How (And Why) to Become an Occupational Therapist

There’s a lot of confusion about what occupational therapy is and whom it’s for. Occupational therapists, or OTs for short, are healthcare professionals who help patients with injuries, illnesses, or disabilities learn or relearn to do the kinds of routine, everyday activities most of us never even think about, such as:

• Tying a pair of shoes
• Cooking eggs
• Getting dressed
• Handling money

Unless you’ve been thinking about becoming an occupational therapist for some time, you probably haven’t ever considered how much mental and physical coordination goes into doing simple things.

Take tying a pair of shoes. It’s not just about tying the laces. First, you have to sit down and get your hands to your shoes. Then you have to grasp the laces. You might have to pull them taut to tighten your shoes before you tie them. It’s a multistep process. Most of us can do it without thinking about it, but people with disabilities—as well as people who have sustained injuries or who endure neurological symptoms due to illness—may not be able to tie their shoes without working with an occupational therapist first.

What inspires many people to explore careers in occupational therapy is the fact that occupational therapists are uniquely able to help patients address their psychological and emotional needs as well as their physical ones. OTs empower their patients to live more independently. If you’ve ever experienced a period of relative helplessness, you know how amazing it feels to be able to care for yourself again. It’s not just about teaching people how to tie shoes or cook eggs. Becoming an OT is about giving people freedom.

In this article about how to become an occupational therapist, we’ll answer the following questions:

• What do occupational therapists do?
• What’s the difference between an occupational therapist and a physical therapist?
• What are the skills necessary to become an occupational therapist?
• What kind of training is required to become an occupational therapist?
• What schools have the best occupational therapy programs?
• What additional qualifications do you need to become an occupational therapist?
• How long does it take to become an occupational therapist?
• Do occupational therapists make good money?
• Is occupational therapy a good career?

What do occupational therapists do?

Occupational therapists are trained to give people exercises, strategies, adaptations, environmental adjustments, and tools that let them function more independently at home and out in the world. Their discipline is broad in scope because of the immense range of physical, neurological, and psychological difficulties that can make it hard for people to complete basic tasks. OTs can help people learn or relearn how to do almost all the things that occupy our time, from taking showers to preparing a bowl of cereal to using a computer.

Many patients who work with an occupational therapist do so because they’ve suffered an injury. For instance, a person who breaks multiple bones in their hand may need to relearn to grasp objects and hold a pen after recovering from surgery. Others need help mastering basic tasks because they have a physical or mental disability that makes it harder to do certain things or to remember the sequence of actions necessary to complete specific tasks.

When you become an occupational therapist, you’ll never have an average day… or an average patient. Each of your patients will have different needs, different challenges, and a different outlook on life. Some will do the exercises you prescribe and work hard to reach their goals, regardless of their circumstances. Others will find themselves demoralized by setbacks; they will need you to cheer them on and give them hope. Still others will do their best only when you push them hard, acting more as a coach than a caregiver.

What your days will have in common is that you’ll spend time performing evaluations, creating custom intervention plans, working one-on-one with patients, and evaluating their progress and outcomes. You’ll also do paperwork—a lot of paperwork.

What’s the difference between an occupational therapist and a physical therapist?

Both OTs and PTs work with patients who need help to function as the result of injury, illness, or disability. Both do hands-on rehabilitative work with their patients. The most significant difference between occupational therapists and physical therapists is the outcome they’re trying to achieve. The end goal in physical therapy is managing or curing pain, restoring range of motion, and in severe cases, helping patients relearn to move or walk.

The end goal in occupational therapy is empowering people to do practical day-to-day tasks. Sometimes a patient will see a PT until they have regained strength and range of motion, and then they’ll start seeing an OT. For example, someone who has suffered a stroke might work with a physical therapist to regain limb and back strength before working with an OT to relearn how to tie their shoes, write by hand, or shower.

What are the skills necessary to become an occupational therapist?

Occupational therapists have to be experts in how injuries, illnesses, and disabilities affect people’s capabilities. Still, this job is about more than just walking a patient with Condition A through the usual treatment plan for that condition. Each of your patients will respond to different strategies and tools, and it’s up to you to understand them well enough to know what will work and what won’t. To that end, you’ll need:

• Excellent communication skills: A big part of this job involves communicating with patients, their doctors, other specialists, and caregivers. You need to be a great listener because your patients’ input will be a major asset to you when you’re creating treatment plans. You also have to be a good speaker, because you’ll frequently have to explain complex therapeutic ideas to your patients in language they can understand.
• Creativity and persistence: The road to recovery is much clearer for some patients than others. Sometimes it will take a while before you figure out the best way to treat a patient. You may need to pivot frequently and come up with adaptations on the fly based on a patient’s mood, physical condition, or energy level, or the equipment available. Being able to think on your feet and to roll with the punches is crucial.
• A lot of patience: Patients can be grumpy. Their progress can plateau. When you become an occupational therapist, it will be your job to be pleasant and empathetic—on days when one patient is testy, or it feels like you’re not getting anywhere with another. Your positive attitude and outlook will help your patients keep working toward their goals.
• Better-than-average organizational skills: Nobody becomes an occupational therapist because they love paperwork, but it’s an essential part of the job. You’ll need to complete required documentation for each patient, and you may even need to keep track of things like insurance authorizations and referrals.

What kind of training is required to become an occupational therapist?

OTs need at least a master’s degree in occupational therapy to practice… for now. The Accreditation Council for Occupational Therapy Education (ACOTE) considered mandating that all entry-level occupational therapy programs transition to the doctoral level by 2027, but in 2019, the group’s Representative Assembly voted in favor of dual degree levels. That said, you should still look into three-year entry-level doctorate in occupational therapy, or OTD, programs while you’re researching master’s degree options.

Before we discuss how to choose between these advanced degree programs, let’s talk bachelor’s degrees. Many aspiring OTs major in biology, kinesiology, psychology, or sociology—all of which are good options if you’re not sure whether you really want to become an occupational therapist. If you already know you want to go all-in on occupational therapy, there are pre-OT programs at schools like The University of Texas at Austin and the University of Colorado Boulder.

During your undergraduate degree years, take steps to boost your chances of getting accepted to a graduate-level OT program. There are often hundreds of applicants vying for a handful of spots in Master of Occupational Therapy programs, and you’ll need to stand out. You can do that by:

• Volunteering or working in a variety of occupational therapy settings
• Doing more than the required number of observation hours (preferably 100+)
• Joining the American Occupational Therapy Association
• Getting certified in subjects like CPR/AED and concussion care
• Making sure you’ve taken all relevant prerequisite courses

You may come across some dual bachelor’s degree/master’s degree programs for aspiring OTs, but these aren’t the norm. Most students earn a bachelor’s degree and then apply to MSOT (or OTD) programs.

Choosing between the two advanced degree pathways open to aspiring occupational therapists can be tough. You might be leaning toward the OTD in case ACOTE votes to require doctoral-level degrees for OTs in the future, but there are some compelling reasons to look at master’s programs for OTs. First, opting for the MSOT may save you money, as it’s a less-expensive degree. Second, you may not need to complete a capstone project to earn a master’s degree. Third, you may be able to complete a master’s degree program in less time. And fourth, you’ll have more colleges and universities to choose from if you opt for a master’s degree because more schools offer them.

Regardless of what type of entry-level program you choose, remember that MSOT and OTD programs can vary significantly in their curricula. Keep your career goals in mind as you research programs and look for ones that include courses closely related to those goals. And remember that you may not be done when you earn your master’s; there are compelling arguments to continue on to a Doctor of Clinical Science in Occupational Therapy (CScD).

What schools have the best occupational therapy programs?

According to US News and World Report, the best occupational therapy programs can be found at:

• Boston University
• Colorado State University – Fort Collins
• Thomas Jefferson University
• Tufts University
• University of Illinois at Chicago
• University of Pittsburgh – Pittsburgh Campus
• University of Southern California
• Washington University in St Louis

You can find a list of all the master’s degree programs for OTs accredited by ACOTE here and accredited doctoral level programs here.

What additional qualifications do you need to become an occupational therapist?

All new OTs must pass the National Board for Certification in Occupational Therapy (NBCOT) certification exam after graduating. Every state requires occupational therapists to be licensed. Check with the state licensing board in the state you plan to work in for additional occupational therapy licensure requirements. Once you have a master’s degree, license, and NBCOT credential, you can start working as an OT.

Depending on what specialty area you choose, however, you may need additional national certifications or continuing education hours to work with certain populations or to employ specific therapies. There are many very-specific certifications OTs can pursue, including:

• Aquatic Therapeutic Exercise Certification (ATRIC)
• Basic DIR Floortime Certification
• Certified Aging in Place Specialist (CAPS)
• Certified Industrial Ergonomic Evaluator (CIEE)
• Certified Stroke Rehabilitation Specialist (CSRS)
• Certified Driver Rehabilitation Specialist (CDRS)
• Certified Neuro Specialist (CNS)
• Seating and Mobility Specialist (ATP/SMS)
• Assistive Technology Professional (ATP)
• Certified Hippotherapy Clinical Specialist (HPSC)

Chances are there is at least certification out there, if not more than one, closely related to your career goals.

How long does it take to become an occupational therapist?

Master’s degree programs for occupational therapists vary in length, but most take about two to three years to complete. Before you can enroll in an on-campus or online Master of Occupational Therapy program, however, you’ll need to earn a bachelor’s degree. That will probably take four years, though there are accelerated educational options for aspiring OTs like the 3-2 program at Washington University in St Louis. Students in the program can finish their bachelor’s and master’s degrees within five and a half years (including fieldwork). Don’t forget to factor in time to meet your state’s OT licensure requirements.

From there, it may take a while for you to land your first OT job. You might end up working at your neighborhood coffee shop for a lot longer than you planned on after graduation if you hold out for your dream position. You’ll start amassing on-the-job experience a lot faster if you’re open to jobs in different settings.

Do occupational therapists make good money?

The quick answer is ‘sometimes.’ Or maybe ‘eventually.’ That’s probably not very reassuring, considering that it’s not uncommon for OTs to rack up hundreds of thousands of dollars of student loan debt before they start working. The US Bureau of Labor Statistics reports that the median occupational therapist annual income is just over $84,000, which is plenty for most people to live on, but remember that the median doesn’t tell the whole story. The average salary of freshly-minted OTs (those with five or fewer years work experience) is closer to $64,000. The payments on a $100,000 loan will be about $1,075 per month, which is more than a quarter of an entry-level OT’s take-home pay. Assuming you can pay off your student loans, you’ll make great money… decades after you become an occupational therapist.

Is occupational therapy a good career?

It depends on what you’re looking for in a career. There are a lot of pros and cons to consider when you’re thinking about becoming an occupational therapist.

The potential for job satisfaction when you become an occupational therapist is near infinite. You’ll have some overwhelming days and some downright terrible ones, but in general, you’ll enjoy the satisfaction of knowing that you’re making a real and significant difference in the lives of the patients you treat. The progress you see in them will make the tough stuff worth it—provided you have a passion for helping people and a high tolerance for bodily fluids.

You may not have to deal with poo or pus every day, but do keep in mind that it’s the occupational therapists of the world who help people relearn how to use the toilet again after a traumatic brain injury or stroke. Many occupational therapists are also qualified to perform wound care management and debridement, which can get messy. It’s not uncommon for patients doing OT post-surgery to vomit.

On the pro side, there are jobs for occupational therapists everywhere, so you don’t have to stay in one state or one part of the country. According to the Bureau of Labor Statistics (BLS), the job outlook for occupational therapists is robust; 23,700 new jobs for OTs will be created between now and 2028. OTs are in demand all over, too, and the highest demand can be found in some of the nicest cities, like Los Angeles, Houston, Washington DC, and San Diego. You can also work in a lot of different settings, from pediatric clinics to nursing homes to hospitals.

The work you do in those settings won’t be easy, of course. Most workplaces have productivity requirements for OTs. These can sometimes be extremely unrealistic. You’ll need to meet with a certain number of patients and handle all the paperwork demands related to those cases. You may end up spending quite a few of your off-hours sitting at your computer, writing up progress reports.

The biggest con of becoming an occupational therapist, however, could be the fact that there will be some people you can’t help, no matter what strategies you try. You will have patients who do everything right and give OT their all but can’t overcome unfixable issues like nerve or brain damage, domr cardiac conditions, or excessive scar tissue. When that happens, you may feel as sad and defeated as your patients. Over time, you’ll learn to deal with those feelings, but you’ll likely never stop wishing you could do more. If you can cope with that reality and keep going, you’ll have cleared one of the biggest hurdles to enduring in this career.

(Last Updated on February 26, 2024)

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