7 Things I Wish I Knew Before Becoming an Occupational Therapist - myotspot.com (2023)

Are you or someone you’re close to interested in becoming an occupational therapist?

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

This list isn’t meant to scare you away from becoming an OT! But, 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; other countries may differ.

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 OT 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 (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 on these factors before taking your first job.

2. Becoming an occupational therapist is expensive.

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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 $86,280, 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.

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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 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, doctors, nurses, 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 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.

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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 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, orworking 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. With OT, 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 January 26, 2022.

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