Choosing Between Speech Pathology or Occupational Therapy

Similarities Between Speech Pathology and Occupational Therapy

According to AOTA and ASHA's description of SLPs, speech language pathologists and occupational therapists work with patients on different sets of issues, but there are many similarities in the approach to helping patients in both careers:

Evaluation: Assessing and evaluating patients for issues and disorders is a key responsibility for both SLPs and OTs

Treatment and Treatment Plans: Both OTs and SLPs must use what they have learned from evaluating their patients to develop treatment plans and execute them. SLPs are expected to use evidence-based decision making, according to ASHA's scope of practice policy

Evaluate Treatment Effectiveness: Once speech pathology or occupational therapy treatment plans are in place, it is important to be able to evaluate whether or not they are working, so that those plans can be adjusted to optimize outcomes for patients

Family Education: Many therapy patients either have disabilities that require help from caregivers, are young children who need help continuing treatment outside of therapy sessions, or have other needs that require family education. SLPs and OTs are charged with educating families about injuries and disorders, including what families can do to help patients benefit from therapy as much as possible, and with improving patients' home environments for their condition.

Speech Pathology and Occupational Therapy Education Requirements

Becoming an SLP or an OT involves graduate education, national certification and state licensure, which are separate requirements. Here is more information on the path to becoming each.

Speech Pathology Certification Requirements

Speech Pathology Master’s Program Prerequisites

Before applying to a speech pathology master’s program, students must meet prerequisite requirements. According to ASHA, some programs accept applicants without prerequisite coursework and build it into the program, while others expect prerequisite or leveling coursework before you apply, so check each program's requirements. Our guide to applying to graduate school covers prerequisites and application steps.

To qualify for ASHA certification, you must complete your graduate coursework and clinical practicum in a program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). The practicum includes at least 400 supervised clinical hours, 25 of them guided observation and 375 direct client contact, before the Clinical Fellowship begins.

Speech Pathology Clinical Fellowship Year

After completing a speech language pathology graduate program, new SLPs typically complete a post-graduate Clinical Fellowship (CF) to qualify for ASHA certification (CCC-SLP). ASHA requires the CF to include at least 36 weeks and 1,260 hours of mentored professional experience, completed under a qualified ASHA-certified CF mentor (CCC-SLP). During the CF, fellows build independent-practice skills with structured mentorship. ASHA expects the CF to be completed in three segments, with required observation and mentorship activities in each segment. Our Clinical Fellowship guide walks through the process. Check your state licensing board for its own requirements.

Speech Pathology Praxis Exam

The current passing score for the Praxis Speech-Language Pathology exam (5331) for ASHA certification is 162, as confirmed by the American Speech-Language-Hearing Association (ASHA).

Speech Pathology Certification

State licensure and ASHA certification are separate. A state license comes from your state’s speech language pathology licensing board, and requirements vary by state, so follow that board’s rules. ASHA’s Certificate of Clinical Competence (CCC-SLP) is a voluntary national certification that, according to ASHA, signals you exceed minimum state licensure requirements. For ASHA certification, you apply through ASHA and must meet ASHA’s certification standards. Keep your state license active by meeting that state’s renewal requirements. If you also hold the CCC-SLP, you must meet ASHA’s certification maintenance requirements to keep it in good standing.

Occupational Therapy Certification Requirements

Occupational Therapy Master’s Program Prerequisites

Prerequisites vary by program, so check the admissions pages of the occupational therapy programs you are considering before you plan your coursework.

Occupational Therapy Master’s Programs

Occupational therapy programs combine coursework with Level I and Level II fieldwork. For Level II fieldwork, ACOTE standards require a minimum of 24 weeks full-time equivalent, which may be completed part-time if it is at least half of a full-time equivalent at the site.

The Accreditation Council for Occupational Therapy Education (ACOTE) accredits entry-level programs at both the master’s and doctoral levels and says there is no mandate to move occupational therapy education to the doctoral level. Programs may offer a master’s degree, a doctorate, or both.

Occupational Therapy Certification Exam

To become NBCOT-certified as an occupational therapist, you must pass the NBCOT certification exam. U.S.-educated candidates need an entry-level occupational therapy degree from an ACOTE-accredited program, and internationally educated candidates use a separate NBCOT process called OTED. You must apply through NBCOT and submit your official final transcript. For students near graduation, NBCOT can use a Degree Verification Form to determine eligibility to test, but it does not release results until it receives and approves your official final transcript. As part of the application, you also answer character review questions. Once your application is approved, NBCOT will issue an Authorization to Test (ATT) so you can schedule your exam. If you pass and meet all NBCOT requirements, you become NBCOT-certified (national certification). You’ll still need to meet your state’s licensure requirements to practice.

Occupational Therapy State Licensure

After earning your national certification, make sure to check with your state on occupational therapy licensure requirements so that you can become licensed to practice in that state. After receiving state licensure, continue to follow all state and national renewal requirements.

Speech Pathology vs Occupational Therapy Salary

Speech pathology and occupational therapy both offer strong earning opportunities. These figures are national estimates from the May 2025 OEWS:

For occupational therapists, the median annual wage is $100,330, and the middle half of OTs earn between $82,510 and $116,670.

For speech language pathologists, the median annual wage is $97,870, and the middle half of SLPs earn between $77,730 and $114,570. Our speech pathologist salary guide goes deeper on SLP earnings.

At the 90th percentile, annual wages reach $134,160 for SLPs and $131,950 for OTs.

About 183,390 SLPs and 162,450 OTs are employed nationally. These counts exclude self-employed workers.

Speech Pathology vs Occupational Therapy Work Settings

Although both SLPs and OTs are needed in many different settings and provide services to a variety of populations, there are some differences in where these professionals typically work. According to BLS data, about 42% of speech pathologists work in educational services, compared to about 14% of OTs. There are certainly many occupational therapists in educational settings, but one who aims to work in a school may want to keep this in mind.

Occupational therapists most commonly work in therapy offices, meaning offices of physical, occupational and speech therapists, and audiologists (29%), followed by hospitals (about 26%), educational services (14%), home health care services (8%), and nursing care facilities (7%). For speech language pathologists, the largest employers are educational services (42%), therapy offices (26%), hospitals (13%), and nursing care facilities (4%). SLPs and OTs are similarly likely to work in therapy offices: 26% of SLPs and 29% of OTs work in offices of physical, occupational and speech therapists, and audiologists. Each percentage is that setting's employment divided by national employment for the occupation, so settings not listed make up the rest. For a closer look at SLP work settings, see our guide.

Median wages also differ by setting. According to the BLS May 2025 OEWS national industry-specific estimates, SLPs have the higher median wage in four of the five settings below, and OTs have the higher median in educational services:

Educational services: $83,120 for SLPs and $87,300 for OTs

Hospitals: $103,690 for SLPs and $102,820 for OTs

Therapy offices: $98,910 for SLPs and $97,940 for OTs

Home health care services: $117,370 for SLPs and $106,300 for OTs

Nursing care facilities: $111,680 for SLPs and $105,850 for OTs

SLP vs OT FAQ

Who gets paid more, SLP or OT?

According to the BLS May 2025 OEWS national estimates, OTs have a slightly higher median annual wage: $100,330, compared with $97,870 for SLPs, a difference of $2,460. The gap depends on the setting. In the same BLS industry-specific estimates, SLPs have the higher median wage in hospitals, therapy offices, home health care and nursing care facilities, while OTs have the higher median in educational services, where a larger share of SLPs than OTs work.

Is it harder to become an OT or an SLP?

Both paths involve graduate education, supervised clinical training and a national certification process, and the training is structured differently. According to ACOTE standards, OT students complete at least 24 weeks of full-time equivalent Level II fieldwork as part of their degree. According to ASHA, SLPs complete at least 400 supervised clinical hours during graduate training and then a post-graduate Clinical Fellowship of at least 36 weeks and 1,260 hours. Which path feels harder depends on your strengths and on how competitive the programs you apply to are.

Is speech pathology considered occupational therapy?

No. They are separate professions with different training, national certifications and state licenses. SLPs focus on communication and swallowing, and may earn ASHA's voluntary CCC-SLP. OTs focus on everyday activities such as self-care, work and school, and earn NBCOT certification.