The Future of OT Education: A Candid Look at What Comes Next
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Occupational therapy stands at a pivotal moment. For years, we’ve operated with an assumption that the future of the profession should be bigger, more academic, more credentialed, and more “doctorate-forward.” For a while, that vision aligned with workforce need and cultural momentum. But lately, the data tell a more complicated story and I believe that many of us in education and professional governance have been unwilling to confront directly.
Here is the uncomfortable truth:
The rapid proliferation of OT programs, especially entry-level doctorates, is no longer being driven by workforce demand, public need, or educational innovation. It’s being driven by institutional survival, tuition dependence, and a structural inability to regulate the supply of programs.
We are now in the early stages of an unsustainable cycle that higher education has seen before - and unless we recognize what the market is actually signaling, the next decade may fundamentally reshape the landscape of OT education in ways we haven’t prepared for.
Let’s walk through what’s really happening, and what comes next.
1. We have far more OT programs than the applicant pool can sustain.
The data are clear: The number of OT programs (especially OTDs) has grown steadily for the past decade, applicant numbers have not kept pace, and national seat-fill rates have dropped from nearly 100% a decade ago to around 70% today.
That means one out of every three OT seats goes unfilled.
In a functioning market, this would naturally lead to contraction: weaker programs would close, stronger programs would thrive, and the system would rebalance. But OT education does not operate under normal market conditions.
2. The system cannot correct itself because no governing body is structurally able - or legally permitted - to regulate supply.
People often ask:
“Why doesn’t ACOTE just stop approving new programs?” The answer is simple: They can’t.
Accrediting bodies are bound by antitrust (Sherman Act) limitations. They cannot restrict competition, cap programs, deny entry on the basis of “too many programs already exist,” or regulate supply in any way that resembles market control. If they tried, they’d be sued, and they would lose. This has happened in other contexts.
Simultaneously, AOTA relies heavily on accreditation revenue to fund association operations. Program closures would meaningfully reduce that revenue. This creates a paradox:
We have an accreditation system structurally obligated to expand and financially dependent on expansion, even while the applicant market contracts.
No amount of professional idealism fixes that governance architecture.
3. The Northeast (especially New York) is the clearest example of saturation.
In New York, we now have a high concentration of OT programs per capita, a shrinking college-age population, and dozens of accelerated “pipeline” models (3+2, 4+1) that guarantee enrollment even when external demand falters.
These pipelines create the illusion of program health, shielding many institutions from the natural consequences of oversupply. But pipelines cannot protect graduates from downstream realities: debt levels, employment markets, and long-term professional fit. New York is a preview of what the rest of the country will look like in 5 or 10 years.
4. As MS programs convert to the OTD, we’ve created a “race to the bottom.”
Because institutions feel pressured to remain competitive, and because a doctorate is increasingly viewed as the “safe” credential, we now see faster/cheaper/leaner OTDs taught in adjunct-heavy programs - and as a result - many OTDs differ from their former MS only in name and a few additional assignments. Right now, according to AOTA, 64.5% of curriculum is taught by full time faculty - that requires careful monitoring because this is not what doctoral education is supposed to be. Doctorates should expand identity and quality while being led by full time faculty. Doctorates are not meant to be compressed entities taught by adjuncts.
When everything becomes a doctorate, the doctorate stops signaling anything meaningful.
5. The OTA collapse gives us a warning we’re not heeding.
OTA programs have been closing across the country, driven by shrinking reimbursement, reduced employer utilization, increased minimum wage narrowing the wage premium for 2-year degrees. Why would anyone incur debt to enter a profession that pays less than marginally-skilled or entry-level labor?
OTA programs have decreased nationally by 7%. When the ROI collapses, students stop enrolling. OT programs should pay attention: this is what market correction looks like when no regulatory body is able to intervene. OT will not be spared from the same dynamics if debt loads continue rising while salaries remain flat.
6. So what is the future of OT education?
As OT education enters a period of resource strain and market instability, ACOTE must modernize its standards with an eye toward clarity, efficiency, and demonstrated impact. Equity and inclusion remain important values, but they should be embedded in meaningful educational practices rather than layered on as additional compliance tasks. The future of OT education requires a leaner, outcomes-driven accreditation system that strengthens core clinical and scientific competencies while eliminating administrative burden that adds cost without improving program quality.
Absent dramatic federal policy shifts (e.g., loan reform (happening underneath our feet - so some of this is already coming) or gainful employment regulations), here’s the most realistic forecast for the next decade:
a. Many programs will struggle, shrink, or close.
Ironically, this may not be a bad thing. This will not happen suddenly, but gradually, as seat-fill drops, budgets tighten, and outcomes no longer justify cost. I am hopeful that in the northeast in particular that small and resource-constrained programs will become pre-health feeders for resourced institutions. These programs, ultimately, will not be able to legitimately convert to doctoral level education anyway.
b. Differentiated programs will thrive.
The programs that survive will be those that offer something fundamentally more compelling than “We have an OTD because everyone else has one.” The future belongs to tech-forward programs that are focused on innovation and interdisciplinary training environments. Programs that develop the therapist-engineers, therapist-designers, therapist-inventors, and therapist-researchers the next century will require.
c. Transparency will become the new currency.
Students and their families are already demanding true cost of attendance, median graduate debt, and information on starting salaries. Under-resourced programs that try to hide behind marketing language will lose credibility (and pass rate compliance) quickly. Again, look at OTA as an example - >20% of programs are experiencing pass rate compliance problems. The accelerated MS models that are moving toward open enrollment to maintain revenues will see this same dynamic soon.
d. Capstones will have to evolve or be replaced.
Right now, capstones range from incredible to meaningless. Doctoral work will need to align with innovation, research translation, systems redesign, community impact, or technology development. “Another literature review” will not cut it. The market does not want it, and the market will not reward it.
e. The profession must rethink what a doctorate means.
This is related to d. (above) - but if the OTD is going to survive as a meaningful degree, it must deepen, not flatten, the professional identity. We have to reward intellectual rigor and cultivate creators, problem-solvers, and system-thinkers. We must produce practitioners capable of expanding what OT can be, not merely repeating what OT has been.
That is why we need OT programs in resourced contexts with qualified full-time faculty.
7. The path forward is not to stop change, but to make change meaningful.
We cannot regulate our way out of oversaturation or accreditation-process our way into quality. It is also clear that we cannot market our way into value.
What we can do is redefine what OT education aspires to produce. As noted above, the programs that thrive in the future will be those that ignore the credential arms race, embrace authentic doctoral-level identity, leverage interdisciplinary power, and prepare students for the emerging centers of healthcare innovation. That is the future - plain and simple.
OT will need practitioners who are systems redesigners, technologists, researchers, entrepreneurs, and problem solvers. Occupational therapists need to shape the environments, technologies, policies, and service models of the future - not just inhabit space for purposes of driving wallet-stuffing of healthcare corporate overlords..
That is the future worth building toward. And despite the current turbulence, it is absolutely within reach.
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