The Pros and Cons of School-Based OT

School-based OT has a fair amount of pros and cons. While I love working in this setting, I’m very aware of all of the drawbacks that come with this role, as well. Whether the pros of school-based OT outweigh the cons is a very personal decision for each therapist. But, if you’re trying to determine if this is the right setting for you, here’s a balanced look at the positives and negatives of working in school-based OT.

PRO: Spending time with the kids

This is an easy one, right? Most of us got into pediatrics because we love kids. Helping students realize their full potential is so rewarding, and it is the thing that keeps me going when I’m fed up with everything else. Kids can be so sweet, cute, and frankly, hilarious. If I’m ever feeling bogged down with paperwork, I know I can pretty much guarantee I’ll forget about it for 30 minutes passing the time with one of my students. 

CON: The toll it takes on your body

I love, love, love working with kids. But there’s no denying it can be EXHAUSTING. If you’re spending the majority of your day treating students, it’s easy to get worn out quickly – especially if you’re working with younger or more active children. School-based OT positions typically involve a lot of squatting, kneeling, getting on the floor, and sitting in chairs that are way too small for you. And don’t assume that just because it’s not a medical setting that transfers are off the table – I’ve worked with many a high school student on positioning that weighed just as much as an adult.

In the short term, this might just result in being tired when you get home from work. But in the long-term, as OTs we know the effect that repetitive movements, poor body mechanics, and physical stress can have on a person. Even if you’re young now, it’s very easy for this kind of stuff to catch up with you faster than you realize. 

PRO: Enjoying a great schedule

It’s hard to beat a job where you can realistically be off work by 4pm every day! Plus, having weekends, holiday breaks, and summers off doesn’t hurt either. This is pretty much the best OT setting you can work in if you have kids of your own, but even if you don’t, the consistency and extensive time off is really nice for planning vacations. 

CON: Only getting paid for part of the year

As much as people like to joke about teachers and other staff having it easy by having summer and winter break, the reality is that you don’t get paid for that time. Yes, there are some districts that are happy to split up your paychecks across all 12 months, and it is possible to budget for this time off. But taking a school-based OT position does mean that you’re potentially giving up a full-time job where you get paid all year round. Many school-based OTs choose to spend their summers working PRN jobs to offset this, so that 2-month vacation may not actually be your reality.

PRO: Getting to consult and collaborate

I love the school-based setting because it offers so many more opportunities to work with a team. In so many other settings, therapy is just something you “do” to a person once a week. But in the school setting, there is a shared understanding that we should be looking at strategies that the student can implement every day in order to more effectively access their education. This means working with teachers and other staff on how to best support your students in the classroom, and when it works well, this type of problem-solving is so fun to me. 

CON: Not everyone will understand or appreciate best practice

In theory, we all know that collaborative practices are in the best interest of our students. In practice, you may have to spend a lot of time educating your teams on this. I’ve met some great people working in education who are excited about OT’s full scope of practice, push-in services, collaborative goals, etc. But I’ve also known a lot of teachers, administrators, and even other school-based OTs who are very resistant to the idea that OT should be anything other than a 30-minute a week pull-out service that works on fine motor skills and handwriting. Things are definitely improving, but there’s still a lot of work on the ground to be done in updating school-based OT practice, and that can be a frustrating and demoralizing position to be in. 

pros and cons of school-based OT

PRO: The opportunity to get paid well

School-based OTs have the opportunity to be compensated very well. In California, it’s not uncommon to see school-based OT roles that are posted for over $100,000 a year. School-based OT pay is also typically very transparent, so if you feel that you’re not being paid what you’re worth, it’s easy to look up salaries to compare. Plus, if you’re interested in travel school-based OT, you can take home even more pay!

CON: The opportunity to get paid poorly

But, on the flip side, there are a lot of states and areas where school-based OTs are not being paid what they’re worth. These tend to be the same places where teachers are paid poorly and don’t have much bargaining power, or even a union at all. So, while it’s possible to make great money in school-based OT, if you’re locked down to a specific state/area, you may be making half of what you could be making in another setting. 

PRO: Having opportunities to reduce student loan debt

Because public schools are nonprofit, working in one may qualify you for Public Service Loan Forgiveness (PSLF). Be sure to read up on the details of this program to see if it makes sense for your personal situation. I have also heard of school-based OTs qualifying for teacher loan forgiveness programs

CON: Getting your debt reduced is harder than it may seem

While it has made some recent improvements, PSLF has been notoriously hard to qualify for, with only 1% of over 29,000 applications being approved in its first year. PSLF also requires that you work for 10 years in a government agency or non-profit. So if you’re in one of those low-paying states, you may actually be better off working in a higher-paying job that doesn’t qualify. And lastly, as PSLF requires you to be employed directly by a non-profit, contract therapists are usually not able to qualify, even if they’ve been doing the exact same job as their district-hired counterparts. 

PRO: Having variety in each workday

No day is ever the same when you work in the school system! Unlike a lot of office jobs, I pretty much never have a day where I sit at my computer writing up the same piece of paperwork all day long. Instead, I get to split my time between seeing students, evaluating, observing, documenting, checking email, traveling, talking with teachers, training staff, ordering equipment, meeting with families, treatment planning, etc. My brain tends to crave novel experiences, so I love that my job rarely feels boring. 

CON: Trying to manage an unreasonable workload

As much as the variety can be fun, sometimes it feels like running around like a chicken with your head cut off, especially if you’ve been assigned a workload that is too large. High caseload numbers and a lack of understanding of all the other tasks required of us often create untenable situations. School-based OTs often feel pressured to work off the clock or take work home. Not every district is like this, and even when the pressure is there, it’s possible to set boundaries and say no, but this remains probably the #1 issue school-based therapists are struggling with. 

PRO: Working with great coworkers

I love working with teachers and other school staff. Unlike other workplaces, pretty much everyone working in education is there because they care about children and want to help them succeed. That’s a pretty impressive shared goal that you don’t really see in for-profit workplaces. Yes, every now and then you’ll meet someone that gets under your skin – and teacher burnout is just as real as OT burnout – but all in all, the coworkers I’ve had in the schools are head and shoulders above the ones I’ve had in previous positions. 

CON: Working with people who don’t understand or appreciate OT

Even though you likely have the shared goal of helping children succeed, your coworkers may have a much different idea of what that looks like. They may not know what OT is at all. They may THINK they know but have a really inaccurate perception. Or they may understand what we do, but disagree that it’s necessary or even useful. It is also incredibly common in the schools to be managed by someone who is not an OT and does not fully understand OT. This can be especially challenging because school-based OTs have a unique set of needs and issues – caught between being medical professionals fitting into an educational context, or educational professionals who also have a separate medical license and set of laws/regulations to worry about.  

PRO: Getting to see visible progress

I’ve worked in several other OT settings, and one of the hardest parts of this profession is that progress can be slow. But in the school setting, it moves much more quickly. Of course, you have the natural advantage of working with a client who is still growing and developing, which usually results in more visible progress. But schools are nice because you are not the only person who is working with your client. They have teachers and other providers who are invested in their success and progress as well. And as a general rule, kids tend to have more family support than adult clients which is huge for carryover.

pros and cons of school-based OT

CON: Dealing with situations where the progress isn’t so visible

When everything goes right, helping students grow is so rewarding. But you will always have situations where that isn’t the case. It’s not fun to tell a family that their child is no longer progressing and wouldn’t benefit from OT anymore. It’s also not fun to have a student who you think is doing well – only to be told by the parents and teachers at the IEP meeting that they absolutely are NOT, and you need to start seeing them twice as much. And while your recommendations for OT services should hold the most weight – the reality is that IEPs are a team decision, and you may end up having to provide OT to a student who doesn’t really need it. 

At the end of the day, the pros of school-based OT still outweigh the cons for me. I hope this breakdown helps you determine if the same is true for you, too. And if you’re still struggling with feeling like you know what you’re doing in school-based OT, I’d love to have you in The Dynamic School OT. I’m happy to teach you strategies you can use to conquer the tricky parts of school-based practice to make sure you enjoy this job for years to come. 

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