{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/occupational-therapists/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Occupational Therapists", "soc_code": "29-1122", "category": "Healthcare", "us_employment": 162450, "median_annual_wage": 100330 }, "verdict": "SAFE", "risk_resistance": 79, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 15, "embodiment": 17, "liability_shield": 15, "trust_premium": 17, "judgment_accountability": 15 }, "reasoning": { "task_resistance": "Grading a dressing task in real time, fabricating a thermoplastic wrist orthosis to a specific joint angle, and reading whether a patient's refusal is pain, apraxia, or depression are not steps that survive being turned into a workflow — but goniometry logging, standardized assessment scoring (COPM, FIM), and discharge summary drafting do, which is why this sits at 15 rather than 18.", "embodiment": "OTs work in ICUs, SNF hallways, school classrooms, and clients' actual kitchens and bathrooms doing home safety assessments — measuring doorway clearances, transferring a 200-pound hemiplegic patient with a gait belt, molding splints on a live limb — environments nobody controls and no fixed equipment covers.", "liability_shield": "State OT licensure under practice acts plus NBCOT certification means you sign the plan of care yourself, your signature is what makes Medicare Part B minutes billable, and a botched transfer or a splint that causes pressure necrosis lands on your licence — not 18+ only because much of the day is delivered under a physician referral and an OTA can execute treatment under your supervision.", "trust_premium": "Getting a stroke survivor to attempt buttoning a shirt they failed at yesterday, or persuading a parent that their child needs sensory strategies rather than a diagnosis, depends on a rapport built over weeks of episodes of care that a new evaluator has to rebuild from zero.", "judgment_accountability": "You decide when someone is safe to go home alone, whether cognition supports independent medication management, and when to discharge or escalate against family pressure — high-stakes and genuinely ambiguous, though bounded by physician orders, established frames of reference, and payer-driven visit caps." }, "rationale": "The core of the job is physically guiding a stroke patient through dressing and transfer practice, fitting and fabricating splints, assessing a home or workplace for fall hazards, and adjusting a plan when the person cries or refuses. AI can already draft evaluation narratives, pick CPT codes, generate home exercise handouts, and pre-fill Medicare progress notes — the documentation load that eats OT hours is genuinely exposed. But treatment delivery requires licensed hands in a room, and state licensure plus payer rules make the OT personally accountable for the plan of care.", "outlook": "Demand grows with an aging population and OTs stay employed, but expect documentation-driven productivity quotas to rise as AI absorbs the paperwork — the winners will be those in specialty, hands-on, or environmental-assessment niches.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "CMS tightening the Medicare Part B requirement that an OT (not an OTA or AI-assisted workflow) personally perform and sign the initial evaluation, reassessment, and discharge — plus state practice acts adding explicit language that AI-generated plans of care require licensed OT authorship and personal attestation. AOTA has already pushed model language on AI documentation attestation; several state boards (e.g., telehealth-era rule updates) are the venue to watch.", "plausibility": "plausible", "would_add": 3 }, { "dimension": "liability_shield", "change": "Malpractice carriers and hospital credentialing bodies adding a condition that AI-drafted evaluations/discharge recommendations are only covered if countersigned by the treating OT with documented independent review — the same mechanism radiology insurers have used for autonomous read tools.", "plausibility": "plausible", "would_add": 2 }, { "dimension": "task_resistance", "change": "Task-mix shift: once documentation, CPT coding, HEP generation and Medicare progress-note pre-fill are fully automated (already in motion via Netsmart/WebPT/Raintree AI scribes), the residual job is almost entirely hands-on assessment, splint fabrication, home-hazard judgment and behavioral de-escalation — the tier AI cannot reach. This raises the share of the day that is AI-resistant without any new law.", "plausibility": "already happening", "would_add": 3 }, { "dimension": "judgment_accountability", "change": "Expansion of OT sign-off authority on consequential calls: driver-fitness and return-to-work determinations, guardianship/capacity input, and discharge-destination safety recommendations. State DMV medical advisory board rules that name OT driving rehab specialists as the assessor of record, and workers' comp statutes accepting OT functional capacity evaluations as binding, both already exist in some states and could widen.", "plausibility": "plausible", "would_add": 3 }, { "dimension": "trust_premium", "change": "Growth of cash-pay niches where the buyer is explicitly purchasing a human's hands and presence — pediatric sensory/feeding therapy, hand therapy (CHT), lymphedema, and private home-safety consulting for aging-in-place. Parents and adult children of aging clients already reject app-delivered substitutes; if payer coverage stays thin these segments grow as out-of-pocket markets.", "plausibility": "already happening", "would_add": 2 } ], "ceiling_note": "Already at 79 with high embodiment and trust; realistic headroom is a few points at most. The countervailing pressure is real: if AI documentation makes each OT able to carry a larger caseload, or if payers push more delivery to OTAs and aides supervised remotely with AI-generated plans, headcount can fall even as the remaining role scores higher on every dimension. A high score protects the occupation's character, not its worker count." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 126050, "wage": 83200 }, { "y": 2018, "emp": 126900, "wage": 84270 }, { "y": 2019, "emp": 133570, "wage": 84950 }, { "y": 2020, "emp": 126610, "wage": 86280 }, { "y": 2021, "emp": 127830, "wage": 85570 }, { "y": 2022, "emp": 134980, "wage": 93180 }, { "y": 2023, "emp": 144840, "wage": 96370 }, { "y": 2024, "emp": 152280, "wage": 98340 }, { "y": 2025, "emp": 162450, "wage": 100330 } ], "from": 2017, "to": 2025, "change_pct": 28.9, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [], "license": "https://cookedindex.com/terms" }