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How to maximize your salary in the world of therapy

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An article for physical, occupational, and speech therapists

Editor’s note: Today’s guest post is the first of its kind here on Look for Zebras – an article geared toward professionals in the therapy field. Author Abbey Guzek, M.S., OTR/L has deliberately worked to maximize her own earnings and growth as a therapist. Now, she shares her insight with us. If you want to learn how to make more money as a therapist, read on!

About the author:

Abbey Guzek, M.S., OTR/L is an occupational therapist specializing in the pediatric and senior populations. In addition to her occupational therapy work, Abbey is a freelance writer and recent blogger with a focus on holistic health and wellness in addition to sensory feeding strategies for families with children in need. You can find her at www.greensandicecream.com.

Many therapists don’t realize the significant differences in salary across the settings you can work in as a physical, occupational, or speech therapist. Thus, it is difficult to know what to expect when looking for jobs or exploring other settings. After working in many settings, talking with other therapists, and using my skills from those darn expensive college research courses, I’ve determined where you can get the most cash for the hard work you do. After all, you’ve earned it- after the years of school and lives you change with your work every day! Below I rank 9 of the common settings from least to highest earnings.

1. Schools

Unfortunately, this setting is the lowest paid in the therapy world. Summers & holidays off? Sort of makes sense. If working in a school is your true passion as a therapist, you can maximize your salary by going through a recruitment agency to a school in need. Some school districts will put therapists on the same track as teachers which could eventually mean you can make a decent living and you’ll be set up with their benefits and retirement.

2. Outpatient pediatrics

Kids growing and developing are the rewarding parts of this field. You can see progress quickly, therefore it is a lot easier to fill these positions. Something to watch out for in pediatrics is guaranteed salary vs. pay per patient. Pediatrics typically have very high patient cancellation rates. You’re gambling a lot if you sign a contract agreeing to get paid only for the patients you see.

3. Outpatient adults

Outpatient is in the lower paying area, but there can be some pros. Many are small businesses or franchises with flexibility. They are typically less stressful because the patients are not medically fragile & they are close on holidays and weekends. Consider looking into outpatient providers that have their clinics in a senior living facility for they offer a bigger pay in this setting.

4. Home health pediatrics (early intervention and home health)

If you want to work in pediatrics but don’t want to give up your daily coffee runs & can still afford your student loans, this may be your niche. Early intervention is very rewarding but it can be tiring as you are interacting with a lot of parents with higher levels of anxiety. Many companies are starting to expand to home health pediatrics where you can see kiddos from ages 0-18. They pay higher because their cancellation rates are a lot lower when you are traveling to them!

5. Inpatient rehab and acute care

Pay in hospital is typically right around the average, unless you specialize in a certain unit such as burns or the NICU. Many hospital systems put therapist on a track so there isn’t a lot of negotiation, but you can guarantee and expect when your pay will increase. Another pro is that since most hospitals are nonprofits, you can look into student loan forgiveness programs, if that is a concern.

6. Skilled nursing facilities

These areas are typically paid a lot due to the expectations in the setting. It can sometimes be super stressful because of the pressure to get therapy in minutes and due to medically fragile patients. They usually pay overtime for therapists who are willing to put in the extra hours in the evening or weekends.

7. Home health

Home health is the most flexible and the highest paying for a full-time job. Home health will typically pay overtime if you have overages in caseload numbers for the week. The cons can be the travel between homes, going into homes, and the mileage on your car. I have found a hack for home health which is an upcoming area of practice, the “senior living facilities.” My patients live in controlled setting and typically all of them live in the same apartment building which cancels out a chunk of the travel and allows me to see more patients.

8. Travel therapy

Travel therapy is notorious for paying high rates due to the positions being in facilities that are having trouble filling the openings. The travel pay will also depend on the city and the population/setting you are serving. Typically, travel therapy offers bonuses and incentives when you sign a contract (the average seems to be 13 weeks). Remember, there can sometimes be unpaid gaps between contracts which should be accounted when projecting your income for the year.

9. Per diem (PRN) therapy

Finally, the best way I’ve found to make great money in the therapy world- the art of per diem work. If you have a spouse or partner fall back on and reap their health insurance benefits, per diem work could be a great gig for you! The positions are usually paid per hour or per patient at a very high rate. I recommend getting multiple bookings for this job – some with flexibility and guaranteed hours in others. For example: a PRN hospital job may give you two days a week, however you can occasionally cut these hours if the census is low. You could then tell your home health PRN job you can pick up a couple patients on those days. The high hourly rates add up quickly if you can ensure you will get the hours.

Other considerations

  • You can work towards a ‘promotion’ to gain higher earnings. Possibilities include: rehab director, clinical lead, clinical manager, or therapy manager.
  • Each city pay ranges can vary a lot. When I moved from Pittsburgh to Charlotte, I more than doubled my salary. This was 1. because of the city and 2. because I was working in pediatrics and switched over to home health when I moved. The five highest paying cities for occupational therapy are Peabody, Massachusetts, Longview, Texas, Las Vegas, Nevada, Colorado Springs, Colorado, & Lubbock, Texas, per the U.S. News & World Report L.P. (2018).
  • Experience is huge in the therapy world. The years you have put in will determine where you fall on the money totem pole.
  • Open your own clinic. This is a lot of blood, sweat, and tears. I have worked for a couple of small businesses, some have thrived, others did not. You can make good money and eventually lessen your work load if your willing to put in the work and the risk.
  • Can you negotiate? Yes. I always recommend negotiating salary. A thousand bucks could be a vacation or a month of rent. I like calculating out all my benefits in terms of money if for some reason, I can’t negotiate PTO or other benefits. Because time is money. The best way to negotiate the salary for a therapy position is per hour or patient. A buck or two an hour seems like a lot less for the payer but when the math is done it adds up to a lot over the course of a year.


U.S. News & World Report L.P. (2018). How Much Can a Occupational Therapist Expect to Get Paid? Retrieved February 2, 2019, from https://money.usnews.com/careers/best-jobs/occupational-therapist/salary

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