Occupational Therapy is one of the most flexible healthcare professions in the United States. OTs are needed in hospitals, schools, home health agencies, mental health programs, rehab centers, and so many other environments.
In recent years, many therapists have turned to contract work as an alternative to traditional full-time employment. Some choose it for the flexibility, some for the pay, and others for the chance to work in different settings.

However, contract work is not just “a different type of job.” It is a different way of practicing, with a different rhythm, a different level of responsibility, and a different level of independence.
This article takes a deeper and more realistic look at the advantages and challenges of contract work in OT, to help you decide whether this path fits you.

The Benefits of Contract Work in OT

1. Real Flexibility and Autonomy

Flexibility is more than choosing your weekly schedule.
For many OTs, contract work allows them to take back control of their professional lives. You have the freedom to choose the caseloads you want, the settings you enjoy, and the hours you feel comfortable taking on. This kind of autonomy often leads to less burnout and a healthier relationship with work.

Some therapists also appreciate that they are not tied to one facility culture for years. If a setting is stressful or misaligned, they can complete the contract and move on.

2. Exposure to Many Practice Areas

Contract OTs often move through several clinical settings throughout the year. This creates a richer and more dynamic clinical experience than staying in the same place for a long time.

Many contractors work in:

• Acute care

• Inpatient rehabilitation

• Pediatric clinics and schools

• Mental health programs

• Home health

• Skilled nursing

• Outpatient and community settings

This variety helps therapists improve their clinical reasoning, become more adaptable, and discover which populations they truly enjoy serving.

3. Higher Earning Potential

Contract roles often pay more per hour than full-time positions.
But the financial advantages go deeper. Contractors can take on multiple assignments, negotiate higher evaluation rates, or work during high-demand seasons such as winter in SNFs or summer in school-based settings.

Some OTs combine contract work with PRN shifts to increase income. This is something that is usually not possible in traditional salaried roles.

4. Significant Tax Advantages

Independent contractors can deduct many legitimate business expenses that employees cannot. This includes:

• Mileage

• Continuing education

• Professional memberships

• Equipment and materials

• Home office expenses

With organized bookkeeping, many contractors find that these deductions help them keep more of their income.

The Challenges of Contract Work in OT

1. Income Instability and Contract Gaps

Contract work does not guarantee consistent or long-term income.
Contracts can end early because of changes in census, budgets, or administrative decisions. There may be periods when work is easy to find and periods when it is not. For some therapists, the financial unpredictability is one of the hardest parts of contract work.

Planning, savings, and flexibility become important skills for anyone choosing this path.

2. Lack of Employer-Paid Benefits

Contractors do not receive benefits such as:

• Health insurance

• Retirement contributions

• Paid time off

• Sick leave

• Paid holidays

For therapists who rely on these benefits or have families to support, this can be a major drawback. Many contractors purchase private insurance or set up their own retirement plans, which adds extra cost and responsibility.

3. More Administrative Responsibilities

When you become an independent contractor, you are also running a small business. This comes with extra tasks that salaried therapists do not deal with. Contractors are responsible for invoicing, tracking expenses, preparing for quarterly taxes, maintaining documentation for compliance, and keeping business records.

Some therapists enjoy the independence of managing their own business. Others prefer to avoid the extra administrative work.

4. Self-Employment Taxes

Independent contractors are responsible for both the employee and employer portions of Medicare and Social Security taxes. This can increase the total tax burden if it is not planned for. Many therapists work with a tax professional to manage this efficiently.

5. Limited Clinical Support

Full-time roles often include mentorship, senior therapists, team meetings, and structured onboarding. Contract positions may not offer the same level of support. Some contractors enter facilities where they are the only OT or where staff turnover is high.

This environment can be challenging for therapists who prefer collaborative or structured settings. Contract work generally suits more experienced OTs who are confident in independent decision making.

Is Contract OT Work Right for You

Contract work may be a great fit if you value independence, want control over your time, and enjoy variety.
It gives you the ability to shape your work life in a way that aligns with your personality and goals.

However, if you prefer predictable income, consistent benefits, and long-term stability, a traditional W2 position may feel more comfortable. The best choice depends on your financial needs, your confidence level, your lifestyle, and how you want your career to look over time.

The OT Job Market Is Changing

Many schools, home health agencies, rehabilitation centers, and SNFs are hiring more contract therapists due to staffing shortages and shifting reimbursement models.
This creates more opportunities for contractors, but also more variability in caseloads and contract lengths. Understanding these trends can help you navigate the market with more confidence.

Looking for OT Jobs? LiriCare Can Help

Whether you want contract work or a stable W2 position, LiriCare connects Occupational Therapists with roles across the United States.
We offer opportunities in schools, hospitals, clinics, home health, and rehabilitation settings. OTs who work with us can choose short-term contracts, long-term contracts, or full-time employee positions.

Our team understands the unique needs of Occupational Therapists and supports you in finding work that fits your goals, lifestyle, and long-term plans.

If you are ready to explore new opportunities in OT, LiriCare can help you take the next step with confidence.