What are the Pros and Cons of Being a COTA?

After searching and investigating professions, you settle on the wonderful field of Occupational Therapy. You’ve seen how much good can truly be accomplished through the occupational therapy process. As you’re looking, you no doubt automatically gravitate towards working in one specific setting or another.

Maybe you received occupational therapy when you were a child and now want to pay that forward by working in a school. Or perhaps you had a loved one recover from a stroke or some other condition so now you want to help others in a similar way.

Before you even begin trying to decide where you want to work, you need to decide whether you want  to become an occupational therapist or a certified occupational therapy assistant (COTA for short).

There are a number of basic differences between the two outlined here, but we thought it would be great to share the experiences of an actual COTA. Being a COTA myself, I am laying out my list of all the pros and cons in this post in hopes it will help you decide if you want to go the COTA route.

Pro: COTAs Have Less Education Requirements

A COTA only has to have an associate’s degree in occupational therapy, while an OT has to hold at least a master’s degree or doctorate. Initially, it might look like an OT is better prepared to handle direct patient treatment than a COTA. They have more education, after all.

However, both levels of education focus on the same amount on patient treatment. On top of that, an OT will also learn techniques for evaluation, billing practices, supervision, and the theory that makes occupational therapy work.

When it comes to creating effective treatment plans, COTAs are just as capable in implementing beneficial treatments. The majority of the time, hands-on experience is even more valuable than classroom education.

Many times, new graduate occupational therapists may ask the seasoned occupational therapy assistants in their department for advice on specific cases or difficult patients.

Con: COTAs Earn Less Money

Of course, we all most likely started working in occupational therapy to help others. But one fact that needs to be considered is money. Obviously, a registered occupational therapist (OTR) holding a master’s or doctorate degree is going to earn more per hour than an occupational therapy assistant with an associate’s degree.

OTRs earn about $41/hr across the country according to BLS data for 2018 median income. A COTA earns around $28/hr according to BLS 2018 median income data. Just looking at that, it may seem like working as an OTR is the best choice for making money.

That isn’t necessarily the case. When considering how much money you can earn working in occupational therapy, you also have to consider the initial investment of the education.

Not only does a master’s or doctorate degree cost significantly more, but it takes an additional few years to earn it before you enter the workforce. This is a factor that has to be considered.

Pro or Con (Depending on How You Look at it): Less Responsibility

If you decide to work as a COTA, there is certain amount of autonomy and responsibility that you lose. For example, you cannot simply begin working without an OT (in some states and rare cases, a COTA can work directly under the supervision of a doctor).

This means that a COTA will have to yield to the OT’s final decision making when it comes to treatment plans, discharge processes, and evaluation outcomes. However, there is also a benefit. If a patient’s treatment somehow causes harm (although unlikely), it is the role of the supervising occupational therapist to accept responsibility and make amends however necessary.

Of course, a COTA is not completely without blame. Still, the majority of the responsibility of handling this will fall to the supervising occupational therapist.

Con: There May Be Less Career Advancement 

There are many articles out there that recommend becoming a COTA for those who are thinking about becoming an OT, and then simply transitioning. Although this is an option, it isn’t typically one that is followed. Once you begin working in the field of occupational therapy, you most likely are going to stay working in that position.

Where advancement is typically seen is within the therapy department of the facility in which you work. An occupational therapist can become a director of rehab or program manager, and honestly make some of the best DORs.

OTs understand the challenges faced by physical therapy as well as speech therapy, making an excellent middleman. In most companies and states, a certified occupational therapy assistant can also work in this position. A COTA can even own their own practice.

The most important thing to remember for a COTA working in a management position is not blurring the line between managing the operations of a facility and dictating the outcomes of evaluations or other decisions.

Additionally, both OTRs and COTAs can go on to become administrators, liaisons, and hold other positions within companies and facilities. However, it may be more difficult for a COTA to get into certain management positions if a bachelor’s or graduate OT degree is required.

Pro: More Patient Interaction

We all enter the field with the intention of helping as many people as possible through our direct interactions. All too often, occupational therapists come out of school and are eager to work with people, only to find that a majority of their time is spent handling paperwork, helping plan discharges, and doing other administrative things.

An OT may only treat their patient for the evaluation, progress note updates, and discharge. Meanwhile, the COTA is the one handling the routine treatments day in and day out. On the other hand, it can be frustrating as a COTA in dealing with patient interactions. When a client or family member asks a question, having to run every answer through your OT supervisor can be difficult.

It is only reasonable for the patient or family to want to know details about progress and discharge. The OT will make the final decision for the OT department, but the treating COTA most likely knows the case of the patient and details better since they may work with the patient more regularly.

Con: There May Be Fewer Job Options 

While being a COTA is a very rewarding job, there has been an increased difficulty for COTAs in many cities to find jobs right out of school. This is also the case for even seasoned COTAs in some cities and job markets.

This is due to a variety of factors, including (but not limited to) living in areas with too many OT and COTA programs, fewer settings hiring COTAs (due to needing evaluating therapists), upcoming Medicare changes, and so on. It is overall easier in general for occupational therapists to get hired on for a position compared to their COTA counterparts due to the OT being able to do all of paperwork components (evaluations, progress notes, and discharges). 

The job market is definitely something to consider when making the decision to become a COTA vs. an occupational therapist. Be sure to do some solid research beforehand on your city’s job market if you plan on staying there after you graduate.

Communication Between OTs and COTAs is Crucial

Regardless of whether you work as an OT or COTA, good communication will be required. As we can clearly see, an occupational therapy assistant is an important part of the rehab team.

Without them, occupational therapy services may just be out of reach for many clients. In many settings, the OT and COTA will have to work closely as a team. When this is done properly, it can make for an effective and productive therapy environment and an enjoyable workplace.

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Are you a practicing certified occupational therapy assistant? If so, do you have any other thoughts about the pros and cons of working as a COTA? What other pros and cons would you add? If you had it to do over again, would you do things differently?