OT or PA: Which to Be?

If you are drawn to the healthcare field—and you’re interested in obtaining a master’s-level education—you may find yourself considering two different professions: occupational therapist (OT) versus physician assistant (PA).

There is no one-size-fits-all career path, but to help you weigh these two options, this post will cover key considerations.

As an OT, I am biased toward the rehabilitation field 🙂 I also have more knowledge about the world of rehab, so I am very thankful to have Holly Solt, PA-C, weighing in on this piece!

General similarities between the OT and PA skillset

When I set out to write this article, I expected the “differences” section to be much longer than the “similarities” one. I was surprised to find that the two professions have more in common than most people probably realize!

Empathy within reason

Regardless of whether you’re an OT or a PA, you’ll work with the general public—and you’ll do so when people at their most vulnerable. That’s why the best OTs and PAs are empathetic, caring practitioners who enjoy working directly with people. That said, if you are overly empathetic, it can lead to taking on your patients’ burdens and pain—so it’s important that you are able to set personal boundaries to avoid caregiver burnout in either role.

Coloring between blurry lines

When you work in healthcare, you’re required to follow rules…lots and lots of rules. Your environment will be highly regulated as either an OT or a PA, as HIPAA and other considerations must always be top-of-mind. At the same time, these roles often have a somewhat nebulous nature; patients are human beings, after all, and the same diagnoses can present in very different ways across different individuals. If you’re too rigid—or if you cannot stand rules and regulations—you may find both professions challenging.

Independent, yet collaborative

Both OTs and PAs should feel comfortable making decisions independently, but they also need to be team players. Because both types of practitioners operate on multidisciplinary healthcare teams, they must be good communicators who can speak in medical terms with their colleagues—but also communicate clearly with patients and families.

Documentation skills

This is healthcare, and a huge part of the work is, unfortunately, documentation. Whether you’re an OT or a PA, you’ll need to create documentation that is thorough, yet concise. You’ll be expected to know how to use documentation to communicate with other practitioners, keep an accurate record of patient care, and protect yourself and your license.

Breadth of knowledge

If you like to have complete mastery over a narrow subject matter, these two career choices might not be for you. That’s because, although both OTs and PAs can specialize, they are effectively generalists. Most of the OT and PA jobs out there require a wide breadth of knowledge on numerous diagnoses and interventions. And, both roles require you to be open to learning new things every day. With many patients, you may not “have all the answers” upfront. Instead, you will deliver steady, incremental care—which might be exactly what they need.

Both are cost-effective forms of care

OT provides a great alternative for patients who might otherwise jump to surgery or expensive pharmaceuticals, and PAs are frequently employed by hospitals to support physicians’ work at a lower cost.

Job opportunities

I was surprised to find that the Bureau of Labor and Statistics noted 160,000 OT jobs in 2024, with an anticipated job growth of 14% over the next decade. Similarly, 162,700 PA jobs were recorded in 2024, with an anticipated job growth rate of 20% over the next decade.

Both can own private practices

Both OTs and PAs work under physicians, but this doesn’t mean they can’t start their own practices.

If owning a private practice is important to you, I encourage you to do your own location-specific research on this topic, as practice ownership regulations vary across states (and countries). If you’re an OT, you can start by checking out our article, “Resources to Start (and Grow) Your OT Business.”

Both offer many opportunities for sub-specialization

I realize that I might contradict myself a bit here, because I said above that both PAs and OTs largely function as generalists. While that’s true, both professions do offer plenty of opportunities to specialize and sub-specialize. For example, as an OT, you can go into mental health, pelvic health (with a focus on men or women), or low-vision therapy. As a PA, you can work in orthopedics, women’s health, dermatology, and many other areas.

If you’re excited about OT-related specialities, be sure to check out my article, “Where to Go with an OT Degree.”

Key differences between the two careers

Despite their similarities, OT and PA are different in several ways—and these key differences are significant, so you’ll want to pay close attention to this section. The ways in which the two fields differ should help guide you toward the one that most aligns with how you’d like to spend your time in the healthcare world. (And, if you are curious about the differences between OT and other types of rehab therapists or even mental health therapists, check out our deep dive in this post: “The Different Types of Therapy and Therapists.”)

The actual work

OT: The focus is solely on therapeutic treatment

When I was considering a career in occupational therapy, I knew that I wanted to walk with people through their most challenging times. (This is probably why I also considered being a pastor or counselor.) I also knew that I was interested in championing people who are most in need of support—like the elderly, those with disabilities, and those with serious and persistent mental health challenges.

I was drawn to occupational therapy because it was a great launching point for working with these populations on collaborative problem-solving and the hard work of healing. Personally, I was never interested in pharmaceutical management of health conditions, even though I know this can be an important part of the healing process.

PA: The focus is on diagnosing conditions and prescribing medication/treatment

Our co-author, Holly, was drawn to the PA world largely due to her personal healthcare experiences with physician assistants—the most pivotal being her mother’s battle with cancer. This initially piqued Holly’s interest in finding a career in the healthcare field. Later, during college, Holly met a physician assistant who was one of the most caring, determined, and knowledgeable people she had ever known—and she was inspired to follow the same path!

Time with patients

OT: Longer individual treatment sessions for shorter durations

In general, rehabilitation professionals provide interventions during longer (usually 20–60 minutes) and more frequent (as often as 2–3 times per week) sessions—but these sessions occur over a shorter time frame (typically 4–12 weeks). This means you’re getting to know patients more quickly, and you’re often saying “goodbye” indefinitely when you’re done treating them.

PA: Shorter individual treatment sessions for longer durations

Both PAs and OTs work with patients on an ongoing basis, but the setup is a bit different for PAs. They’ll typically see patients for shorter individual treatment sessions (15–30 minutes), but these visits are often spread across many years rather than discrete, bookended care periods. Similar to family physicians or primary care physicians (PCPs), PAs develop lasting relationships with patients—but the actual time spent together during appointments can sometimes feel a bit rushed. Note that specialized PAs might see patients more frequently, depending on the type of care they provide.

The stress of emergency situations

OT: There are no OT emergencies

Even though I felt drawn to healthcare from a young age, I also saw how my mom’s work as a nurse sometimes ate into her personal time. Being in a profession that provides round-the-clock care meant being involved in emergency situations—and sometimes working hours that weren’t ideal. While I care deeply about helping, I questioned whether this type of care was the right fit for my personality. I greatly value my personal time.

At my first job, whenever our team got stressed about coverage and scheduling, my rehab director reminded us that “there are no OT emergencies.” This definitely felt like the right culture for me!

OTs do still have to work on weekends in some cases, depending on the setting. In fact, therapists in most settings are expected to work some weekends and holidays. However, working odd late or early shifts is not super typical for OTs.

PA: There can be PA emergencies (depending on your setting)

PAs often find themselves working shifts more like the ones my mom dealt with as a nurse. This can include nights, weekends, super early shifts—you name it. Of course, certain specialities, like dermatology, typically provide a more traditional schedule. But if you work in a hospital environment as a PA, you might roll your eyes a bit when you hear the rehab staff complaining about having to work weekends 🙂

Furthermore, the work itself can be stressful. Sure, we OTs know the fear of seeing a patient’s face go pale and having to scramble frantically to prevent a fall. But PAs often work in medically complex, truly life-or-death scenarios. If you thrive in high-pressure situations, PA might be a great fit for you!

Differences in schooling

Let me quickly touch on educational similarities first. The length of both programs are similar: around 2.5 years. The actual course work has some similarities early on (it is not uncommon for PAs to take foundation courses with rehab professionals). At the end of either a PA or an OT program, you’ll need to pass a national exam in order to get a license. To keep that license active, both professions must complete a certain number of hours to maintain “continued competency” (there are a few exceptions in the OT world). That’s where the similarities end, though.

The curriculum itself

I encourage you to check out this example PA curriculum and look at this example of OT courses at my own alma mater. As the programs advance, you’ll see that the course content diverges—and you might find yourself drawn to one field over the other.

Overall, based on the programs I have reviewed, it also appears that PAs spend slightly more time in clinical rotations, but both professions require quite a bit of time working under supervision before they can obtain a license.

Continued competency

One of the big differences between PA and OT is that PAs must sit for their certifying exam every 10 years to maintain their national certification. Our co-author Holly says this exam alone should not deter you from this field, as the test is geared toward everyday practice.

Differences in salary

One of the most significant differences between the two professions is pay. While I’ve clearly shown my bias toward the occupational therapy profession, I won’t sugarcoat things and pretend that our pay stacks up to our PA colleagues.

OT: Salaries are lower

According to the Bureau of Labor and Statistics (BLS), OTs earned a median salary of $98,340 in 2024. Here at OT Potential, we also delved extensively into all of the available salary data out there, and we calculated a mean (remember, that’s different from a median) OT salary of $98,833 in the US. You can learn more about how we landed on this number in our article, “Occupational Therapy Salary Guide.”

PA: Salaries are higher

According to the Bureau of Labor and Statistics (BLS), PAs earned a median salary of $133,260 in 2024. This is significantly higher than OTs’ median salary: 35.5%, to be exact. When you consider the cost of education and the significant debt burden both professions can incur, this difference can substantially affect your ability to reach your personal financial goals.

Important information to consider about salaries:

Physical therapists, who must obtain a clinical doctorate to practice, only have a median salary of $101,020. (This is slightly more than OTs, but significantly less than PAs.)

One would think that more education equates to a higher salary, but this is not always the case.

Salary in the medical field is very dependent on levels of reimbursement. Reimbursement rates are complicated because they are tied to complex systems like Medicare, Medicaid, third-party insurance companies, etc.

PAs have been very effective at positioning themselves as efficient, cost-effective complements to MD care. This has led to more positive reimbursement changes.

The same has been true for nurse practitioners (NPs), who can practice with either a master’s-level degree or a doctorate. NPs (who are grouped with nurse anesthetists and nurse midwives in BLS salary reports) make a median salary of $132,050 per year according to 2024 data.

Rehab reimbursements, on the other hand, have taken several big hits over the past decade. (This baffles me, to be honest.)

The level of reimbursement for different services in the future is anyone’s guess!

The big point that I want to drive home is that levels of reimbursement, and therefore salaries, may be drastically different in a decade.

Broad changes to our healthcare system will likely play a role in these changes—and the future of healthcare overall is uncertain.

Hypothetically, rehab services should gain traction with payers because they are non-invasive, cost-effective, and evidence-backed; for the most part, research continues to support their efficacy.

But, it is definitely beyond the scope of this article to get too detailed about projections for the future of either profession.

If you are curious about other differences between OT and PT (beyond just schooling and salary), check out our post, “Occupational Therapy vs. Physical Therapy vs. Speech Therapy.” This is also a great read if you are thinking about a career in one of the other rehab therapy disciplines and need help choosing which one to pursue.

Is it worth it to transition from OT to PA?

Let’s talk about the burning question that probably led quite a few of you to this article: is it worth it to make the switch from OT to PA?

My answer, as is so often the case, is “it depends.”

Becoming a PA is not cheap, and it’s not a walk in the park. Your earning potential will be higher at the end of it all—but you do need to factor in the time and money spent on schooling while your OT peers would be earning, saving, and investing.

We created a graphic to help illustrate the actual cost of transitioning from OT to PA. As you can see, it typically takes over a decade to break even financially.

Plus, if your gripes about OT involve bureaucratic red tape, working long hours, or feeling unappreciated, keep in mind that every healthcare profession tends to have those same complaints.

At the end of the day, if you think PA work sounds like a better match for your personality, a switch might make sense for you. It is usually easier on the body than OT, and the profession is exploding in popularity. If you crunch the numbers and find that you can make things work financially, making the switch from OT to PA might be the right move for you.

Conclusion

In any case, whether you’re leaning toward OT or PA—or you simply can’t decide which one suits you more—the best thing you can do is shadow OTs and PAs, line up plenty of informational interviews, and do personal introspection to discover what truly makes the most sense for your overall career (and life) goals.

Keep in mind that OT and PA are essentially different players on one big, overarching healthcare team. It’s always worth exploring how these positions operate and collaborate—and how any discipline fits into the bigger healthcare picture for our patients.

Happy health-caring, everyone!