s and have many mentors. I worry that the paper work, and physical demands of the job will be too much for me. But I’m hoping to love every minute of my future career as well. Thank you all!

    • Yolanda K January 16, 2023   Reply →

      Hi Carolyn thank you your comment was helpful!

      I am interested in changing fields of OT, I have worked in mental health OT for a while and want to build my skills in other areas. Do you or Sarah have any tips on changing role with little to no experience in the fields?

      • Kale July 3, 2023   Reply →

        Hello! I was wondering how did you start working into the mental health OT field, and what kind of work do you do?

  • Ana March 30, 2021   Reply →

    Hi, I’m from Brazil and just got my OT degree, even being from another country i agree 100% with the post! Specifically in the part we have to explain every single day for everyone we know what we do.

    • Eric March 8, 2022   Reply →

      Hi Ana, Are you working in Brazil or the usa?

  • Mike July 27, 2021   Reply →

    All of this is very true! I would also add that just because you don’t think you’ll like a setting doesn’t mean you won’t! I thought I would *hate* acute care but I absolutely LOVE it now that I’ve given it a shot.

  • C April 30, 2022   Reply →

    Thank you for your contribution. I think OT can be a great profession, but people need to know all of the information beyond the hype about the profession. Being accepted into an OT program is hard and very competitive. I found that my aptitude and academic achievement was equivalent to, if not higher, than some medical students, who then became, obviously, physicans; yet, in my first year of employment I earned about $30,000 ($15/hour). while my physician medical resident peers complained about a $30,000. stipend for their residency work. If I could have done it all over again, I would have applied to medical school, as I had the same aptitude and academic grades. Unless you absolutely love OT and would choose it over being a M.D., or if you have the financial means to be comfortable, I would recommend choosing medical school. The disparity in financial compensation is just awful, honestly. Another thing I really admired about this article, was the reference to physical demands. The profession can be very physically demanding, which I did not know upon my entrance into school. Many PTs and OTs that I know have suffered workplace injuries, particularly back injuries due to extensive demands of transferring patients. When I learned this, I quickly transitioned to positions where transferring adult patients was not a requirement. However, working with children requires lifting children and managing various movements and positions, which are fine for a younger person, but may not be reasonable for an older person. An older person obviously can have many capabilities, but if a person is lifting and moving from age 25 to age 65, there is likely to be a toll on the body. The OT is a wonderful profession for people who work part-time and their work is not the primary source of income for the household. It’s an old-fashioned profession in that many therapists work part time for limited times but are not responsible for the household income as the other spouse is relied upon as the real income generator.

  • Becky Bowers August 7, 2022   Reply →

    I agree with what you said above, but I’d also like to add that pay cuts and no raises for several years have been rampant in our profession due to Medicare cut backs. Also, if you work in long term care care, there is significant pressure to be at a productivity rate that is often unattainable if you are really practicing ethically. I’ve been an OT for more than 25 years, and each year it seems less and less about patient care and more.about money. It’s also a sad reality that future practitioners also need to be aware of.

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