General Admissions & OTCAS OT Concerns in Current Healthcare Climate

[occupationalguy]

Hello All!

I am an occupational therapy student currently in my Level IIs. Overall I would say that I am happy in my decision to become an OT, but, there are some concerns that I believe are legitimate for any entering student. Let me start off by saying: what we do as OTs is greatly rewarding. I love making a difference in client's lives. The purpose of this post is to describe what I see in my outpatient setting, and some concerns I have about reimbursement and our profession in the future.

Debt vs. Salary: Many programs already cost 6 figures for an OT degree. The average OT salary is 70k ish a year. That's a lot of debt. Do your own math and accept the debt load you feel comfortable with, but as we move towards an OTD (in the next ten years) many programs will start to push the 150k+ range and that would make becoming an OT a much more complicated decision from a cost benefit standpoint.

The Field: From what I see in my practice I see that PT's are stretching out and eating up our areas of practice. PTs are addressing ADLs and IADLs. In my clinic we have 4 PTs and 1 OT. The climate here, and from what I have seen in many places is that the PTs have a "doctorate" and are the "experts" and we are interchangeable with them. PTs in my clinic are even pushing into our domain treating upper extremity issues. There will always be a place for OT, but PT's are becoming jacks of all trades, and they are even eating into Speech Therapists job titles.

Reimbursement vs. the OT: Insurance companies and some aspects of insurance reforms since the mid 1990s have reduced our reimbursement for services rendered. There is also a therapy cap of 1900$ per year for medicare patients. This isn't likely to be repealed any time soon, and it limits the patients we can bring into our clinic, and the money we can bring to our clinics and our hospitals. This in turn limits our salaries. We can'ts exactly justify being paid high salaries when the money we bring in to our hospitals, clinics etc is being limited further and further.

Productivity vs. the OT: There is a massive effort to push your productivity levels up by the clinics and hospitals out there. Some as high as 90%+. That means 90% of your day+ is supposed to be spent treating patients. What if you get a patient who isn't fit for treatment? In your best judgement say you determine you should discharge the patient. Guess what your therapy director might have to say about that? Uh, treat them. Bring in the bacon, because not treating is reducing your productivity numbers which your director is under pressure to have higher. When you treat and the client doesn't need services, you may be subject to an audit; who is under fire in that situation? Not your clinic. You are.

Time vs the OT: Due to the aforementioned productivity demands you will likely have placed on you in many settings in many clinics and hospitals there is a culture, if not outright expectation that you sit at your desk and document as you eat your lunch during your lunch break. To get 100% productivity you are expected to treat 4 clients an hour (15 min increments are one billing unit). Most insurance companies have a cascade scale of reimbursement; the more time you spend with a client the less and less you get reimbursed for the units you bill. It's to incentivize you to bill less.

Salary/Hourly vs the OT: Most clinics pay you hourly wage. What happens if they don't have enough patients for you to treat that day? Many clinics or hospitals will send you home. After all, if you aren't treating, your productivity percentage will drop. When that happens you'll be under fire to treat, and you'll be asked as to why your numbers aren't up. You say, how will I pay my bills though? Well, I have seen OT's in many settings take vacation hours and PTO to go home when there are no patients to treat.

But hey, I'll just be a traveling OT: What happens when you travel all the way to Timbuktu and the client cancels or just isn't home because they forgot? Or just doesn't care and isn't home. You don't get reimbursed, and in most cases they won't even reimburse your travel for mileage to the client in that case.

The creep of physical therapists into our field, treating shoulders, doing ADLs etc. is problematic. Couple this with the high, and set to be massively higher cost of an OT degree as we move to an OTD and you're set to realize one thing: our reimbursement is DROPPING and our degree is skyrocketing in cost. The therapy cap makes it kind of hard for us to justify a higher salary than we get; there is limited career growth as a regular clinician. You tend to hit a glass ceiling really quickly, it's very rare to hear of OT's making six figures. My CI stated that he has never met one who does, and I am in a area with a relatively high cost of living. With current trends in reimbursement it will become more rare.

You can't reduce OT to the problems (reimbursement trends, time and productivity concerns etc); our field is excellent and I'd do it all over again. These concerns are very real; and I think many people who have an interest in being an OT might start to glance at PAs and NPs who don't as acutely face the concerns I documented above. I think solid advocacy by our field for clinicians is the way to go, and I hope these concerns help some of you understand things I didn't think about prior to becoming an OT.

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[OldHopeful]

Thank you for all of the information. I've heard OT's express some of these concerns but didn't realize this was super problematic. You mentioned these are issues you have seen in an outpatient setting. Do theses issues exist across the board i.e. inpatients settings as well?

 

[beestrng]

Bruh I agree with everything you said.

I was told today that there was no need for OTs for any UE care or functional activity by a PTA loooll. Hell, she told me that they were specialists of flexor tendon repair too. No need for CHTs.

I should have become a COTA. It would of cost like 5% of my MOT degree and make 75% of what an OT makes.

I cry every time.

 

[occupationalguy]

Thank you for all of the information. I've heard OT's express some of these concerns but didn't realize this was super problematic. You mentioned these are issues you have seen in an outpatient setting. Do theses issues exist across the board i.e. inpatients settings as well?

@beestrng That is an attitude which is not uncommon among PTs. I am not saying all PTs are dismissive of our field; but they tend to market themselves as able to do everything we can do. They are increasingly integrating ADLs and IADLs into their approaches. Medicare says that once a patient can walk xyz feet they are fit for discharge; so where exactly do we fit in? I have yet to hear of an OT program which teaches us about ambulation, or anything regarding treatment of the lower extremities. Meanwhile PTs learn all about upper extremities. If Medicare says a client is fit to discharge after walking xyz feet; where do we come in with the client's feeding issues? The client's ADLs and IADLs? Guess what? Medicare (and most other insurance companies as a result) say: the patient's caregivers can take care of those ADLs. Do you see the problem? The PTs can do most things we do; we can do little of what they can do. ADLs are super important, but Medicare (which sets the standard for most all insurance policies) incentivizes cost savings. We ge the short end of this stick, meanwhile PTs are gobbling up our domain. I love the holistic approach of OT- otherwise I wouldn't have chosen this field. The sad reality is; OTs are being undercut by PT's who can do what we do, and the anatomical stuff, and with more specific precision.

@OldHopeful I think it is setting dependent. I think this situation is most acutely felt in an outpatient setting; keep in mind that my setting has next to no juvenile clients. I see the PTs doing everything OTs do, and more, and meanwhile we are limited to upper extremity issues. It's not all dire. OT has a home: neurological deficits are our bread and butter. PTs are far from our "enemies" but they have to further their field; they are acting logically. They are encroaching on other healthcare domains: doing speech therapy, vision, and most of what we do.

The reimbursement questions are very real. You are pressured like an assembly line to get in as many patients as you can, and insurance companies are incentivizing you spending as little time as you can with those clients. This results in the desire for you to take 2 billable units per client (1/2 hour) and treat up to 4 clients at the same time so you can be productive the entire day long. Even then, many modalities are paid little - fluidotherapy for instance: a client spends 15 minutes in a fluidotherapy machine and Medicare/other insurance reimburses you $15. A hot pack for 15 min? Reimbursement: $0. Electric TENS therapy: 15 minutes in that, reimbursement is like $10. Exactly how can you justify a salary paying you much more than $30 an hour or a career high of $40 an hour, if you're bringing in this little money due to healthcare reform? Also, why bother hiring an OT when you can hire a PT to do all of those things, and more?

These are real problems, and I don't have the answers. Healthcare reform is seeking to cut costs; and I know I have a duty to help my clients. A lot of what I do now is not reimbursable, and I don't "care" if it is or isn't, I am still going to treat the client to the best of my ability, because we care. The reality is that I suspect insurance companies know this, and we are getting the short end of the stick. We are being pressed for MORE productivity, and MORE clients, for SHORTER times to get more and more and more and more for the companies. Meanwhile our degree is moving towards an OTD, and the salaries adjusted for inflation are not going to be growing.

I'm not sure that I would recommend OT to a person who also has an interest in fields without these challenges felt as acutely. That being said; I am still here for a reason - I don't care. I love treating my clients, and I love OT. I also know what I am dealing with and I am realistic in the face of the future challenges we face as a profession. Food for thought.

 

[jblil]

@occupationalguy: PT here. All the issues that you described for OT regarding productivity, insurance companies and reimbursements, equally exist in the PT world. We have a screwed-up healthcare system that rewards quantity over quality. Like you, I do not regret getting into this field, but I would advise potential applicants to think long and hard about how much the degree will cost, and how that number compares with their future salary.

As for PTs encroaching on OTs' turf: I personally have not seen it happen in my job (I am in home-health); in fact, our office just got the approval to hire an OT.

 

[Bokonomy]

@occupationalguy: PT here. All the issues that you described for OT regarding productivity, insurance companies and reimbursements, equally exist in the PT world. We have a screwed-up healthcare system that rewards quantity over quality. Like you, I do not regret getting into this field, but I would advise potential applicants to think long and hard about how much the degree will cost, and how that number compares with their future salary.

As for PTs encroaching on OTs' turf: I personally have not seen it happen in my job (I am in home-health); in fact, our office just got the approval to hire an OT.

Thank you for providing your perspective! I'd love for some international OTs to weigh in on their experiences as well, because while OT pay (not sure about PT) is less in other countries, (which I'm sure their health care pays a large role), I'd imagine productivity is less of a hindrance to actually achieving goals.

 

[occupationalguy]

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[occupationalguy]

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[occupationalguy]

@Bokonomy You're right! Productivity is much less of a concern in most West European countries. In most other Western countries school is 100% free. Many countries have a "physiotherapy" degree, which is OT and PT combined, and is usually a bachelor's degree, not a MS. Further, salary is lower (often times much lower), but again you have no worries about insurance and benefits, since they almost all have universal healthcare, and universal free higher education. They also have no productivity concerns or billing concerns in most of these countries since you work for the state.

Different system.

@jblil

Thanks for your response. I am reporting what I see in my limited scope in an outpatient rehab facility. There is absolutely no animosity towards PTs; you guys are great, but at least in my setting you guys are doing ADLs and IADLs and you do upper extremity.

My CI has informed me that doctors in the hospital where he also works consult the PTs and are more dismissive of the OTs, it wasn't particularly encouraging to hear. My clinic where I am doing my level IIs has a very high divide between the PTs and the rest of the staff, and I am not sure why. I'm just doing my time and getting out of there. I can tell you that the healthcare system is messed up: pay me less, I am fine with that, but then make my education entirely free. Otherwise pay me enough to pay for my education.

I hate to sound do dismal; but I am starting to be concerned about the future of our fields. Meanwhile PAs and NPs are facing much higher reimbursement - since they are undercutting the costs of doctors being used. Of course insurance companies love to pay a PA billable hour, or a NP one!

As for PTs encroaching on OTs' turf: I personally have not seen it happen in my job (I am in home-health); in fact, our office just got the approval to hire an OT.[/QUOTE]

PS- Does your home health company pay you for visits if the client cancels? Do they reimburse your mileage if the client cancels?

 

[beestrng]

@Bokonomy You're right! Productivity is much less of a concern in most West European countries. In most other Western countries school is 100% free. Many countries have a "physiotherapy" degree, which is OT and PT combined, and is usually a bachelor's degree, not a MS. Further, salary is lower (often times much lower), but again you have no worries about insurance and benefits, since they almost all have universal healthcare, and universal free higher education. They also have no productivity concerns or billing concerns in most of these countries since you work for the state.

Different system.

@jblil
As for PTs encroaching on OTs' turf: I personally have not seen it happen in my job (I am in home-health); in fact, our office just got the approval to hire an OT.

I can just tell you what I see in outpatient rehab. I see Physical therapists doing what we do, and then some. No animosity towards PTs; you guys are great, but at least in my setting you guys are doing ADLs and IADLs and you do upper extremity. My CI has informed me that doctors in the hospital where he also works consult the PTs and are more dismissive of the OTs, it wasn't particularly encouraging to hear. My clinic where I am doing my level IIs has a very high divide between the PTs and the rest of the staff, and I am not sure why. I'm just doing my time and getting out of there. I can tell you that the healthcare system is messed up: pay me less, I am fine with that, but then make my education entirely free. Otherwise pay me enough to pay for my education.

I hate to sound do dismal; but I am starting to be concerned about the future of our fields. Meanwhile PAs and NPs are facing much higher reimbursement - since they are undercutting the costs of doctors being used. Of course insurance companies love to pay a PA billable hour, or a NP one!

As for PTs encroaching on OTs' turf: I personally have not seen it happen in my job (I am in home-health); in fact, our office just got the approval to hire an OT.[/QUOTE]

PS- Does your home health company pay you for visits if the client cancels? Do they reimburse your mileage if the client cancels?[/QUOTE]

physicians i have worked with are dismissive of PTs and some do not know what OTs are.

Surgeons working with hands value OTs at the clinics I have been to.

Worked in physician group for about 10 yrs. They loled when I said im going into therapy. Most of them think its quackery and all said I should go into PA.

Funny thing is that they were right. Should have went the PA route. Rip.

 

[jblil]

Does your home health company pay you for visits if the client cancels? Do they reimburse your mileage if the client cancels?

I work for the HH department of a large hospital system, and I am on salary; so yes, I am still paid if the client cancels. If I drive to the client's house and s/he declines to see me, I still get paid for the mileage. If you plan to work in HH, I suggest you join the HH unit of a hospital like I did. There are productivity requirements but they are generally not too bad. There are lots of not-so-ethical HH companies out there who lure you in with promises of high pay, but don't tell you about the non-paid cancellations and un-reimbursed mileage.

In one of my clinical rotations, I worked alongside a hand therapist. He was very good, and seemed to be quite respected by the MDs. I would look into specializing in hand therapy if I were an OT. Our hands are crucial for ADLs and for returning to work after accidents, so I expect hand therapy to be a little more sheltered from all the cost-cutting.

 

[occupationalguy]

I would look into specializing in hand therapy if I were an OT. Our hands are crucial for ADLs and for returning to work after accidents, so I expect hand therapy to be a little more sheltered from all the cost-cutting.

I can only tell you what I see where I am. I am in my level IIs working under a hand therapist. I see the PTs being very dismissive of OT, and the PT here told me that he is planning on becoming a CHT. I really think if I was the OT here I would be worried about the situation: why exactly do you need an OT when the PTs can do everything we do? It seems like this could be more the situation in THIS setting/office and not generalizable everywhere?

In either case - productivity, specialization, encroaching of other disciplines on our field/expertise of care, reduced pay and reimbursement, and increasing tuition costs are all major concerns I have about the future of our field.

 

[deleted517237]

OTs do learn about lower extremity interventions in school! Hip and knee replacements are very common on inpatient units and I doubt a PT would bust out a sock aid any time soon (I've never seen it at least). Hand therapy seems like the type of setting with the vaguest distinction between OT and PT, probably because it is very biomechanical and less occupation-based. I've also never seen the animosity between disciplines as you've described; sometimes we do treatments that could fall into either PT or OT categories like strengthening or transfers, but I think it's our job to justify the unique perspective of OT, not just to payer sources but to all health professionals. I also think breaking down OT into upper extremity and PT into lower extremity does both professions a disservice, though I realize it's sometimes done that way in practice.

 

[occupationalguy]

OTs do learn about lower extremity interventions in school! Hip and knee replacements are very common on inpatient units and I doubt a PT would bust out a sock aid any time soon (I've never seen it at least). Hand therapy seems like the type of setting with the vaguest distinction between OT and PT, probably because it is very biomechanical and less occupation-based. I've also never seen the animosity between disciplines as you've described; sometimes we do treatments that could fall into either PT or OT categories like strengthening or transfers, but I think it's our job to justify the unique perspective of OT, not just to payer sources but to all health professionals. I also think breaking down OT into upper extremity and PT into lower extremity does both professions a disservice, though I realize it's sometimes done that way in practice.

You're right that we learn about ADLs related to the lower extremities. I never once had an anatomy exam in OT school. We never once discussed any of the muscles of the lower extremities in a class. I think this is a deficit we have; PTs can, and are picking up our area of expertise with ADL's and IADLs, at least from what I see.

I agree with you that the animosity between PT and OT in my practice is rather strange, but there it is.

 

[resot]

You're right that we learn about ADLs related to the lower extremities. I never once had an anatomy exam in OT school. We never once discussed any of the muscles of the lower extremities in a class. I think this is a deficit we have; PTs can, and are picking up our area of expertise with ADL's and IADLs, at least from what I see.

I agree with you that the animosity between PT and OT in my practice is rather strange, but there it is.

This may differ program to program. During my OT program, we did have to learn anatomy of the LE. And our profs did teach us (not in super detail, just enough for us to be familiar with the basics) about gait and ambulatoon. However, as we got to later courses with regards to ADLs and activity analysis, LE tends to fall off the curriculum.

 

[beestrng]

You're right that we learn about ADLs related to the lower extremities. I never once had an anatomy exam in OT school. We never once discussed any of the muscles of the lower extremities in a class. I think this is a deficit we have; PTs can, and are picking up our area of expertise with ADL's and IADLs, at least from what I see.

I agree with you that the animosity between PT and OT in my practice is rather strange, but there it is.

PT and OT had same anatomy, physio and wet lab at my school.

 

[jblil]

I agree with you that the animosity between PT and OT in my practice is rather strange, but there it is.

How old are those guys? In their 20s, 30s? I work with PTs and OTs in their late 40s to mid-50s, and we get along very well. No animosity at all, in fact we often consult and bounce ideas off one another when we have an interesting case. Something to be said for maturity...

 

[occupationalguy]

This may differ program to program. During my OT program, we did have to learn anatomy of the LE. And our profs did teach us (not in super detail, just enough for us to be familiar with the basics) about gait and ambulatoon. However, as we got to later courses with regards to ADLs and activity analysis, LE tends to fall off the curriculum.

Exactly. Same here. Not in specific detail. PTs get those specific details usually.

I think this could be more symptomatic, a bit, of my clinic to be honest with you, and I hesitate to generalize this toxic clinic to other places lightly.

I can only report what I see here: I see DPTs who very much feel they have a superior education and knowledge base - we have one here who insists his clients call him DOCTOR. I keep to myself and keep my opinion that it is an absurd request to myself. In my practice the OTs are eating up the scope of practice and taking patients away from the OT side. The OT in my clinic is prohibited from treating shoulders; now that is the domain of PT. The PTs on staff state explicitly that they can address all the ADL and IADL functions of clients, and do the biomechanical stuff needed. OTs in MY practice are being pushed out from what I see. Their client base is being funneled to PT. It's hard to tell these PTs what we can do that they can't, after all ADLs used to be our DOMAIN.

@jblil The PTs are 20s-30s in age. There seems to be palpable mistrust of the OT knowledge base; I catch the PTs listening as I talk to clients - ignoring other duties - they are searching for opportunities to report a deficit, or to correct what I am telling a client. Apparently this is kind of rampant in my clinic from the PTs.

I am not sure why this is the way it is, but I certainly hope this is not a harbinger of what is to come when I practice in the field and work with PTs. I know most PTs are NOT like this, but this is a pretty bad experience of their clinicians; it is likely just in this particular clinic, I hope!

 

[prodigiousflame]

Totally agree with your thoughts on cost of tuition vs salary and productivity concerns. I do think however the clinic/setting where you are practicing is jading you a bit. Ive only completed my level 2's and am not yet out in the field practicing, but in peds outpatient the tx's ot and pt did were different and well defined. Therapists worked well together and some who worked there for awhile were making 100k+. At the snf, pts wouldnt be caught dead doing adl's. In fact ots started taking over transfers and some of pt's duties if anything which imo was a little sketch. I would maybe move to another setting or clinic for a more well rounded atmosphere?

 

[jblil]

we have one here who insists his clients call him DOCTOR. (...) I catch the PTs listening as I talk to clients - ignoring other duties - they are searching for opportunities to report a deficit, or to correct what I am telling a client.

You are working with a bunch of stupid, immature and insecure PTs. And frankly, if the management or owners of the clinic let this go on, they ain't much better. My advice to you is to lay low, finish your rotation, and get the h3ll out of there. If I were you, I'd be out so fast on my last day that the carpet will be smoking.

 

[Bokonomy]

Exactly. Same here. Not in specific detail. PTs get those specific details usually.

I think this could be more symptomatic, a bit, of my clinic to be honest with you, and I hesitate to generalize this toxic clinic to other places lightly.

I can only report what I see here: I see DPTs who very much feel they have a superior education and knowledge base - we have one here who insists his clients call him DOCTOR. I keep to myself and keep my opinion that it is an absurd request to myself. In my practice the OTs are eating up the scope of practice and taking patients away from the OT side. The OT in my clinic is prohibited from treating shoulders; now that is the domain of PT. The PTs on staff state explicitly that they can address all the ADL and IADL functions of clients, and do the biomechanical stuff needed. OTs in MY practice are being pushed out from what I see. Their client base is being funneled to PT. It's hard to tell these PTs what we can do that they can't, after all ADLs used to be our DOMAIN.

@jblil The PTs are 20s-30s in age. There seems to be palpable mistrust of the OT knowledge base; I catch the PTs listening as I talk to clients - ignoring other duties - they are searching for opportunities to report a deficit, or to correct what I am telling a client. Apparently this is kind of rampant in my clinic from the PTs.

I am not sure why this is the way it is, but I certainly hope this is not a harbinger of what is to come when I practice in the field and work with PTs. I know most PTs are NOT like this, but this is a pretty bad experience of their clinicians; it is likely just in this particular clinic, I hope!

Oh wow. That DPT is just arrogant. I hate when professors felt strongly about using doctor over professor (although I only had one), and they had to spend a lot more time on their degree then that guy did.

The OT I shadowed in the hospital worked with a PT, and both respected each other and worked as partners. Of course, people would understand PTs better, but at least that wasn't an issue with the PTs themselves. Same with the program for adults with DD. Didn't see any in schools, but the SLP and OT made a great team. The PTs ranged from 30 to 50. But of course, you don't see as much shadowing than as you do in fieldwork, so...

 

[occupationalguy]

some who worked there for awhile were making 100k+. At the snf, pts wouldnt be caught dead doing adl's. In fact ots started taking over transfers and some of pt's duties if anything which imo was a little sketch. I would maybe move to another setting or clinic for a more well rounded atmosphere?

I am really happy that your practice is not like my experience. That is great! I have to say I am skeptical, to be honest, about any OT not in a managerial or executive role, working 40 hours a week, who tells you she or he is making 100k. I have looked at the salary stats, without some serious creative hardwork I don't know if it is easy for us to break through to 6 figures like NP and PAs can. I did a salary crunching project in my OT school, I saw that the highest paying jobs are in the Sun Belt (especially Texas and Florida). The national average for OTs is about 75k, and sadly salaries don't seem to be adjusted fairly for cost of living: e.g. if you live in NYC your average OT salary is 65k. I'm not in it for money, but I do have to pay these loans back, sadly.

There are, of course, exceptions. I don't want to say I know this is the case everywhere!

@jblil YOU KNOW IT! I am keeping my head down to the ground. I can tell you that the manager (a PT) has never once said hello to me, never smiles when I walk by. Not a single PT has ever ever said good morning to me, or hi. I try to say it, and I force a response back. I offer them things to be nice, and show goodwill, I bring in coffee, energy drinks, and healthy snacks. Zilcho. Not so much as a thank you from a single one. I am not sure why; I believe there is some conflict between my CI and them, and I get the residual of it. I can tell you, with 100% certainty, if I didn't know they were just weird it would make me have a really poor impression of PTs.
I have clients who hold very radical right wing views, and I just nod my head and say "Oh I don't follow the news too much". "I don't know about politics". This just keeps me away from that entire discussion; I learned to tolerate having the same conversation 20 times in a day when you have so many clients.

 

[jblil]

@occupationalguy: out of curiosity, what is the average starting pay for an OT? I have been running an online survey for new-grad PTs since 2012, and our starting pay seems to be pretty consistent at $60K-$65K. I shudder when I see some of my classmates going into $100K+ debt for the degree. You can see the survey results here (scroll down a bit to the Excel table; I also made a few charts):
https://dptfinances.wordpress.com/2012/07/10/hello-world/

the manager (a PT) has never once said hello to me, never smiles when I walk by: this is how one of my CIs behaved, with me. Worst rotation I've ever had. If I run into her again now, somebody please physically restrain me or...

As a PT, I rarely venture out to this OT forum; I really should do it more often since the challenges PTs and OTs face are very similar. FWIW, I wrote the post below shortly after I passed the Board and got a job offer; I hope it will be useful to you guys as you finish up your degree:
http://forums.studentdoctor.net/thr...for-dpt-new-grads.931151/page-5#post-17428121

 

[beestrng]

my current snf site pays 1st year OT 72k in a nice area.

 

[c2902]

Dang, I guess I lucked out. I make a fair salary as an OT, and I work in a clinic where all of the disciplines get along, and our management is nice! Productivity is something that affects everyone, everywhere. It's simply the nature of healthcare and it stinks, but it is what it is. It might be handled differently depending on where you work (for example, I work at a non-profit hospital system where we aren't pushed to do borderline unethical things to maintain productivity, so again, I'm lucky), but it's a reality no matter where you work.

 

[occupationalguy]

http://www.bls.gov/oes/current/oes291122.htm

This is the BLS report for OTs - these are govt stats. You can download the actual BLS data set, and you can manipulate it in SPSS (I did this for a project).

You can take a look at the dataset because it weights the data reliability for each city, so you know the predicted reliability of each region/urban area.

If you look at places like NYC you'll see that the average is in the 60s. San Diego? 90s. It's way more important to know what the average salary is for a starting clinician i your area and in your sub field. The dataset breaks down into 10% percentile, 25% and 50% and 75% and 90%. You're likely to be in be somewhere around the 25% percentile in your field or a little less as a starting clinician.

These averages are generally quite reliable. This is why I can say with some degree of confidence that the average clinician *50 percentile* in most regions/urban areas is nowhere near making 100k. I'm honestly looking at living in some less savory areas so I can make back money to pay off the enormous student debt I have. I'm kind of tired of hearing about how much debt doctors have honestly; I have 6 figure debt myself, and I'm not going to make even a fraction of what they make. Our degree takes 7 + years to get once you factor in fieldwork, and that's if you do it straight through. Once we move doctorate our degree will take 9 ish years to get, and we will be making the same amount of money, and our debt load will be so high, I just would think 3-4-5-6 times before going to OT school in that case.

It's all very complex stuff we all think about as clinicians. I really wish my fellow Ot's the best of luck. You guys are on the long road starting. We all get there!

@c2902 I am definitely considering non profit. Not as MUCH pressure to do borderline unethical stuff. I've seen people get chewed out for not focusing on billing enough, or, for giving discounts when the person was there for only a fraction of a session. It's a powder keg I didn't feel comfortable with.

 

[kc0716]

http://www.bls.gov/oes/current/oes291122.htm

This is the BLS report for OTs - these are govt stats. You can download the actual BLS data set, and you can manipulate it in SPSS (I did this for a project).

You can take a look at the dataset because it weights the data reliability for each city, so you know the predicted reliability of each region/urban area.

If you look at places like NYC you'll see that the average is in the 60s. San Diego? 90s. It's way more important to know what the average salary is for a starting clinician i your area and in your sub field. The dataset breaks down into 10% percentile, 25% and 50% and 75% and 90%. You're likely to be in be somewhere around the 25% percentile in your field or a little less as a starting clinician.

These averages are generally quite reliable. This is why I can say with some degree of confidence that the average clinician *50 percentile* in most regions/urban areas is nowhere near making 100k. I'm honestly looking at living in some less savory areas so I can make back money to pay off the enormous student debt I have. I'm kind of tired of hearing about how much debt doctors have honestly; I have 6 figure debt myself, and I'm not going to make even a fraction of what they make. Our degree takes 7 + years to get once you factor in fieldwork, and that's if you do it straight through. Once we move doctorate our degree will take 9 ish years to get, and we will be making the same amount of money, and our debt load will be so high, I just would think 3-4-5-6 times before going to OT school in that case.

It's all very complex stuff we all think about as clinicians. I really wish my fellow Ot's the best of luck. You guys are on the long road starting. We all get there!

@c2902 I am definitely considering non profit. Not as MUCH pressure to do borderline unethical stuff. I've seen people get chewed out for not focusing on billing enough, or, for giving discounts when the person was there for only a fraction of a session. It's a powder keg I didn't feel comfortable with.

That's all disappointing to hear.

You mentioned 7+ years to get the degree with fieldwork.

Do you mean 4 years of undergrad + 2.5~3 years of Masters program?

As far as I know, all accredited programs have Fieldwork I and II built into the program.

So, for any college grads who meet the pre-reqs to apply for Masters, the time needed to get the license is most likely : Length of Master's program + Time till passing the Exam..which will be like 3~3.5 years..no? Am I missing something

 

[occupationalguy]

Do you mean 4 years of undergrad + 2.5~3 years of Masters program?

Most programs are 2.5 years long plus two 3 month fw rotations. That is 3 years right there. Then you add the 4 years minimum for an undergrad degree.
If you do that straight through, that's 7 years minimum for the average OT degree. That's not to even mention the people who have to go back like I did and do pre-reqs. We are set to move to a doctorate in the next decade which will put the total amount of higher education into the 9-10 year bracket to become an OT. That means graduates from OT programs will have substantially more debt; it's already common to meet new graduates with 150k in debt. I love this field intensely, but our avg salary is 75k, and I think if you are looking at the prospect of having 150k in debt vs. going to become a COTA and have NO debt, making 50k a year it's be an option I wouldn't turn down lightly.

That's not to even mention NP school or PA. Average salaries are much higher than ours with same number of years to commit to.

 

[c2902]

Most programs are 2.5 years long plus two 3 month fw rotations. That is 3 years right there. Then you add the 4 years minimum for an undergrad degree.
If you do that straight through, that's 7 years minimum for the average OT degree. That's not to even mention the people who have to go back like I did and do pre-reqs. We are set to move to a doctorate in the next decade which will put the total amount of higher education into the 9-10 year bracket to become an OT. That means graduates from OT programs will have substantially more debt; it's already common to meet new graduates with 150k in debt. I love this field intensely, but our avg salary is 75k, and I think if you are looking at the prospect of having 150k in debt vs. going to become a COTA and have NO debt, making 50k a year it's be an option I wouldn't turn down lightly.

That's not to even mention NP school or PA. Average salaries are much higher than ours with same number of years to commit to.

My Masters program was 2.5 years which included the two 3-month long full-time Level II fieldwork rotations. We had academic work for 4 semesters and Level I fieldwork started during the second academic year, then we went straight into fieldwork for 6 months. I graduated in December, took the boards in February and got my license shortly after. I started working at the end of March - but I had the job lined up before I took the boards.
And no, the doctorate will not add 9-10 years as it's not a PhD that takes years and years to do - an OTD is a clinical doctorate, and most of the current programs are 3 years, like the DPT. So for someone going from undergrad, they won't get a Masters and then an OTD; the OTD will simply replace the Masters as the entry level degree, so it would only be 7 years. However, those of us who are already licensed OTs will not be required to get our OTD in order to continue being a clinical practitioner.

 

[occupationalguy]

Top OT Salaries I crunches - by location. Weighted by the MOST reliable stats on down from BLS. They have an error measure which weights the reliability of data, then I organized it from highest salary on down.

Note: Please keep in mind the extremely high cost of living of nearly all of the top top paying places. e.g. making an OT starting salary of 65k in San Francisco nearly qualifies you for many subsidized housing options. Even an OT in management making a salary of 100k in SF could never afford to buy a house. He/she could maybe rent their own apartment, maybe. Emphasis on maybe.

Take a look at the more affordable places with high pay: your starting salary is going to be between that 10% and 25% - in a really great market that translates to 75kish.

I am happy to make these stats for anyone here for any metro area/region you are interested in working in. Just ask!

 

[kc0716]

Most programs are 2.5 years long plus two 3 month fw rotations. That is 3 years right there. Then you add the 4 years minimum for an undergrad degree.
If you do that straight through, that's 7 years minimum for the average OT degree. That's not to even mention the people who have to go back like I did and do pre-reqs. We are set to move to a doctorate in the next decade which will put the total amount of higher education into the 9-10 year bracket to become an OT. That means graduates from OT programs will have substantially more debt; it's already common to meet new graduates with 150k in debt. I love this field intensely, but our avg salary is 75k, and I think if you are looking at the prospect of having 150k in debt vs. going to become a COTA and have NO debt, making 50k a year it's be an option I wouldn't turn down lightly.

That's not to even mention NP school or PA. Average salaries are much higher than ours with same number of years to commit to.

It indeed is not a LIGHT decision to choose between 150k debt (75k salary OT) vs no debt (50k salary COTA).

However, NP and PA require a lot more pre-reqs.

In terms of career change though (this is where I am at) OT vs. NP vs. PA doesn't appear, in my opinion, to be a fair comparison since NP and PA take a lot longer to even start the program at Master's level. Reputable PA require you have healthcare (hand-on) experience before even applying I believe.

Anywho, given Bachelor's degree in related or non-related field, and ignoring the debt from undergrad (because you will be paying for this no matter what your degree was and wehther or not if you choose to go into OT), I think if we can get into accredited public school for the OT master's program, I think the debt is more than manageable.

Among all health-care careers (non-assistant position), I think OT stands fair and is a worthwhile option when considering 1) amount of pre-reqs needed for potential career changers 2) amount of schooling needed 3) debt 4) salary.

I have many RN friends who are making upwards of $110k in Cali with $0 debt, some with $100k in debt.
I have some Pharmacist friends who are making $120~130k in Cali startigng, but have $200k or more in debt.

I guess the take away is...

Study your ass off for them GRE scores, Get all As in pre-reqs, Write a good personal statement (they have paid review services out there), and hope to get into a public program.

 

[occupationalguy]

And no, the doctorate will not add 9-10 years as it's not a PhD that takes years and years to do - an OTD is a clinical doctorate, and most of the current programs are 3 years, like the DPT. So for someone going from undergrad, they won't get a Masters and then an OTD; the OTD will simply replace the Masters as the entry level degree, so it would only be 7 years.

I'm sorry if I didn't explain my addition clearly on this one. I meant to say that once AOTA mandates a doctorate as an entry level degree for OTs that will bump us from 7-8 years of higher education to 9-10 years of higher education.

Most OT programs are currently 3 years long, and require a BA/BS to enter. That is a minimum of 7 years currently for an OT degree. Once we move to a doctorate that will shift from 7 years to 8-9 years from your 1st year of undergrad until you become a practicing OT. Those numbers wouldn't change my desire to be an OT, I love this field, but it would make it substantially harder for many people to enter our field, and would change a lot of people's formulas on cost vs benefit of this degree.

@kc0716 Absolutely. Don't forget the cost of living between California and other places. We ain't makin 100k that's for sure
I think you can go to many websites and compare what a salary in one metro area is like compared to another - this will help you do the math to see if it is better to take that 100k job in Cali vs the 60k job in Topeka, Kansas.

This is all a struggle, but I think your advice of telling people to work hard and try to get into public (e.g. cheaper) OT programs is very, very wise.

 

[NIM-NIM]

I'm sorry if I didn't explain my addition clearly on this one. I meant to say that once AOTA mandates a doctorate as an entry level degree for OTs that will bump us from 7-8 years of higher education to 9-10 years of higher education.

Most OT programs are currently 3 years long, and require a BA/BS to enter. That is a minimum of 7 years currently for an OT degree. Once we move to a doctorate that will shift from 7 years to 8-9 years from your 1st year of undergrad until you become a practicing OT. Those numbers wouldn't change my desire to be an OT, I love this field, but it would make it substantially harder for many people to enter our field, and would change a lot of people's formulas on cost vs benefit of this degree.

@kc0716 Absolutely. Don't forget the cost of living between California and other places. We ain't makin 100k that's for sure
I think you can go to many websites and compare what a salary in one metro area is like compared to another - this will help you do the math to see if it is better to take that 100k job in Cali vs the 60k job in Topeka, Kansas.

This is all a struggle, but I think your advice of telling people to work hard and try to get into public (e.g. cheaper) OT programs is very, very wise.

Hi occupationalguy:

Very informative posts! I wish that more people considering OT know and see this. I recently got accepted into a cheap state program for OT, and it was the only program I considered.

In the current climate, I find that recent graduates from their undergrad see OT as a "back door" profession into the medical field...an easy way to get in. They believe that OT offers stability and good pay, which justifies the 100k+ debt without further research.

As an undergrad who volunteered 1000+ hours at various clinical sites, I saw the exact problems you stated about the field. There are doctors, surgeons, and PTs that don't respect our field. Reimbursement for all therapy in US healthcare was cut by 40-50% years back. Therapists have to "rack and stack," treating multiple patients at time to reach productivity rate. Not to mention the move to an OTD in the next ten years, which will probably leave many students going into more massive amounts of debt.

I think that the ongoing trend will shrink our profession. These issues are not going to go away until our profession has an honest talk and resolution about what's going on.

I have friends who are DPTs with 200k+ debt and do not know what to do b/c there salaries of 65k do not cut it. So a doctorate will not raise salaries. I truly don't understand why there is a move for OT to go in OTD. Health insurance companies will not pay more, more people will be pushing back having homes, families, etc. b/c of the massive loans they shoulder. Holistically, this will reduce people's quality of life.

Granted like you, I love the OT profession. It is the one of the few professions in our healthcare system that treats people holistically, with research showing our profession prevents the most hospital readmissions (our healthcare system doesn't like that though).

I agree with your points 100%.

 

[2016OTHopeful]

Hello All!

I am an occupational therapy student currently in my Level IIs. Overall I would say that I am happy in my decision to become an OT, but, there are some concerns that I believe are legitimate for any entering student. Let me start off by saying: what we do as OTs is greatly rewarding. I love making a difference in client's lives. The purpose of this post is to describe what I see in my outpatient setting, and some concerns I have about reimbursement and our profession in the future.

Debt vs. Salary: Many programs already cost 6 figures for an OT degree. The average OT salary is 70k ish a year. That's a lot of debt. Do your own math and accept the debt load you feel comfortable with, but as we move towards an OTD (in the next ten years) many programs will start to push the 150k+ range and that would make becoming an OT a much more complicated decision from a cost benefit standpoint.

The Field: From what I see in my practice I see that PT's are stretching out and eating up our areas of practice. PTs are addressing ADLs and IADLs. In my clinic we have 4 PTs and 1 OT. The climate here, and from what I have seen in many places is that the PTs have a "doctorate" and are the "experts" and we are interchangeable with them. PTs in my clinic are even pushing into our domain treating upper extremity issues. There will always be a place for OT, but PT's are becoming jacks of all trades, and they are even eating into Speech Therapists job titles.

Reimbursement vs. the OT: Insurance companies and some aspects of insurance reforms since the mid 1990s have reduced our reimbursement for services rendered. There is also a therapy cap of 1900$ per year for medicare patients. This isn't likely to be repealed any time soon, and it limits the patients we can bring into our clinic, and the money we can bring to our clinics and our hospitals. This in turn limits our salaries. We can'ts exactly justify being paid high salaries when the money we bring in to our hospitals, clinics etc is being limited further and further.

Productivity vs. the OT: There is a massive effort to push your productivity levels up by the clinics and hospitals out there. Some as high as 90%+. That means 90% of your day+ is supposed to be spent treating patients. What if you get a patient who isn't fit for treatment? In your best judgement say you determine you should discharge the patient. Guess what your therapy director might have to say about that? Uh, treat them. Bring in the bacon, because not treating is reducing your productivity numbers which your director is under pressure to have higher. When you treat and the client doesn't need services, you may be subject to an audit; who is under fire in that situation? Not your clinic. You are.

Time vs the OT: Due to the aforementioned productivity demands you will likely have placed on you in many settings in many clinics and hospitals there is a culture, if not outright expectation that you sit at your desk and document as you eat your lunch during your lunch break. To get 100% productivity you are expected to treat 4 clients an hour (15 min increments are one billing unit). Most insurance companies have a cascade scale of reimbursement; the more time you spend with a client the less and less you get reimbursed for the units you bill. It's to incentivize you to bill less.

Salary/Hourly vs the OT: Most clinics pay you hourly wage. What happens if they don't have enough patients for you to treat that day? Many clinics or hospitals will send you home. After all, if you aren't treating, your productivity percentage will drop. When that happens you'll be under fire to treat, and you'll be asked as to why your numbers aren't up. You say, how will I pay my bills though? Well, I have seen OT's in many settings take vacation hours and PTO to go home when there are no patients to treat.

But hey, I'll just be a traveling OT: What happens when you travel all the way to Timbuktu and the client cancels or just isn't home because they forgot? Or just doesn't care and isn't home. You don't get reimbursed, and in most cases they won't even reimburse your travel for mileage to the client in that case.

The creep of physical therapists into our field, treating shoulders, doing ADLs etc. is problematic. Couple this with the high, and set to be massively higher cost of an OT degree as we move to an OTD and you're set to realize one thing: our reimbursement is DROPPING and our degree is skyrocketing in cost. The therapy cap makes it kind of hard for us to justify a higher salary than we get; there is limited career growth as a regular clinician. You tend to hit a glass ceiling really quickly, it's very rare to hear of OT's making six figures. My CI stated that he has never met one who does, and I am in a area with a relatively high cost of living. With current trends in reimbursement it will become more rare.

You can't reduce OT to the problems (reimbursement trends, time and productivity concerns etc); our field is excellent and I'd do it all over again. These concerns are very real; and I think many people who have an interest in being an OT might start to glance at PAs and NPs who don't as acutely face the concerns I documented above. I think solid advocacy by our field for clinicians is the way to go, and I hope these concerns help some of you understand things I didn't think about prior to becoming an OT.

Thank you for sharing this! Very real concerns, and exactly why as OTs and OT students, we need to join and support our national and state associations and organizations. AOTA + state organizations are critical in our fight to protect our scope of practice, and the services OTs should rightly be billing for (vs PT, vs Speech), as well as healthcare reform and insurance reform. Speech therapists are required to join their national association.. why on earth aren't we? We need these associations lobbying for us, but they can't do that effectively with our dismal membership numbers.

 

[occupationalguy]

Hi occupationalguy:

Very informative posts! I wish that more people considering OT know and see this. I recently got accepted into a cheap state program for OT, and it was the only program I considered.

In the current climate, I find that recent graduates from their undergrad see OT as a "back door" profession into the medical field...an easy way to get in. They believe that OT offers stability and good pay, which justifies the 100k+ debt without further research.

As an undergrad who volunteered 1000+ hours at various clinical sites, I saw the exact problems you stated about the field. There are doctors, surgeons, and PTs that don't respect our field. Reimbursement for all therapy in US healthcare was cut by 40-50% years back. Therapists have to "rack and stack," treating multiple patients at time to reach productivity rate. Not to mention the move to an OTD in the next ten years, which will probably leave many students going into more massive amounts of debt.

I think that the ongoing trend will shrink our profession. These issues are not going to go away until our profession has an honest talk and resolution about what's going on.

I have friends who are DPTs with 200k+ debt and do not know what to do b/c there salaries of 65k do not cut it. So a doctorate will not raise salaries. I truly don't understand why there is a move for OT to go in OTD. Health insurance companies will not pay more, more people will be pushing back having homes, families, etc. b/c of the massive loans they shoulder. Holistically, this will reduce people's quality of life.

Granted like you, I love the OT profession. It is the one of the few professions in our healthcare system that treats people holistically, with research showing our profession prevents the most hospital readmissions (our healthcare system doesn't like that though).

I agree with your points 100%.

Wow, you're right on. I can't fathom how students have 100-200k in debt, and will be making 60-80k. Please do not believe the fantastic salary claims people make online; go look it up with the government stats.
The move to an OTD will have a positive effect for us I guess: there will be fewer of us. Supply and demand.
The therapy cap has seriously cut our ability to bring in money for our places of employment; no one is going to pay us 6 figures when reimbursement is capped and minimized.
There is a student loan crisis in our country, students who are willing to go to any OT program at any cost are in for a rude awakening imho.

 

[CoolRunning]

Really a great thread. Thank you @occupationalguy. Now I'm a little scared about what my future entails... :-(

 

[OTlove91]

Great thread! I think it's important that we continue to spread the word about the OT profession and the advantages of receiving OT. I think it's important to remember that Medicare and Medicaid are looking more for functional outcomes in documentation, which is what we are focused on so that helps us with our reimbursement. Also, we have the ability to work in much broader areas that PTs. PTs often do not feel comfortable with addressing cognition, mental health issues, upper extremity injuries, psychosocial factors, etc. We have a huge advantage that we take a holistic approach when looking at the individual.

 

[occupationalguy]

Really a great thread. Thank you @occupationalguy. Now I'm a little scared about what my future entails... :-(

Don't be scared. Just know the climate we are in and make it work to your advantage. It all depends on what your needs are.
I am looking at OT as my career of choice, and I love it. I am also doing this as my only career- some people go into our field (usually women) and think of it as a field that lets them go PRN when they have kids. That is a very different outlook than the one I have. (I'm not saying this with any negative connotation to those who do that).

I think a student MUST know the reality surrounding our workplace and salary:

* Have realistic expectations about salary. Don't listen to people who go around telling you that it is easy to make some fantasy OT salary of 6 figures. That's not easy to do, and when it happens you're usually in a very expensive place to live OR you have to work multiple jobs.

* Have realistic expectations regarding documentation. Many employers expect you to document on your time. Many places expect you to do point of service documentation - and this can interfere with your patient care, or, you just don't have the time to do it as you treat with the level of documentation the employer wants. Most employers expect you to clock in and clock out when you are scheduled to be there. ONLY. This means if you have documentation to do, oh well, that's done in your free time before or after work, or during your lunch hour, or all of the above. I'm not entirely sure how our profession gets away with this, I think it's free labor and there will eventually be a class action lawsuit.

* Think twice before you go to a school which is expensive. If you are paying 6 figures for an OT degree you're making a mistake if paying that back is a problem. Maintain a focus on the fact that you may have: a car payment, a mortgage payment, and if you choose to have kids, factor that in. 6 figure debt for a degree that hardly ever brings in 6 figures is a risky proposition.

With this said, I LOVE this field, I just know what I am getting into, and I make it work for my needs. You should do the same.

Why OTs don't unionize is beyond me.

 

[CoolRunning]

Don't be scared. Just know the climate we are in and make it work to your advantage. It all depends on what your needs are.
* Think twice before you go to a school which is expensive. If you are paying 6 figures for an OT degree you're making a mistake if paying that back is a problem. Maintain a focus on the fact that you may have: a car payment, a mortgage payment, and if you choose to have kids, factor that in. 6 figure debt for a degree that hardly ever brings in 6 figures is a risky proposition.

Do you think employers even care which OT school you went to? Or does it matter that we just get our degree and pass the OTR exam?

 

[occupationalguy]

Do you think employers even care which OT school you went to? Or does it matter that we just get our degree and pass the OTR exam?

For 99% of you working as OTs NO - no employer will ever care what school you went to. Ask clinicians in our field; no one cares what school you went to, or how tough your classes were. I have never met a clinician who was ever asked his/her GPA. You will however be asked about what debt you have when you apply for a mortgage or car loan, or need a credit card. Many of us have debt over 100k. Our salary is gonna be like 60-80k max. Remember that.

You will be asked if you are credentialed and licensed to work as an OT. You will also be asked what relevant job experience you have. This isn't undergrad or law school. No one will ask your GPA or care much where you went.

For those of you planning an academic career: I think that where you went to school may be somewhat important. Most important is your work as a clinician, and your research credentials, and who you worked UNDER. Those of you considering academic careers you're wise to pursue a PhD (4-6 years on top of the OT MS degree). I had many professors who only had a MS, and never once a professor who had an OTD. I believe the OTD is seen as a fluff degree for clinicians to add an alphabet soup after their last name by most in our field. PhD is the route to take, or a relevant additional MS degree, should you want to be an academic.

 

[NIM-NIM]

Apart from the fact that most employers do not care what school you go to, public state programs are GREAT for students of low income. I recently found out that the public OT program I am going to gives out University GRANTS for their Masters Program. According to previous students there, many individuals who got accepted into the OT program got grants 5 out of the total 7 semesters there (grants are not given during summer).

 

[occupationalguy]

Apart from the fact that most employers do not care what school you go to, public state programs are GREAT for students of low income. I recently found out that the public OT program I am going to gives out University GRANTS for their Masters Program. According to previous students there, many individuals who got accepted into the OT program got grants 5 out of the total 7 semesters there (grants are not given during summer).

Yes, you're right. I honestly think it has to be posted on top of the forum heading since we get the question so often here.
It doesn't matter where you went to school. It will have no impact on your ability to get a job. This is not law school. It's OT school.

What fieldwork experience you have (e.g. is it relevant to the environment you wish to work in) does matter. I have a bridge to sell you if you think you'll make more money based on what school you went to...

The only snag? Public programs are harder to get into because tuition is less. Spending 100k on an OT degree is simply absurd. Look at the salary stats. Your starting job is going to be 65k, and we hit a salary ceiling quick. Ot's dont make more than 90k in a high end market hardly ever; in mid markets it's more like 75k (cost of living accounts for these ranges).

 

[elischeesecake]

Hello! I am a student just accepted to a program and anticipating a few more acceptances to start next Fall. I am very much interested in a career with pediatrics, specifically NICU. These kinds of conversations scare me about getting in debt for the degree. Does anyone have experience in a children's hospital or children's outpatient (or in-home) field? Are we seeing these trends in pediatrics as well?

 

[NIM-NIM]

Hello! I am a student just accepted to a program and anticipating a few more acceptances to start next Fall. I am very much interested in a career with pediatrics, specifically NICU. These kinds of conversations scare me about getting in debt for the degree. Does anyone have experience in a children's hospital or children's outpatient (or in-home) field? Are we seeing these trends in pediatrics as well?

Hello there!

I have volunteered and interned at pediatric clinics ranging from patients with low to high income. It literally depends on where you work. When I was at a medi-cal based clinic in Southern California, occupational therapists there were paid extremely low...less than $20.00 per hour. If you go to an outpatient clinic where over 60% of patients are on medi-cal, be prepared for your employer to say that they cannot pay you extremely well. Medi-cal in Southern California pays around 30-36 dollars for a half hour session, and for the rest of the half hour...an extra $6-8. This does not account for how much your employer takes to pay themselves, rent, etc. of the facility. Also, in pediatrics, you cannot "rack and stack," meaning treat multiple patients at a time to get more billing.

If you go to an outpatient pediatric clinic in a well-off area that DOES NOT ACCEPT MEDI-CAL/MEDICAID, you can get paid pretty decently. When I was working in a pediatric clinic in the beach cities of California, the therapists were normally booked. They were paid very well...I think above $40.00 an hour + benefits. However, their productivity rates were really high. The therapists always seemed stressed out too.

At hospitals, you can get paid decently. It depends on which hospital you go to. I know that for the NICU, it is very hard for therapists to get into. You have to not only have the experience, but the connections to get into the NICU. However, some therapists argue that hospitals are the best place for pediatrics.

The trends in the therapy field are pretty consistent. We have a lot of students coming out with a lot of debt, and asking for better pay because they got a degree at an expensive school. You will see high productivity rates at places that give you higher pay. Due to a bill that passed 1997, you may find the therapy cap to be extremely annoying depending on where you work. However, I find that the field of therapy is a good field to get into. Occupational therapy offers stability, decent pay (as long as you do not bury yourself in debt), and you are helping others gain their lives back.

I have had therapists tell me that if this is your passion, you will find ways to pay for it. I have had other high ranking therapists tell me it is not worth going into the field if you are going to put yourself through 100k+ debt. However, financial advisors have always suggested that if you go to school, you do not want to get into debt that is higher than how much you will get paid the first year (unless you are going to be a highly paid surgeon and whatnot).

In my opinion, do your passion, but do so knowing what your reality is.

Overall, it really depends where you decide to go.