This article will describe the top least stressful occupational therapy settings to work in. Some of it will be based on research from the literature, from public forums, and lastly, my personal opinion.
Introduction
There are two things to note:
(1) What is stressful for one person may not be for another. For example, you may feel like working with children in pediatrics is stressful. On the other hand, another occupational therapist may thrive in this environment and enjoy working with this population.
(2) Work settings can change over time. As the pandemic has shown us with working from home, work settings can change over time. Even within the world of occupational therapy, some therapists have pivoted to working remotely with virtual consultations and telehealth. Anecdotally, most OT still remains largely in-person. However, if the idea of working in your pajamas appeals to you, working from home as an occupational therapist is a possible reality in today’s 2021.
This means what was hot and popular for being the least stressful in 1997 may not be applicable today due to changes in client expectations, funding, insurance, work culture, competition from other similar professions, and community needs. Clients are becoming more informed consumers with the ability to research on the internet and conversate with social media in today’s more connected world.
This also means that things may have changed even in recent years. For example, acute care may have been the least stressful setting, but with the pandemic and COVID-19, it may have actually become the most stressful setting.
“Overall I think acute care is one of the least stressful settings. I do what I need to do and that’s it. I don’t to take my work home with me. I don’t worry too much about productivity. Yes we have requirements but is a lot less than SNF and IPR. Plus it’s a given in acute that you’re not going to meet productivity most days. You’re working around patient availability, if they’re medically appropriate to be seen , going off unit for tests. Etc. You just see who you can and that’s it.” – pinotdawn, Reddit
While many of pinotdawn’s point about acute care are true, acute care has had to be very flexible and adaptable with the day to day changes of COVID-19 – especially during the height of the pandemic when some were told to not even wear masks when working with COVID-19 patients or when there was a PPE shortage and no N95’s to go around. Do we wear PPE? Can we allow visitors? How do I find time to call family and update them? Is this billable? Etc. This may be stressful to some people.
Is Occupational Therapy Stressful in General?
Occupational therapy in general made it on the top 16 least stressful jobs according to US News in 2021. Stress itself can be a very broad term. Factors that contributed to meeting low stress according to US News included earning potential, quality of life, flexible scheduling, safe working conditions, and work-life balance.
Job growth in the field is expected to be strong in the years to come, and workers can choose from a variety of employment settings. – US NEws
Other reasons that occupational therapists may perceive the profession to be less stressful and less prone to burnout include autonomy, the meaningfulness of work, flexibility, and my personal opinion, OT can be fun!
If you are considering a career in occupational therapy, it is well worth looking into compared to other professions such as nursing, physician’s assistant, and physical therapy that may include high patient ratios, physical demand on the body, and/or patient responsibility/liability. Occupational therapy is susceptible to these factors as well, but not as much due to the focus of the profession’s on meaningful occupations and participation in functional activities.
Early Intervention (Pediatrics)
“COTA here. I did EI for 5 years, and, while I loved it, the cancellations and driving became too much.” – kablammywhammy, Reddit
Early intervention involves working with children and their parents. This setting is often outpatient and the patient’s home. This means you need your own car, to put mileage on your car, and spend more time on the road. Cancellations may be common and you are often tasked with the logistics of scheduling and interfacing with clients instead of this being done for you by scheduling or managers. This potentially means less treatment time. However, EI offers a lot of flexibility to say, stop by at home to eat lunch or pick up your children from school. OTs working in EI get to work with their clients in their own natural environment compared to say, the hospital setting. This also provides a change of scenery compared to working in the same physical space every shift. You may even be able to deduct some expenses such as mileage, gas, parking, and toll for tax purposes.
Pros
- More Autonomy
- Less supervision
- More flexibility in scheduling
- Working with children
- Change of workplace scenery
- Tax deductions for mileage, etc.
Cons
- Driving and spending time on the road, including in traffic (depending on your service area)
- Putting mileage on your vehicle
- Cancellations
- Working with families can be stressful
- Documentation can pile up if you are not on top of it
- You need to bring your own supplies and materials to each session
Adult Daycare (Outpatient)
Adult daycares are settings where adults (often older adults) go for community, socialization, and less intensive rehabilitation. Transportation may be provided to the facility by shuttles from patient’s homes and assisted living facilities (but not SNFs because rehabilitation is provided in the SNF setting). Patients spend varying hours at this setting during the day and go home at night. This means the OT has the same hours. OT are not required to be available on staff at all times. OT includes individualized treatment based on patient’s needs such as safety and fall prevention, exercise, fine motor skills, socialization, and community reintegration.
“The functional approach used by occupational therapy helps the older person overcome multiple disablements associated with aging. Intervention promotes independence, adaptation, and the maintenance of occupational performance in self-care, work, and leisure. Working collaboratively with the day-care staff, participant, and family or care giver, occupational therapy personnel use their expertise to analyze activities and facilitate problem solving. Occupational therapy personnel may also work as administrators, activity coordinators, and consultants within the adult day-care setting.”
Pros
- Community and positive milieu
- Patients are often mobile and require less assistance
- Easier on your body
- Slower pace
- Lower patient acuity (less sick)
- Lower or no productivity demands and expectations
- Workplace flexibility
- Opportunity to mentor occupational therapy students
- Flexible roles
Cons
- A less common setting for OT positions
- Harder to find full-time hours
- May pay less compared to other settings
Outpatient Behavioral / Mental Health
Clients often benefit from programs such as outpatient behavioral health. These settings include interventions such as CBT, DBT, stress management, mindfulness, counseling, and more. Compared to other OT settings, mental health, in general, is often the easiest on your body as there is no lifting or transfers involved. Clients are often ambulatory and drive themselves to these programs. The programs are run during the day so shifts are often 8 hours shifts.
OTs in this setting may be involved with case management of several clients. If the idea of running groups is not stressful for you, then this is a great setting to work in. Groups can be very insightful and a lot of fun. One downside is the impact that clients can have on OTs mental health due to transference and low morale of clients who may be depressed. However, it’s not like settings such as SNFs do not involve mental health. Many residents of SNFs may also have conditions such as depression coupled with dementia. Clients often either drop out from these programs or graduate and reintegrate with society. It’s less likely that clients continue to ‘malinger’ in these programs and have prolonged lengths of stay as insurance is likely not to continue authorizing these cases.
Pros
- Teamwork and collaboration with healthcare staff – LMFTs, nurses, psychiatrists, counselors
- Can be fun depending on the types of groups your run and the client population
- No lifting and less physical exertion
Cons
- Running groups is not for everybody
- May involve case management (can be a pro or a con, depending on your preferences)
- Documentation: needing to document on multiple clients after sessions and keep track of each of them
- Safety concerns with clients who are a danger to themselves or others or psychotic, etc.
- May pay less than other settings
- Harder to find positions as many are filled by LMFTs
Hand Therapy (Outpatient)
“Try hospital OP hands. I went from seeing 20-27 patients a day to 5-8. Hand therapy is really fulfilling but it sucks when you work at a mill.” –kalifornian, Reddit
Hand therapy is a specialty of occupational therapy that focuses on providing well, hand therapy to clients. Responsibilities include evaluations, the use of PAMs, fabricating/modifying splints, dressings and wound care, and rehabilitation. This setting is also less physically demanding than others such as acute care or acute rehabilitation as there are no transfers involved. Clients are often very friendly and the setting is often perceived to be relaxed. However, some settings may have high productivity expectations with back-to-back client sessions. Productivity is less of an issue in private practice settings compared to larger healthcare systems such as hospitals, e.g., Kaiser. While creativity may be integrated into practice, most of hand therapy is protocol-driven. OTs are more likely to have a better work-life balance due to fewer chances of ‘bringing your work home’.
Pros
- No lifting and easier on the body
- Therapeutic environment
- Clients often want to get better are very friendly (YMMV)
- Good work-life balance
- Competitive salary and high earning potential
- Good mentorship support while getting certified and for long-term career
Cons
- Requires specialty training and certification (including CHT, PAMs)
- More protocol-driven and may seem redundant
- May have high productivity demands depending on the setting
Acute Care
According to this Reddit thread, many OTs find acute care to be a low-stress work setting.
“Acute care!! My documentation time for evals is considered Productive time. It’s the best work-life balance. I never work off the clock to document. I work in a level 1 trauma hospital so I strictly do evals most days.” –StoreSad4525
“I would say acute care or IPR I considered least stressful. You get your work load, do your stuff, and leave it all at the door when you’re done. Some hospitals have productivity requirements, but they are significantly less than what a SNF is.” –kaitie_cakes
“Acute care at a community hospital was the best. I liked working in a huge hospital system, but the ICU can be really stressful. When I was in a community / small hospital I was able to provide quality care and really enjoy it (sans the max A x 2 transfers)” –twogreenturtles
Based on these comments, it’s important to remember that even within the same settings, some positions may be more stressful than others depending on the expectations, company, client population, work environment, funding, culture, etc. So one acute care position may be low stress while another may be high stress for the same OT who compares the two positions. Potential stressors include high productivity demands, poor work-life balance, lack of OT appreciation and support by other staff, and feeling the ‘grind’.
Pros
- Autonomy
- Flexibility in seeing patients for scheduling
- Good work hours for full time, part-time, and per-diem (the hospital is open 24/7 and there are constantly patient’s being admitted)
- Job security (even through a pandemic)
- Co-treating with PTs, SLPs, and other staff
- Good exercise – lot’s of walking between hospital units
- A medical-based and medical model may include OT interventions with a variety of conditions including working in the ICU
Cons
- Can be fast-paced
- Very physically demanding
- Lots of walking involved
- Potential poor support and appreciation depending on work culture (e.g., PT is more valued than OT)
- Not a good fit if you are not flexiblible for schedule changes such as surgeries, discharges, and patient refusals for treatments.
- Difficult to transition into this setting as a new grad if you have not done fieldwork here due to the acute nature of patients
- The day can be quite unpredictable and lead to low productivity
SNF
“I’ve traveled in the SNF setting and found some facilities to be great and some that were just straight out toxic. I’ve done a few other settings and prefer SNF for now.” –
Sure_Tank_6127
SNFs often get a bad rep in the medical community and many patients often misperceive this setting as the place where their deathbed will be. This is of course not true. Like any setting, some SNFs may be better than others. Many OTs find working at SNFs to be low stress compared to say acute care and inpatient rehab (ARU). Sessions are at a much slower pace and clients are seen for longer durations. The goal is to discharge residents back to their homes and reintegrate them with the community. There is potential for a good work-life balance, but high productivity demands are often the most stressful part of working in this setting. Benefits are very good for full-time and part-time positions. While initial salary may be high, many SNFs may offer low or no raises and higher earning potential. OTs working in this setting should be cautious not to injure themselves, burn out, or have poor work-life balance from the daily ‘grind’.
Pros
- No special certifications or training required compared to other settings
- Good and consistent work hours
- Smaller team and staff sizes
- Seeing patient progress and improvements
- Good benefits
Cons
- High productivity and seeing many patients a day
- Potientally toxic culture
- Patients who do not improve with poor prognosis
- Raises are less likely and lower earning potential
Inpatient Rehab (ARU)
Pros
- Smaller caseload due to seeing patients for longer duration (30 mins to 1 hour+)
- Teamwork and collaboration with PT, SLP, RNs, MDs, PAs, NPs, SW, case management, etc.
- Seeing patients improve and progress
- High earning potential
Cons
- OTs often comment that this setting is difficult because they don’t know what to do with patients for an hour. This is largely due to OT experience, perception, and training.
- More difficult to get into this position if not trained during fieldwork. OTs often transition into this setting from acute care.
- Requires special training for CARE Tool.
- Physically demanding: transfers, exercise, lifting, etc.
- Patient showers can be redundant
- Rounding and team meetings
Schools
Another great setting for OTs is working in the school system. This setting involves working with lots of energetic students who may love OT. Some OTs may have high productivity or larger caseloads depending on the setting. This can equate to added evaluation, documentation, and meeting times. Still, this setting is very ‘OT’ as therapists can incorporate their creativity into interventions. If you do not like meetings though, then this setting may not be as good as a fit as you may sit in a lot of IEP meetings, meet with family, etc.
Pros
- Autonomous
- Creativity
- Less physically demanding
- Working with cute little ones
- Great work-life balance with lots of time off during school breaks
- Competitive pay
- Great benefits
Cons
- Documentation and performing standardized assessments
- Can be isolating as you are often the only OT
- May involve driving between schools
- IEP meetings can be time-consuming
- Family and parent dynamics and demands
- Can be easy to overspend on materials and supplies
Conclusion
While this article provides a general overview of settings that may be lower stress, each specific setting can have a lot of variation and your experience may vary. Overall, many OTs report acute care to be a good environment for lowering your stress levels compared to say, SNF. There are many settings not mentioned in this post that are also good candidates for low-stress occupational therapy work-settings. Some of these are harder to get hired in such as adult day programs, but may also be hiring as well if you look hard enough.
Good luck and don’t burn out!
Additional Reading
Least stressful OT setting
by u/eherna59 in OccupationalTherapy
Lloyd, C., & King, R. (2001). Work‐related stress and occupational therapy. Occupational Therapy International, 8(4), 227-243.
Wressle, E., & Samuelsson, K. (2014). High job demands and lack of time: A future challenge in occupational therapy. Scandinavian Journal of Occupational Therapy, 21(6), 421-428.
