Growing in Number, Shrinking in Value

In this episode of Outspoken OT, Michelle Eliason takes a hard look at the growing disconnect between occupational therapy’s rising employment numbers and its declining professional worth. According to the U.S. Bureau of Labor Statistics, OT employment is projected to increase from 160,000 to 182,100 jobs by 2034—a 13.8% jump that sounds promising on the surface. But when you compare those projections to federal reimbursement trends, a different story emerges: occupational therapists may be growing in number, but each position is worth less per unit of service than ever before. Michelle breaks down where this growth is happening and what it means for the profession. Skilled nursing facilities are projected to decline by 2.7%, which aligns with the 2024 Access to Care Report showing widespread closures and staffing shortages in long-term care. Hospitals are growing modestly at 10.8%, while the biggest jumps—outpatient practice (+25.1%), home health (+18.7%), and self-employment (+24.4%)—are occurring in sectors where reimbursement models have shifted risk and responsibility onto providers. These are the same settings where clinicians face the steepest documentation burdens, productivity demands, and payment reductions. From 2018 to 2025, the occupational therapy profession has weathered a series of financial blows. The OTA differential cut payments by 15% for assistant-delivered care, the Patient-Driven Groupings Model (PDGM) eliminated therapy visit thresholds in home health, and the Medicare conversion factor has fallen by nearly 10% in just four years. Add sequestration and the newly proposed 6.4% aggregate payment reduction for CY 2026, and it’s clear that OTs are being asked to do more for less. The system may tout growth, but its infrastructure continues to undervalue the labor and expertise that define occupational therapy practice. The implications are sobering: worth is decreasing as the payment pie shrinks, use of OT is at risk of reduction when therapy add-ons don’t increase reimbursement, yet the need for OT is rising as aging, cognitive decline, and functional deficits increase nationwide. Home health agencies still rely on OTs to improve discharge-to-community rates and prevent hospital readmissions, but their payment models now expect therapists to produce those outcomes in fewer visits and with less financial support. Michelle challenges listeners to move beyond frustration and toward action. If reimbursement systems won’t honor your worth, build one that does. Practitioners can shift into private or hybrid practice models, reform the profession from within through organized advocacy and education, and actively mentor new graduates who are entering a complex system unprepared for its realities. The future of occupational therapy depends on those willing to combine evidence with action—to speak up, show the data, and redefine value on their own terms. Occupational therapy isn’t disappearing, but its perceived worth is at risk if practitioners remain silent. Growth without respect is not progress—it’s erosion. It’s time to push for transparency, outcome-based valuation, and public recognition of what OTs truly bring to patient care: measurable, meaningful independence. Stay grounded, stay ethical, and keep saying what needs to be said. Connect with the Outspoken OT community at www.botportalceus.com or on Instagram @buffalo.ot .