Should You Transition From COTA to OTR

Should You Transition From COTA to OTR? The Pros and Cons of Making The Leap

Are you thinking about making the transition from COTA to OTR? You’re definitely not alone!

One of the most common questions I see in Occupational Therapy Facebook groups and OT forums is something along the lines of:

“Should I put in all the time and money to go to grad school to become an OTR if I am currently a COTA?”

Seeing this so frequently, I wanted to compile the most common responses and things to think about for those of you who have this big question on your mind.

Like with most major life decisions, there are pros and cons to weigh.

The pros and cons in this post come from in-person conversations as well as many online discussions from COTAs exploring the prospect, COTAs that have transitioned to OTRs, and from COTAS who have decided against becoming an OTR.

The Pros of Transitioning from COTA to OTR

+ An Increase in Pay

According to the Bureau of Labor Statistics (BLS), a COTA’s national average pay is $61,730 per year. By comparison, Master’s or Doctorate level Occupational Therapists (OTRs) earn an average of $85,570 per year (or $41.14 per hour) based on the median salary. Therefore, an OTR’s salary is roughly 43% higher on average.

Of course, the amount you earn as a COTA or OTR can be higher or lower based on your location, experience, and setting

For additional occupational therapist salary information based on actual data from both OTs and COTAs, be sure to also check out our article, Occupational Therapist Salary: Data From 2,322 OTs and COTAs.

+ An Increase in Job Opportunities

Many facilities such as hospitals, outpatient clinics, and schools are hiring fewer COTAs or no COTAs at all in some cases. In some cities, it can be increasingly challenging to find a clinical job as a COTA, and many have stated this is the reason for going back to school to become an OTR.

+ Greater Autonomy and Independence

As an OTR, you are in control of your patient’s plan of care, treatment planning, discharge planning, etc. As a COTA, you are following the OTR’s treatment plan and you may not have a lot of creative treatment options based on the OTR’s goals for the patient.

+ You Will Be Furthering Your Education

This one may seem like a given, but many COTAs that have made the transition to OTR stated they felt like they really expanded their knowledge of OT by going through an OT graduate program. If you’re passionate about healthcare and helping patients through their therapy journey, you may find that your enthusiasm for the field is what motivates you to pursue a graduate OT degree.

+ You Will Have More Non-Clinical Opportunities

One popular non-clinical opportunity is teaching. Many OT schools will hire OTR’s with a Master’s or Doctorate to become educators.

One other common example is that it’s typically much easier to start your own therapy practice as an OTR. This would be much more difficult as a COTA if it is related to occupational therapy, as you will likely have to have an OTR on staff. 

These other popular non-clinical positions may hire COTAs but are often more likely to hire an occupational therapist with a Bachelor’s degree or higher depending on the specific job requirements.

Note: I’m now seeing so many creative COTAs start their own non-clinical businesses that don’t involve direct patient care, so having a non-clinical career is still very possible as a COTA!

The Cons of Transitioning from COTA to OTR

While there are fewer cons than there are pros, these big drawbacks are often enough for many COTAs to decide against going back to school to become an OTR.

– The Huge Expense

While OTRs have a higher salary than COTA’s, the cost of getting a Master’s or Doctorate in OT is very expensive. Many COTAs who only plan on working ten to twenty more years state they would have difficulty being able to pay the debt off by retirement.

– It Will Probably Take A Long Time To Break Even

Using the national averages for salary and the average cost of a weekend Master’s program, it will take a minimum of 7.5 years to pay off your OTR degree assuming all of your additional income goes to pay down your OTR degree.

Looking at this more closely, we took a top weekend OTA to OTR Master’s program that consists of six semesters that cost $14,760 each, with the program in total costing $88,560

Using those numbers, we found that the additional income you’d make using the difference between the national averages for COTA vs. OTR is $25,750 per year (or about $18,025 after taking out 30% for taxes). The table below illustrates how much will be added to your balance at the beginning of each year in interest (8% annually) and how much it will go down from paying off $18,205 per year.

Using numbers 

Years After Graduating Beginning Balance  Add 8% Loan Interest Pay Down $18,205
(Difference OTR vs. COTA Avg. Salary)
1 $88,560 $95,645 $77,440
2 $77,440 $83,635 $65,430
3 $65,430 $70,664 $52,459
4 $52,459 $56,656 $38,451
5 $38,451 $41,527 $23,322
6 $23,322 $25,188 $6,983
7 $6,983 $7,542 $0

If you put all of the additional $18,205 of income towards paying off your student loans, it would take you a minimum 6.5 years to pay off the OTR degree (including 8% annual interest over that time period).

Including the time spent applying to school and interviewing, the six semesters in the program (2 years), and the time to repay your loans, your total time investment is about 10 years to complete an OT Master’s program and pay the loans off.

That said, this example shows the fastest possible timeline and may not be realistic for most people. You are most likely wanting to earn more money to pay for regular living expenses and other things within the next 10 years. This calculation is mainly to illustrate the best-case scenario break-even point.

More typical student loan terms are anywhere from 10-20 years. Your monthly payments will be lower than in the case of accelerated payoff, but of course you’ll be paying more for the program over time in interest.

Note: This is a simplistic example to determine the break-even point and does not represent actual interest accumulation or an actual payoff schedule. The tuition rates and interest may also be higher now in 2023 vs when we first created this chart in 2020.

– Even Bridge Programs Have Some Drawbacks

If you’ve decided to take the plunge into becoming an OTR, you are likely aware of the several COTA to OTR “bridge” programs. But you can also choose to attend a traditional Master’s or Doctorate Occupational Therapy program if you already have a Bachelor’s degree. The cost breakdown for a bridge program and a traditional Master’s or Doctorate program may help with your decision.

Because there are only a few weekend bridge programs, traveling or moving closer to the location of the OT program is usually required. Many programs require at least monthly visits to the school, which can be challenging for those with families.

Additionally, just like traditional OTR programs, getting into a bridge program even with years of experience can be a challenge due to the high number of applicants.

– Finally…the BIG Increase in Paperwork

This is a huge reason why many COTAs decide that becoming an OTR is not for them. As an OTR, a lot more of your time every day will be spent doing paperwork; this means writing evaluations, weekly progress notes, and discharges along with the usual treatment notes.

While OTRs still do treatments, these can be less frequent due to having many evaluations and discharges along with the added paperwork requirements.


In the end, you should of course do what’s right for your situation. Everyone’s personal circumstances will vary. Both careers are great choices, and there’s no clear-cut right or wrong answer.

I will say that I love being an OT and I am glad I chose my OTR degree. If you are passionate about working in occupational therapy I would say you should go for it, whether it’s as a COTA or OTR. If you’re unsure if occupational therapy is right for you and the economics are a primary concern, choosing between becoming a COTA or OTR may be a tougher decision requiring more careful thought.

If you’re already a COTA contemplating this decision, or you have already made the jump, I’d love to hear your thoughts in the comments below. What were your biggest deciding factors for or against becoming an OTR?

And if you’re looking for even more information on making the transition from COTA to OTR, be sure to listen to the accompanying podcast on this topic from Seniors Flourish here: Pros and Cons of Transitioning from COTA to OTR.


Occupational Employment and Wages: Occupational Therapy Assistants (Bureau of Labor Statistics)

Occupational Therapist Salary Info (Bureau of Labor Statistics)

This post was last updated on March 4, 2023.

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  • I'Nico February 10, 2017   Reply →

    This was spot on! I chose to attend school again for all the pros except teaching. I am in my first year of my OT program. I agree, if an individual finds that this is a thought that continuously reappears then maybe they should consider. I am still VERY excited about being in the program and about finishing it. I personally have considered the cons but as it was stated they seem worth the hassle, in my opinion. Great blog post! Loved it!

  • Ann February 10, 2017   Reply →

    Funny, I just received my acceptance letter today! I have been a COTA for 9 years and I feel that there is so much more to learn about OT! I feel that each individual has to weigh their own pros and cons as each has their own situation and factors to consider. It does help if you already obtained your BA degree! Best of luck to all those making the transition. Your blog was right on the money as far as what to consider when making the plunge! 🙂

  • Jeanine July 27, 2018   Reply →

    I was a COTA for 12 years and went back for my OTR because I wanted to be the one to make the decisions. While in Graduate school, I had 3 children and worked full-time as a COTA, this was the hardest thing I have ever done. I am finding that the pay does not differ much from a high paid COTA (which I was) to an entry level OTR but an OTR has the opportunity to excel higher with time (this is in the civil service school based system). I have also taken advantage of PSLF (Public service loan forgiveness) which will pay approx. 2/3 of my student loans because I work in a low income school district. This is a major savings. I love the empowerment of being in charge of my lesson plans and the increased knowledge I have acquired during school. I have learned where to find ALL the answers and also when to admit I don’t have ALL the answers…but that I will try to find them. I love OT and the MANY friends and colleagues I have come to know over the years.

    • Sarah Stromsdorfer, OTR/L July 27, 2018   Reply →

      Thanks so much for your input on your experience, Jeanine!

  • Lisa August 19, 2018   Reply →

    I’m going into my third year of a bridge/transition program to obtain my Master’s degree. I live in a very rural area and I have found that the need for OTRs is much greater than the need for COTAs. We are saturated with assistants because we have many technical colleges that offer the OTA program. This was one large deciding factor for me. Another factor was that I found i was already practicing much of the clinical judgement and decision making that reflects an OTRs thought process. A third factor for me was that I didn’t like being limited. As a COTA I am limited in my scope of practice, where I could work and ultimately how I could serve my clients. As an OTR I feel I will have more say and limitless ability to help my clients.


    • Sarah Stromsdorfer, OTR/L August 19, 2018   Reply →

      Thanks so much for sharing, Lisa! I would agree that obtaining your OTR will really open up more opportunities for you and give you more freedom with decision-making and your practice. Best of luck with the rest of your program!

  • Rebekah December 3, 2018   Reply →

    I am contemplating going for my OTR degree through the bridge Program. Your Pros and Cons article was so helpful and so were the comments. I have been a COTA for 6 yrs and feel very limited in my scope of practice. My situation. Is very similar to Lisa’s (above comment) as far as so much more of a need for OTRs vs. COTAs. This is due to the saturation of technical schools in my area and the output of OTAs, there is less of a demand vs. supply. I want to also further my education as Occupational Therapy offers so many avenues as well as looking to get my Hippotherapy Certification too. Thank you as all the pros and Cons were right on!

    • Sarah Stromsdorfer, OTR/L December 4, 2018   Reply →

      Thanks, Rebekah! I’m so glad the article was helpful for you. I think you’ll definitely be satisfied with the increase in job opportunities once you get your OTR degree 🙂

  • Kat April 7, 2019   Reply →

    I have been a COTA for 18 years. This was a second career for me. I have a B.A. degree and an A.S. degree. Unfortunately I cannot afford cost of OTR program. I feel we do a lot as COTA’s but don’t get the respect. I do feel frustrated with this at times. I think a job title change would help but this has been voted down in the past and ufortuntely mainly by OTRs.

    • Brianna Valerie Valenzuela June 17, 2019   Reply →

      Hello my name is Brianna Im doing a project for one of my college classes and i need to interview an OTA if anyone is free please let me know .

      • Naj June 19, 2019   Reply →

        I am free if you are still interested.

        • Brianna valenzuela June 20, 2019   Reply →

          Thank you so much can I email you my questions? My email is

        • Brianna Valerie Valenzuela June 21, 2019   Reply →

          i’ll just post them here
          What is a typical day like at your job?
          – What training/education do I need to get a job in this field?
          – What do you like most about your job?
          – What do you like least about your job?
          – what made you want to become a OTA?
          – any advice before i start studying to become a OTA?

    • Bana December 6, 2021   Reply →

      As a COTA, I completely agree. Unfortunately more than once I have felt disrespected/overlooked by OTRs simply due to the word “Assistant”, as if we are a personal assistant for our OTs and not our clients or the profession as a whole. I love being a COTA, I love OT, but after 3 years, I’m deeply considering a bridge program so that I can grow past this phenomenon in our field and gain autonomy/further my knowledge base. This article is so perfect! I

  • Lorena Kazmierski July 4, 2019   Reply →

    Thanks for this. I finished OTA school 2 years ago (career change), and have a great job in pediatrics. I’m very lucky to have this position as a COTA. Not only would there be job security and more room for growth if I got my masters degree to be an OTR, I’d love to expand my knowledge. Major downside: at 50 years old, I simply cannot see myself taking on that debt, and the organization I work for provides very little tuition reimbursement. If I were 10 years younger, I wouldn’t hesitate. It’s a shame that further education is so out of reach for so many simply due to the expense.

    • Gail Enriquez August 28, 2019   Reply →

      I also graduated 2 years ago to be a COTA (also a career change) and working in peds has been my passion. I found a job right out of school and was laid off by the same clinic, not once but twice, because of Tricare rules not reimbursing for services provided by COTAs. Ever since then, I have had a really hard time finding a job in peds. I have not had steady work since I graduated. And as much as I love working with kids is how much I dislike working with adults lol. Right now, working at a SNF or hospital seems to be my only option and I am afraid that I’ll end up burning out and not wanting to work in the field at all. I know there’s no guarantee that I’ll get a peds position if/when I got out of school to be an OTR, but it looks like there are a lot more opportunities in peds for OTRs than COTAs in my area, at least right now. I live in San DIego and COTAs can’t even do early intervention and some clinics won’t hire COTAs at all. I am considering doing a bridge program, but I am 40 years old, married with 3 kids. My youngest will be in kindergarten next year. The bridge program I was looking at is in another state and would require me to fly out every 3 weeks, but I don’t need a bachelors, which I don’t have. There is a school close by that offers a flex MOT program, but it is $80,000+ and I would still need my bachelors. I would be looking at around 5 years total in schooling, not to mention the monetary expense. I am just worried that insurance rules change all the time and COTAs could be phased out in the future. A friend of mine working in SNF said there was an insurance rule that changed recently, which caused patients to stay in SNFs for a shorter amount of time and therefore cut back on the need for PRN COTAs so she’s not getting much work either. Sorry for the long post. I have had a lot of this on my mind lately since I haven’t been able to find work and have been rejected for “lack of experience”. There is so much to consider!

  • Zach Gordon September 23, 2019   Reply →

    Can use some opinions. I have a bachelors and am a COTA that has been working for almost 3 years.
    With the recent insurance changes many of my friends have been laid off and I think i will be soon.
    Considering going back to school but not sure if i should do OT or DOT . cant really find info if i am
    able to do either or if i must do OT first and then the doctor program. i have no patience to do both
    and frankly not a great student , so what is my best option and best bang for buck.

    Any recommended schools would also be welcome as we dont seem to have a good clearinghouse for unbiased

    Thanks again

    • Sarah Stromsdorfer, OTR/L September 23, 2019   Reply →

      Hi Zach, you can certainly look into the Master’s programs as they are still a low(er) cost option than the doctorate. You will not have to get the doctorate after unless you choose to. You can check out AOTA’s list of Master’s-level OT programs here to compare costs, pre-reqs, etc. here: AOTA’s list of accredited MOT Degrees

  • Evelyn October 12, 2019   Reply →

    I am a COTA in NY that has been in practice for 21 years. I was always planning to transition to OTR at a local bridge program. Unfortunately an injury that my husband sustained 18 years ago eventually made me the primary breadwinner. I went on to become a partner with an OTR in a small private clinic. Recently I have been able to finally return to school. I have step aside as a partner in the clinic just treating patients so that I have the time to return to school for my MOT. I am grateful that I will be able to do this without going into debt. However, with all that is going on with changes in reimbursement I am concerned about spending the money for the degree instead of keeping it in savings. On the other hand if the clinic I work in closes as the otr is close to consideration retirement I will not have as many opportunities as a COTA. I am one trimester into the program. I am 56 years old so a career change is out of the question. And I absolutely love what I do. Should I continue?

    • Sarah Stromsdorfer, OTR/L October 15, 2019   Reply →

      I would definitely talk to a financial planner about the tuition costs versus your savings to see if it’s a good idea financially. If you can swing it cost-wise, you will have more job opportunities being an OTR but again, I would still see if it makes financial sense. I currently work in the hospital settings (acute care and inpatient rehab) and as of now, hospitals nationwide aren’t affected by the Medicare changes and still have many openings from acute care to outpatient for OTRs. If you have any other questions about OTR hospital positions please feel free to email me at I wish you the best with whichever path you choose!

      • Cammy July 4, 2020   Reply →

        I have been a COTA for 3 years, initially starting at a SNF and this year have transitioned to Home Health ( which I absolutely love). I had talked with my supervising OTR (at the SNF) about the pros/cons of going through the bridge program and becoming an OT, she said that was what she had done years ago. However, she said that with all of the politics, increased paperwork, she would much rather be a COTA because she enjoys “working with people not the computer” as she put it. Granted this may not be the case with all facilities or fields, and while the pay increase would be very helpful, for me personally I enjoy being a COTA.

        • Sarah Stromsdorfer, OTR/L July 6, 2020   Reply →

          Thanks for sharing your insight, Cammy! It’s definitely a big decision to consider so it’s really helpful hearing peoples’ perspectives.

  • Shena December 23, 2020   Reply →

    Could you help because I’m confused.
    I have a bachelor’s degree in Occupational Therapy(studied abroad) and would want to work as an Occupational Therapist Assistant, would that be possible? Can I apply for the certification? because I was planning to work as a COTA to earn money for my Master’s degree.
    Thank you.

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

      I’m pretty certain that to take the COTA NBCOT boards, you’d have to graduate from a COTA program. I would definitely reach out to NBCOT and state OT license boards for clarification and to see what options you have with your international OT degree. Good luck!

  • Michael January 5, 2021   Reply →

    Greetings Everyone!

    I am a COTA with almost 5 years of experience currently about to go on fieldwork with the MSOT Bridge Program. I have been through so many struggles such as having to travel from a different state to finding a work/life balance and the struggle has been present every step of the way in doing this transition; however, I have to remind myself that these sacrifices are for my greater future and I have been more than ready to make this transition into my masters and am looking forward to greater autonomy in my practice as an OTR. I know many who are happy in their practice as a COTA, but previous experiences have taught me that many folks have not been as fortunate as myself. The decision is up to the individual and whether they are willing to do whatever is necessary to move forward professionally. Everyday is a choice to keep going and I have gained a cohort of like minded individuals, who have been there since the beginning with me.

    I guarantee whichever route you go, your future self will thank you for your sacrifice and dedication!

    • Sarah Stromsdorfer, OTR/L January 6, 2021   Reply →

      Thank you SO much for sharing your insight, Michael!

  • Matthew Coppola January 10, 2021   Reply →

    Hello all , my name is Matthew. I’ve been a PTA for about a year and a half all in skilled nursing which I love. If I were to bridge , I would go from PTA -MOT due to my own personal desires. Most of these bridge programs discuss OtA-OT transition and don’t seem to mention PTA so I wonder how common it is, as well as if they accept PTA’s. Anyways always interesting to hear other people’s experiences. Best wishes everyone

  • Morgan Grisham June 3, 2021   Reply →

    I know a woman who was a PTA and attended Belmont University in Nashville TN Through their bridge program to OTR. As a PTA I think you have to get some shadowing hours of OT but yes it is possible!

  • Valerie March 5, 2023   Reply →

    I am currently 22 years old and stuck on deciding if it worth bridging over but being in debt scares me and the options of limited school near me (I would more than likely move out of state). I just want to know if it is worth it. Is there any regret being an OT? I graduated from OTA school last year in May and currently will finish my year experience required for most bridge programs, but I am just contemplating if it is worth it.

  • Rachel W. September 7, 2023   Reply →

    I have been a COTA for 5 1/2 years. I currently work school based in California. I am well paid at $39.45 hr. Our OTR’s start, even as a new grad, at $131,000 per year. That being said, I really wanna do a bridge program, but I don’t have a bachelor’s. I just don’t know what decision to make. Side note, I am 48.

    • Sarah Stromsdorfer, OTR/L November 2, 2023   Reply →

      Hi Rachel, sorry for the delay in responding! I think if it makes sense for you financially, it’s never too late to go back to school. I actually have an article that covers OTA to OTR bridge programs with no Bachelor’s needed here, so be sure to check that out if you haven’t already. Wishing you the best in whatever decision you make!

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