pros and cons of being a COTA

What are the Pros and Cons of Being a COTA?

After searching and investigating professions, perhaps you’ve settled 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 OT 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’ve had a loved one recover from a stroke or some other challenging medical condition with occupational therapy 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/OTA for short).

There are a number of basic differences between the two outlined in our companion article here, but we thought it would be great to share the experiences of an actual COTA as well. 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.

COTA pros and cons education

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

When it comes to creating effective treatment plans, COTAs are just as capable in implementing beneficial treatments for all patients regardless of age or setting. 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 $46/hr across the country according to BLS data for 2023 median income. A COTA earns around $31/hr according to BLS 2023 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 (here are the current averages of OT school cost), but it also will take you 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 vs an OTR, there is certain amount of autonomy and responsibility that you lose. For example, you cannot simply begin working without an OT supervising you (in some states and rare cases, a COTA can work directly under the supervision of a doctor).

COTA pros and cons supervision

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 to become an OT. Although this is an option, it isn’t typically one that is followed, at least not right away. 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.

Occupational therapists understand the challenges faced by physical therapy as well as speech therapy, making them an excellent middleman. In most companies and states, a certified occupational therapy assistant can also work in this position. A COTA can even start 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, clinical 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.

COTA pros and cons hands on

An OT may only treat their patient for the evaluation, progress note updates, and the 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 (which saturate the area), fewer settings hiring COTAs (due to needing evaluating therapists), 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/OTR. 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

COTA communication

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.


Are you a practicing certified occupational therapy assistant yourself? 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 to prospective COTAs?

If you had to do things over again, would you do things differently? Please share your thoughts in the comments below, and thank you!

This post was originally published on August 16, 2019 and updated on May 3, 2024.

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  • Henry Kathurima murithi August 16, 2019   Reply →

    Thanks a lot for connecting with me through my e_mail .l’m a kenyan; an occupational therapist by profession; practising in a public hospital and have a passion in pediatric, currently operating in out_patient pediatric unit. l would like assistant in obtaining reading materials and therapeutic equipments and tools since it is challenging to get them here.

  • Melissa Morgan November 14, 2020   Reply →

    I would push for our being called OT Practitioners. Licensed nurses and with less than a 2 year degree are still called nurses, as well as RNs with AS degrees whereas Certified Nursing Assistants have less education than COTAs or PTAs. The word assistant presumes that we are on equal footing with Teacher Assistants , MAs and CNAs who have certificates, rather than 2 year degrees. Not to denigrate their roles and MAs and CNAs do have to pass an exam but the word assistant implies that we are not therapists.

  • Dayna June 23, 2021   Reply →

    I have read that COTA is a growing career and many job opportunities. Is this not the case? I would hate to complete a program and the job becomes non existent.

    • Sarah Stromsdorfer, OTR/L June 26, 2021   Reply →

      Hi Dayna, while there are definitely still opportunities for COTAs, the job market has decreased somewhat after the Medicare changes in 2019. Be sure to look for job postings in your area to see how the market is (if you regularly don’t see postings, the market in your area might be tough). It can be variable by city/region from what I’ve been told from currently practicing COTAs.

      • Dayna January 5, 2022   Reply →

        Thanks you! I am suppose to start the OTA program next month. I am a mom and almost 40 so I don’t want to make any mistakes. I searched indeed and regularly see about 50 jobs. Is this a decent amount?

        • Sarah Stromsdorfer, OTR/L January 12, 2022   Reply →

          I think 50 COTA jobs posted regularly in your city is great!

  • kathy Thureen December 1, 2021   Reply →


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

      It’s so variable from town to town, so I definitely recommend looking at job postings on in both big and small cities that you’re interested in living/working in.

  • Dayna January 5, 2022   Reply →

    Thank you! I am suppose to start the OTA program next month. I am a mom and almost 40 so I don’t want to make any mistakes. I searched indeed and regularly see about 50 jobs. Is this a decent amount?

  • Richard January 23, 2024   Reply →

    i understand that COTA’s are are not given sufficient time between patients to document properly.. Is this the case and how do you solve this dilemma since you cannot take treatment time away from the patient

    • Sarah Stromsdorfer, OTR/L January 31, 2024   Reply →

      This can be true of both OTs and COTAs unfortunately. The best thing to do is to try to find an ethical company with more realistic productivity standards (through interviewing current employees and doing company research) so that you won’t find yourself documenting off of the clock all of the time.

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