Saturday, February 03, 2007

Is a doctoral degree necessary for entry level Occupational Therapy practice?

I entered my profession in 1987 and at that time a bachelor’s degree was required to practice as an occupational therapist. At the American Occupational Therapy Association's Annual Conference in 1999, the Representative Assembly passed Resolution J, mandating post-baccalaureate education for entry into the profession.

I still have not seen any study that indicates that baccalaureate-trained professionals are in any way less effective than people who enter the profession at the master’s level. The marketplace also never acknowledged the alleged benefit of the master’s degree, as people with advanced credentials did not make any more money than people with bachelor’s degrees.

I summarize from this set of facts that the move to post-baccalaureate education served the needs of educational institutions who were able to get more tuition from students who were trying to enter the profession. Students stay in school longer and educational institutions benefit by collecting more tuition. I do not see any other benefit to any other stakeholder (consumers, therapists, or others). I imagine that the possible intent of OT post-baccalaureate education was to ‘keep up with the Jones’ – that is the PTs and pharmacists who moved in that direction. Still, important decisions should be based on what is good and necessary for the occupational therapy profession, not based on what someone decided was a good idea for some other profession.

Following Resolution J, ACOTE (the educational credentialing agency for OT) began looking at doctoral level education and formed a committee to look into the issues. The ESRC (Educational Standards Review Committee) identified some significant concerns about any move toward accrediting doctoral level programs. It seems that someone didn’t care what ESRC had to say because a different committee was formed (the ACOTE OTD Standards Committee) to develop standards for doctoral degrees despite what ESRC reported. This represented a major switch for ACOTE, who traditionally was always in the business of credentialing PROGRAMS, but now would be granting different credentialing for different DEGREES.

Additionally, the AOTA Representative Assembly was supposed to be the body responsible for making recommendations about the doctoral level of education. They were supposed to finish this work in 2006 but had to extend their process until 2007. Now whatever the RA has to say is a moot point because ACOTE has already made unilateral decisions about doctoral level education.

At this point I imagine that the eyes of many street-level occupational therapists begin to glaze over… but this is an important issue to study. The question I have is this: why does it appear that ACOTE, with the tacit approval of AOTA, is trying to ramrod an entry level doctoral level of training on the profession?? Is there some unpublished study that has been done that identifies how this change will benefit consumers?

Just because other professions have moved to a doctoral level of training doesn’t mean that OT also has to. Just because some people have the IDEA that advanced training is needed for practice doesn’t mean that IN FACT advanced training is needed for practice.

As collective shepherds of our occupational therapy profession we can’t allow major decisions like this to occur without the input of the membership or without careful and thoughtful study of the impact.

What should street-level OTs be concerned about:

1. If it is true that practice is becoming so complex that doctoral training is required, what does this mean for people who are functioning as occupational therapy assistants and only have an associate’s degree?

2. Are there some glaring inadequacies in the skill sets and competencies of associate and baccalaureate and master degree level practitioners that need to be acutely addressed in order to ensure the safety of consumers?

3. If there will be two levels of entry into the profession (from the masters level and from the doctoral level) does this mean that people with degrees below the doctoral level will be restricted from certain areas of practice?

4. If it is true that doctorally trained professionals are practicing at a stratospheric level of competence do they even need to be credentialed for entry level practice? How would they be credentialed and what will state regulatory boards think of multiple levels of certification?

5. Since there was an RA process in place to look at the issue of doctoral level education, does this mean that the RA is irrelevant since ACOTE already acted on this issue?

6. If the RA is irrelevant and if constituent feedback to the ESRC was irrelevant, and since the ESRC report was summarily dismissed, do we even really have a representative membership organization?

So if you managed to read through all of this, contact your RA representative and ask them what they think.


References/background:

AOTA (11/12/06). Frequently asked questions about the Doctor of Occupational Therapy Degree (OTD). Downloaded 2/3/07 from http://www.aota.org/nonmembers/area13/links/link56.asp

AOTA (July 2006). Background on the development of ACOTE standards for OTD programs. Downloaded 2/3/07 from http://www.aota.org/nonmembers/area13/docs/otd-process-7-06.pdf

5 comments:

Anonymous said...

Whilst I defend the need for academic rigour within the profession practising OT is fundementally a pragmatic or "doing" process. "Academia" doesn't value the apprenticeship aspects of our training and we can't afford to lose them on the alter of more and more specialist qualification.

Adele said...

I'm a new OT grad (master's level) and while I can't say I am well-versed in all of the policies and politics governing the changes to the degree/certification in our profession, what I can say is the following:

Bachelor's level OTs are certainly competent practitioners who, with their years of experience, are highly valued members of the healthcare team regardless of their degree level.

However, the intent of a higher level degree (while I can't deny that there is a monetary aspect to it) is multifaceted. Firstly, evidence-based practice is no longer just a "buzzword," it is a reality and an imperative. While bachelor's level therapists may very well be versed in reading and interpreting the literature to keep their practice evidence-based, the intent of the master's degree is to enable therapists to have the tools to both implement results of research studies done by others and to conduct their own studies if they so desire. Master's level therapists also, I believe, get more training in the business aspects of OT, which gives them the tools to move into leadership positions and "blaze the trails" for new/non-traditional practice arenas (e.g. community-based).

Secondly, it may seem that OT is just "copying" other professions by adding extra credentialing--and this very well might be the case. Yet I feel that this may not be such a bad thing; If there are doctorally-trained PTs coming out of school, then OTs need to appear (and be) at or approximately at the same level educationally--after all we are "sister professions." In the world of healthcare the bottom line is do you have the skills; yet it also doesn't hurt to have the additional letters after your name!!

I hope I haven't offended anyone by these comments. I am simply being the devil's advocate and bringing another perspective to the situation. I do respect your opinion and believe that AOTA and ACOTE should endeavor to be as thoughtful and methodical as possible before drastically changing the direction of the profession. Hopefully this will be the rule, rather than the exception, as we move into the future of healthcare.

Chris said...

I appreciate Adele's comments, but my question is: What proof do we have that the advanced degree actually makes a difference???

I understand the concept that it COULD set people up to be more competent in research, or that it COULD lead to more community-based practice. These seem to be reasonable assumptions, but we really do not know this to be FACTUAL.

Unless we ACTUALLY KNOW, on what are we basing our decisions to make such radical changes? A hunch?

Thanks for posting though and I encourage everyone to keep thinking about it and discussing it!

Anonymous said...

I'm a final year OT student in Australia, studying at bachelor level (which is still the entry level here although AAOT will eventually shift this to Masters level in order to keep up with the US and Canada, who is raising the entry level in a few years) and I've got a different perspective again...... As someone who is about to enter the profession, I feel that the value of an advanced degree in OT (be it Masters or Doctoral level) lies in allowing practicing clinicians to update their skills and/or improve their clinical reasoning. I think that having an advanced degree as an entry point to the profession may cause difficulties in the long-term ,especially among entry-level doctoral trained clinicians, as they may essentially be stuck with no means of updating and improving their clinical skill level, in a formalised and structured manner, as they have already obtained a terminal degree. It also makes CPD critically important and unfortunately maintaining currency of skills whilst engaged in clinical practice is something that many OTs struggle with despite the huge push for evidence-based practice.
And, finally ..... the entry level required to the enter the profession is in some ways not very important..... Any level of study will prepare a student for practice only to the extent that they engage in the process of learning, and essentially regardless of the educational level required to begin practicing no one can be prepared for every reality of practice and therefore advanced degrees are most valuable as an aid to practicing clinicians in the pursuit of life-long learning.


It's a very interesting debate which I think eventually will intensify, i look forward to watching from afar :)
Cheers, moses

Anonymous said...

Doctoral education costs much more more. Saleries are the same (BSc, MS, or DOT). Reimbursment is static or shrinking. Quality students will consider other profressions where thay can feel adequately compensated for all their schooling - an additional year or two and they can be an MD.

Time limits on length of hospital stay or limits / monetary caps on outpatient visits etc. are making difficult to provide basic therapy. How will DOTs put into practice all this advanced knowledge with less and less time and resources to do so. A typical inpatient OT just about has enough time to introduce the sock aid, reacher, and long handled sponge before the patient is discharged!!

I belive that we should focuss on board certification and other advanced cont. education in our areas of specialty, rather than years more "basic training" .
Perosally I would rather be treated by a COTA or PTA with 20 years experience than a new DOT or DPT who is consumed by student loan debt and who hurries off the read their text books before putting on the hot pack!!!