Occupational Therapy Assistants

Tasks largely resist digitisation. Hand-over-hand cueing during a sit-to-stand, splint fabrication and heat-moldable thermoplastic fitting, grading resistance mid-exercise when a patient's tone spikes — these are the billable minutes, and none of them survive being turned into a screen prompt; the 14 rather than 18 reflects that a real slice of your shift is SOAP notes, CPT unit math, and home-program handouts that software will write for you.

Hands-on in uncontrolled environments. You work on the floor of a SNF room, in a patient's own cluttered bathroom, and in a hand clinic — transferring a hemiplegic patient with a gait belt, guarding during tub transfers, positioning a contracted wrist — uncontrolled spaces with unpredictable bodies, which is why this sits at 18 and not lower.

Licensed human required and personally liable. Nearly every state licenses or certifies OTAs (NBCOT COTA credential, state license with supervision requirements written into the practice act), and you can be disciplined for practicing beyond the plan of care — but the 12 rather than 17 is because the supervising OT signs the evaluation, the plan, and the discharge, so the ultimate professional exposure is not yours.

The human relationship is the product. Patients see you three to five times a week for weeks while the OT sees them at eval and recert, so the rapport that makes someone attempt a transfer they're afraid of is yours specifically; capped at 15 because referral flow comes from the facility and physician, not from patients choosing you by name.

Meaningful discretion. You decide in the moment whether to downgrade an activity, stop for pain, or hold treatment and call the nurse — genuine clinical discretion — but the frequency, duration, goals, and modalities are set by the OT's plan of care, and changing them is outside your scope, which is exactly what holds this to 9.