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The brisk job market for occupational therapists is running into a few potholes this year. While jobs are still readily available, new OTs are not finding the starting salaries they need to support their college debt. At the same time, some settings are holding off on new hiring until they see how healthcare reform, the presidential race and, most important, future reimbursements play out.

While this "perfect storm" of conditions may put a damper on OT employment opportunities for awhile, the effect shouldn’t last long, said Lydia Ostermeier, president of the National Association for Health Care Recruitment.

2012 will be a transition year, but with the baby boomers growing older and needing occupational therapy services, and healthcare workers retiring, there is bound to be turnover of jobs sooner or later, Ostermeier said. Occupational therapy is definitely one of the strongest careers for the future, and there is job longevity there for OTs, she said. "So we have to keep the pipeline of new students and graduates robust," she said.

But Ostermeier doesn’t think its a good time for OTs to change jobs in the short-term. "If you have a job, I would suggest staying put until we see how the reimbursements play out," she said.

U.S. News and World Report ranked occupational therapy No. 10 on its best jobs list for 2012. The magazine’s annual analysis looks at salary level, job satisfaction and job growth projections, the latter from the Bureau of Labor Statistics, an arm of the U.S. Department of Labor.

BLS projects a job growth of 33% from 2010 to 2020 for OTs, with 36,400 positions being added over the decade. This rate is much higher than the overall projected job growth in the country, which is expected to climb 14% by 2020.

Market geographically driven

While jobs are readily available, the demand is not as wide open as it was five years ago, said Gail Fisher, OTR/L, MPA, a clinical associate professor who has studied OT workforce issues at the University of Illinois at Chicago. "We’re graduating more therapists now," she said. "Classes are full and there is a huge application pool, double or triple what we had before."

The drop in open positions for OTs could have a local effect for some seeking jobs, she said. "They might have to relocate or not get their preferred setting or go hourly instead of monthly on their salary," she said. "But OT has become very diversified, much more so than 10 years ago. If one setting or payment source changes, it won’t have as much effect in the job market overall."

This can be seen in Fisher’s charts of employment settings for OTs and occupational therapy assistants drawn from workforce survey data from the American Occupational Therapy Association (see sidebar.) For example, when nursing home positions decreased from 1997 to 2006, jobs in schools increased. From 2006 to 2010, that trend reversed again.

Historically, rural areas and small towns pay more to draw recruits, and that hasn’t changed, Fisher said. This plays out in the locations BLS pinpointed as offering the highest OT salaries. The small town of Elizabethtown, Ky., population 28,531, ranks as No. 1 in the nation with annual mean wages of $98,920. Other small cities on the top 10 list for OTs include Amarillo and Beaumont, Texas; and Coeur d’Alene, Idaho.

But some major markets made the bureau’s Top 10 list for salaries as well, including the Dallas/Fort Worth area, Las Vegas and San Francisco, showing there is a geographically wide range of OT needs.

While six figure salaries are available, the average annual wage for an OT is $74,970, or $36.05 an hour, according to the BLS. But the bureau said that one-quarter of OTs make less than this — $61,520 ($29.58 an hour) or less — and one in 10 OTs make $49,980 ($24.03 an hour) or less.

The OTA job market is even more robust. According to the BLS, OTA job growth is expected to rank 12th among professions with the largest job growth over the decade ending in 2020, with a predicted 45% increase in employment. This translates into more than 50,000 new jobs for OTAs.

Salaries for OTAs range from $33,110 for the lowest 10% of the workforce to a high of $70,790 for the highest 10%, according to the BLS. Average salary for OTAs was pegged at $51,010.

School debt problems

The current job market is a mixed bag for students graduating with debt, Fisher said. "Debt is a huge issue for graduating OTs," she said. "I have seen students with over $100,000 in debt. Some have graduate debt ... on top of their undergraduate school debt. It’s like having a second mortgage."

Tuition and fees alone for the two-year occupational therapy program at her university run $50,000 for those who live in Illinois, or $80,000 for out-of-state students.

The good news is that these students are successful in finding positions after graduating, Fisher said. "I surveyed our last class and we had 38 students who graduated last July all employed," she said. "I see a lot of jobs. There are even sign-on bonuses in some settings."

The bad news is that the available jobs are not necessarily the graduate’s first choice. "When you’re in a high-demand state, you have lots of opportunities," she said. "But if that tightens up a little bit, students will need to look beyond their preferred location."

To deal with their student debt or other financial needs, Fisher said she sees more OTs taking on second jobs. "Many don’t work just one full-time job," she said. "They are moonlighting with an hourly per diem job on Saturday or treating a few patients in their homes. That’s not uncommon and you’ll see more of that with new grads."

According to the 2010 AOTA Occupational Therapy Compensation and Workforce Study, almost one in three OTs work in a second setting, averaging six hours a week, Fisher said. Hospitals, skilled nursing facilities and home health are the most common settings for the second job.

Healthcare reform uncertainty

Because of the uncertainty of how the healthcare reform law will play out, or whether it will be struck down by the Supreme Court, hospitals and other healthcare settings have been cautious in hiring, Ostermeier said.

"This is a slow time for postings, even for internships," she said. "This is usually the biggest hiring time — the first and second quarter — but there are not as many postings around the nation. Across the nation, hiring has slowed across the board."

Ostermeier, who also is director of nursing and patient care services recruitment for Indiana University Health, said her organization of 22 healthcare centers across the state is proactively working to address potential cuts in reimbursements.

"We are financially healthy, but hiring has dramatically slowed since the beginning of the year," she said. "Everyone is waiting to see how their Hospital Consumer Assessment of Healthcare Providers and Systems scores turn out. The board and senior executives want to be cautious."

HCAPS scores — part of healthcare reform — will be compiled by the federal government based on assessments of patient satisfaction, which will affect reimbursement for Medicare, Ostermeier said. Third-party insurers are expected to follow the federal government’s reimbursement policy.

Critical areas of need — such as OT, PT and nursing — will continue to draw a demand, "but not as robust at it normally is," Ostermeier said.

This will have some impact on salaries. "It’s not causing a decrease in salaries, but what we will see this year is fewer raises and bonuses," she said. "We will be very cautious."

Jean Sulier, PT, director of rehabilitation at Scripps Health in San Diego, said California will continue with many aspects of healthcare reform, no matter what happens at the national level. "Five healthcare exchanges for insurance options are being set up right now in California," she said. "There are provisions of the law that are not going to go away. The change is inevitable, but what it’s going to look like seems to change every month."

As a result, her three-hospital system also is being cautious with new hires this year and may fill some OT positions on a per diem basis without any benefits, or "casually" meaning the OT will work as a substitute when needed.

"That’s how you get your foot in the door," she said. "You prove your value and you can get promoted to a full-time position." •

Teresa McUsic is a freelance writer.