Pros and Cons of Being a Per-Diem PRN Occupational Therapist


Many new grads are faced with the opportunity to work PRN (as-needed) / Per-diem / Relief — these all mean the same thing versus Full Time (FT). Part-time is another option, but is rarer these days compared to the PRN and FT.

If you are provided the opportunity to be hired by an employer as PRN or FT versus no job at all, you should go for it — especially as a new grad and if it the opportunity is a good fit for you.

The pros and cons mentioned here may of course have exceptions, e.g. PRN may pay 401K. What may be a pro or con depends on the individual, their age, culture, background, OT job experience, risk tolerance, etc.

Here is an interesting survey on what is perceived to be most important for a job based on generations.

Source: Employee Happiness Index 2019

What is PRN?

You schedule with your employer days that you are available to work.

You are not guaranteed a minimum number of hours.

You are often paid hourly age.

The work may vary from part-day, half-day, full day (8 hours).

Some employers may have more specific requirements based on their own policy, so read up on this and find out before you start.

Hourly vs. Per Gig

This post will focus on hourly wage PRN, but there is also per gig – such as with home health. It is very similar in terms of scheduling but differs in salary compensation. Your employer provides you with clients to see, and you get paid per evaluation, intervention, for documentation at a set rate (e.g. $100 per evaluation – made up number) instead of an hourly wage.


This has a different incentive in the sense that the “more you do, the more you get paid”. Whereas with hourly, no matter what amount of work you do, you get compensated the same. This is obvious by nature of the two pay types, but it is worth mentioning the “incentives”. Of course, occupational therapy is unlike other jobs such as sales and while it may be tempting to emphasize quantity over quality as a new grad, don’t do it! Be ethical.

Pros and Cons of PRN

Higher Pay – Pro

PRN is often paid at a higher hourly rate than full-time due to the lack of benefits, PTO, and other incentives.

The million-dollar question is “How much higher?” — this depends on your area and other factors. If you are job searching, check out our OT Salary Survey for guidance or consult Google.

When comparing salary offers to your peers, it is important to make this distinction of PRN or FT because the difference can be significant.

Higher Pay – Con

Most people, especially therapists I see and bloggers just talk about “higher salary” which must mean it’s better, right? But there is more that goes into this. It is easy to see the $_$ and not think about the bigger picture – and long term.

If you end up paying more to make up for benefits such as health care, dental, vision, life insurance, disability insurance, retirement, etc. then it might end up being more “expensive” to work PRN. So crunch some numbers and compare how much it may cost to purchase benefits “a la carte” for PRN added up vs. full time. What benefits should you look for? Look at job postings and see what is being offered and compare to shopping yourself for the same amount of benefits.

This will take some research on your part, but it is better to research this early before or while you are job hunting, not after – as you’ll be starting a new job and could easily forget or procrastinate for seeking your own PRN benefits.

More than likely, healthcare in the US will be more expensive for PRN.

Another thing to factor in is taxes and your tax bracket. If you are single, this is likely less of an issue. However, if you are married (and therefore have multiple income sources), having higher gross income often translates to higher healthcare premiums per month in the healthcare marketplace. One option is to be insured through your spouse if they are full-time and offered such benefits.

A more expensive scenario would be a married couple filing jointly who are both working PRN – their combined salary would be very high and they would have to purchase healthcare in the marketplace at a higher premium to be covered by the “equivalent” amount of benefits if one spouse were to be working full-time and have subsidized benefits.

Lack of Benefits – Con

Health, dental, vision, PTO, retirement, and more.

As mentioned earlier, health, dental, and vision may end up costing more based on your marital status, tax situation, even what state you live in. You don’t accrue PTO as a PRN in general, which is a major con in the long term. Don’t show up to work as PRN? You don’t get paid. Don’t show up to work for FT? You may be able to take PTO/ETO (earned time off).

For retirement, you can contribute to an IRA if under income limits as either FT or PRN, but you will likely miss out on employer 401K match as PRN. There is also the loss opportunity of increased employer match for 401k. Oftentimes, the longer you work at a company (years), the higher their match accrues. If you keep working PRN jobs year and years, you miss out on this opportunity. It’s “free” money. While you can save a significant portion of your earnings (and you should) such as in an IRA, you won’t get this increased employer match every few years.

These are the common benefits that most people think of, but some employers offer additional benefits. Short-term disability, long-term disability, insurance (such as malpractice — not sure if PRN’s are covered for malpractice by their employer), mental health and physical wellness programs / employee care programs, discounts (e.g. gym memberships), continuing education, pension plans, stock options, annual review and wage increases, bonuses, employee clubs and gifts, career advancement, and leave accrual for PTO.  PRN OTs may be missing out on a lot of these benefits.

Expecting a child? With FT, if you have worked for a year+, you would be entitled to personal leave (along with FMLA job protection), wage compensation (up to say, 65%), and the option to supplement with PTO. With PRN, you get none of these options from your employer.

Got injured for a disability? FT benefits would cover you if you meet the criteria. With PRN, you would temporarily not working (no income), no disability insurance from the employer (have to look into state benefits – some states are better than others) all the while having to worry about medical bills, paying bills, etc. Even if you are young and healthy, life happens. It is better to be prepared.

Would you be willing to purchase short-term disability or life insurance as a PRN?

These insurances are important but could be expensive depending on your age and other demographic factors. As FT, they would be subsidized and a much less expensive monthly premium.

Flexibility and Work-Life Balance – Pro

PRN OTs are not tied to a 40-hour workweek. Working 40 hours or even more can be mentally and physically draining – leading to burnout.

You are not obligated to work, even when asked for weekends or holidays – but this often is when PRNs are often asked to come in. There may be exceptions to this and some employers may require a minimum amount of hours/days.

Be careful, if you are known to turn down working often, the employer may be more hesitant to ask you to come in and would rather ask someone else for PRN who is more consistent.

You’ll have more free time to do other things such as running errands, completing CEUs, or working on your side-hustle, traveling, vacations, whatever you want! If you have childcare responsibilities, it may be easier to arrange for childcare.

Some PRNs may still get consistent hours (but they are not guaranteed). For example, in the hospital, as a PRN I often worked every Tuesday and Saturday until the Pandemic. But guess what happened during the Pandemic? PRNs were not called in due to a lower census. Even FT OT hours were cut, but they were after PRNs’ were cut first. So this is an important consideration.

Flexibility – Con

In the workforce as an employee, you are trading your time for money. So by nature of working less – you make less money. Your income goes down. In general, FT OTs make consistent money and it is more predictable than PRN.

Having a lot of flexibility can be great, but if you are not disciplined in your daily routine, you may also not be as productive with your time that could have been spent making money. This depends on the individual OT’s specific goals.

No Guaranteed Hours and Pay – Con

Sure money is not everything. But we have to pay rent, bills, our loans, food, etc. Lack of PRN hours can be a source of added stress if you do not live with your parents, do not have a spouse bringing in income, do not have other sources of income, all while having financial responsibilities.

It may be possible, such as the pandemic, that PRNs do not get called into work often due to low census. So that will require working additional PRN jobs, but even these do not guarantee hours. In a non-pandemic situation, it is less of an issue, but this is something to think about if you get offered a FT position.

Setting Variety – Pro

PRN OTs often work multiple PRN jobs. FT OTs work in the same place, all week, every week. While there is nothing wrong with this, PRNs may have a good change of scenery and pace. It is likely better for your mental health and lower chance of burnout as you can get this variety.

PRN variety provides an additional set of coworkers, patients (sometimes even populations, e.g. pediatric and geriatric), resources such as tools you have assess too, and guidance/expertise from being exposed to additional allied health professionals.

Setting Variety – Con

More settings means more to keep track of. Cognitively, an example is more names to remember, workplace policies to keep track of, where thing are such as supplies, and a big one is potentially documentation.

If your two PRN jobs use different documentation software, you have to learn both! Theoretically, if you use only 1 software, you become faster and more proficient with it. With 2, it may slow you down as you may get confused when switching between the 2. You’ll have two name badges, two work e-mails (meaning more e-mail to check). Administratively, you’ll have to keep track of 2 paychecks (making sure they are correct), 2 W-2’s / W-4’s for taxes, and so on — you get the idea. While this is easily manageable, if you are averse to technology and paperwork, FT may be a better option.

Documentation Lag – Con

This is a term I came up with, but basically, if you are working FT as an OT, you’ll be there the next workday to make changes, edits, or correct errors. If you are PRN, do not know when you will be back. This can be an added stressor for PRN OTs. While documentation should be done on time, life happens.

As a PRN, you need to finish your documentation the day you work. You won’t necessarily be back the next day. Even if you are scheduled to work, say the next day — you could get called off for days on end. And you won’t know when you’ll be back next time. FT OTs know they will be back the next day to finish up or add some notes – especially when employers don’t want their OTs to work overtime.

What happens if you are doing an evaluation and an emergency such as your child needs to be picked up? As a FT OT, you would be back the next day to finish up. As PRN, you would have to notify your employer and have them arrange for you to come back in or have another therapist pick up where you left off. Would they start from the beginning or collaborate with you from where you left off? See how this could potentially create more work for both you and others and would not be an issue with full-time OTs.

Another example is unfinished work from other therapists. If another OT did not finish an evaluation or note, you may have questions are may be stuck and probably not able to see your client because you have incomplete information. You may have to move onto the next or clock out early. Instead, FT OTs would move onto the next client, and the next, and the next, but they would likely have enough work to do for the full 8 hours. PRN OTs would have to be clock out and be unpaid.

Commute – Con

Commute may be a con for PRN OTs from not only a financial, but mental health standpoint. Think about the time, gas money, the distance you spend on your commute, wear and tear on your vehicle. If you bike or walk to work then this of course does not apply.

In general, it would be ideal to work closer to home for better work-life balance, stress, etc. for both PRN and FT. But modern life has made it so that people have to commute farther from where they live.

Sometimes it cost you more to work PRN due to commute and not working enough hours. An example would be a job that is far away (commute time, gas, risk of being late to work), and bridge tolls (The Golden Gate bridge costs $7+ per shift!).

Now imagine getting called off early.

If you get called off work and work barely a couple of hours, then it is a waste of your resources. Instead for FT, the OT would work 8 hours and more than make up for commute – time, gas, toll, and so on. As a PRN, if you grab a coffee in your routine, eat out for lunch, etc. this is also an added expense for PRNs who do not work a full shift. In the grand scheme, it may not matter, but these little components may compound if significant enough.

Less Workplace Politics – Pro

FT OTs see their coworkers basically everyday. This can be good, but also bad. Workplace conflict is more difficult to avoid than a PRN OT who comes to work, clocks in, does their job, clocks out, and leaves. The FT OT will be back the next day when the issue may still be “hot”.

Less Mentorship – Con

If you are a new grad looking for mentorship, FT is the better option. You are consistently at work and more likely to engage and have support from a mentor OT. As a PRN, you work less days (more inconsistently too), and the days that you do work do not necessarily mean that your mentor is there. While OT, in general, is supportive as a professional community, the OT that is there may not be willing to take you on when they have their own things to worry about.

Working More than 40 Hours (Not Recommended) – Pro

A FT OT job will unlikely pay you overtime. You can work more than 40 hours with either PRN or FT – you just take on more jobs.  Some nurses, for example, do this and go from one job to the next. You can do this with PRN much easier especially if you are interested in different settings and figuring out where you want to settle. It’s not recommended to work 6 or even 7 days a week, but if you must do so with the understanding of burnout and the consequences on your mental health.

No Meetings – Pro and Con

While not guaranteed, it is more likely that an FT OT goes to a collaborative round or weekly meeting than a PRN because the FT OT is there more often and is basically “in the know” more about everything that is going on. They know more about the clients because they see them more frequently, likely co-treated or worked with other disciplines more and can speak on their behalf, etc. So PRNs are more likely to be excluded from meetings – yay!

How could no meetings be a con for PRNs? You may miss out on important updates and meetings. If there are changes say, how you manage equipment after it is used – this is important information. It would require more work such as manager or other therapist repeating what was said in a meeting.

Having to Tie Up Loose Ends / More Work – Con

We discussed a little about the documentation piece for PRN as they have to get their documentation done. This is oftentimes not the only responsibility. PRN OTs will have to do extra work to effectively communicate to other staff either directly (or with notes, such as sticky notes) for when they are not there.

Imagine you are a FT OT. You finish your treatment and documentation. You’ll be back the next day to see the same client. No extra work. You may leave notes for yourself on a client, but if you forget or don’t have time, it’s not the end of the world.

Now imagine you are PRN OT. You won’t be back until a few days. So you’ll have to tell the therapist how a client is doing, what your plan is, and so on. Let’s say the other OT is not present. You’ll have to find them or leave a sticky note or somehow communicate everything that is important to them. This adds a layer of communication that can fail and lead to missed-communication. Not good.

Meetings: PRNs may have to communicate what is pertinent to bring up in these collaborative meetings since they won’t be there. In my experience, we have had missed information not because PRNs were not doing their jobs, but just the amount of work they are responsible for is so high they just don’t have time and the opportunity. With FT, OTs have more opportunities to relay this information to the person attending the meeting.

Now multiple this by the many clients you saw. This could translate to communicating to multiple therapists. And we are not just talking OTs. There may be PT, SLP, doctors, social workers you’ll have to communicate things to. See how this can add to a lot of extra work? The staff will not be calling you on your day off (at least you don’t want them to) so they are stuck not knowing.

Another point is generally how much more work PRNs need to do. When I was a PRN, everytime I showed up to work – I was guaranteed to have new clients that I had to read up on – their orders, evaluation, progress notes, other discipline notes, etc. Now multiple this by multiple clients. This all comes at once on the same day, say on a Monday. So you’ll be expected to do the same amount of work, but have to be caught up to speed.

As a FT OT, sure – you get new clients all the time, but it’s more gradual, say over the course of a week. You slowly add this client information to your brain. But as a PRN, it’s likely that every day you show up to work you’ll have a different set of clients. If you have multiple PRN jobs, it gets multiplied by that many clients. While there is nothing wrong with this, and it increases your skills, it is very cognitively draining and more stressful in today’s healthcare setting of higher demands than the time you’re given to document and read up on research, etc. – especially if you are a new grad.

Continuity of Care – Con

So far, our points have been all about us. Us OTs. But most of us got into the profession for our clients and our community.

PRN OTs likely have poorer continuity of care. They are not there consistently compared to FT OTs. This is generally better for client continuity of care. FT OTs know a client better, how they performed the last session, establish a stronger therapeutic relationship, may reduce anxiety, errors (due to changes that made, e.g. client condition worsens – OT would know this having worked with them before). There is nothing wrong with PRN, as I was once one, but it is a common theme that my team discussed. For patients with longer lengths of stays, PRN OTs may ask the same questions that otherwise would not have to be asked by a FT because they already know from seeing the client before. A client may like working with a therapist they have established care, built rapport with, etc.

Getting Approved for Adult Stuff – Con

This is a big one that I think most people overlook for PRN. Even as a FT, you may encounter this issue, but as a PRN, it’s even more difficult.

Financial institutions often ask for prior months paystubs or your salary when you:

  • Renting a new apartment
  • Apply for a credit card
  • Apply for a loan (general, business, personal, etc.)
  • Buy a car or vehicle
  • Buy a house
  • Refinance your mortgage
  • Apply for a home equity line of credit
  • Any other company or institution that may ask when you want to borrow money

When you work PRN, you may have inconsistent pay and may have to estimate your annual income – which can be difficult to do and less reliable.

If your most recent paystubs happen to be lower than your usual amount, then you may get approved for lower loans or even get denied. FT would have more consistent paystubs that are more likely to get approved. This of course is not this simple and depends on many factors such as credit score, history, societal factors, etc.

Even if you are young, a new grad, or not expecting any major financial events in the near future, it is something to consider when working prn.

Financial institutions like to see consistency. So even if you have several PRN jobs that pay well when combined, your employment history may be short (< 1 year) as you are bouncing around PRN jobs and sometimes these employers may even disregard some sources of income for not being established. My wife who works full-time had her paystubs rejected because she did not work at the employer for at least a year. It’s also more work on your part – for every PRN job you have you’ll need say, 3 most recent paystubs from each, in addition to other requirements and information they ask for.

In life, you never know and cannot plan for some things. Recent interest rates are very low, the pandemic made many people lose their jobs, unemployment insurance is backed up, etc. What happens if you just happen to pass by a house for sale that is your ideal home? If your lease is up and there is a new listing for much cheaper? But you were working PRN with pay stubs that go up and down with no real pattern.

If you are in a situation such as PRN, you would be put at a disadvantage.

Critical Thinking Exercise

I saved this last con last because all the other pros and cons seem small to something like these big life decisions. So “stack the deck” in your favor and anticipate things in the future. If you are in the market for a new home, looking to start a family, whatever – how would PRN’s finances and financial history such as paystubs affect you compared to if you were FT? Timing matters.

Hope this helps!