In this discussion, Cassandra, an OTD (Occupational Therapy Doctorate) student, shares insights into the unique OTD program, its distinctions from other educational paths in occupational therapy, and the process of becoming a registered occupational therapist (OTR) in the United States, including the licensure examination NBCOT. She contrasts the educational and professional environment of occupational therapy between the U.S. and the United Kingdom, touching on topics such as the licensing exam, state registration, and professional grading. Cassandra also talked about the practical aspects of working as an OT, including patient management, documentation, and billing within the U.S. healthcare system. The conversation highlighted few differences in OT practice in the UK and US, the challenges and expectations in professional development, and the personal preferences that guide an OT's specialization within the field.