Wednesday, June 17, 2015

How NY State will enact the entry level OTD


Laws, like sausages, cease to inspire respect in proportion as we know how they are made.
  (John Godfrey Saxe)

The occupational therapy profession is considering a change to requiring a doctoral degree for entry level practice despite the overwhelming opposition to the concept by most practicing occupational therapists.  The current requirement for practice in NY State includes training at the Masters level.  Academic programs can't begin offering an entry level doctoral degree until they receive approval from the State.  Because the OTD is a new degree, Sections 3.47 and 3.50 of the Rules of the NY Board of Regents related to Title VIII of the Education Law that lists approved degrees will need to be amended.

There is a lot of confusion and misinformation about this process.  This blog post attempts to explain what is happening at both the surface level as well as 'behind the scenes.'  The purpose of discussing the process is educational and represents my opinion based on information that I have tried to document via embedded links.

The American Occupational Therapy Association's Board of Directors has stated that "ultimately, the only body with regulatory authority to mandate the entry-level degree is the Accreditation Council for Occupational Therapy Education (ACOTE®). ACOTE is recognized as the accreditation agency for occupational therapy education in the United States by both the United States Department of Education (USDE) and the Council on Higher Education Accreditation (CHEA). USDE and CHEA regulations require that all actions and decisions of the accreditation agency must be made independently from the parent association(s). Historically, ACOTE has been careful to consider the positions and policies of the profession’s leadership groups when determining entry-level degree requirements."

Although it is technically true that ACOTE has decision making authority to MANDATE this on a profession-wide basis, it is not how the process is unfolding and it is not how the move to the entry level doctorate will occur in NY State.

As background for understanding this process it is important to consider the relationship between the national member association and its credentialing arm, which is technically a separate organization.  In my opinion, AOTA and ACOTE are functionally indistinguishable.  The AOTA Board of Directors issued a position statement promoting the change to entry level doctoral education.  ACOTE is an "Associated Advisory Council" of the AOTA Executive Board.  Although ACOTE has theoretical distinction from its parent organization, there are other issues to consider when evaluating the statement that the authority rests with ACOTE.  “In a ballot election concluded October 31, 1994, the AOTA membership approved the proposed AOTA Bylaws Amendment that reflected the creation of AOTA’s new accrediting body and establishment of ACOTE as a standing committee of the AOTA Executive Board.”  As such, it is notable that intertwined relationships exist between the two groups since the creation of the credentialing group.

ACOTE has its own Board of Directors, but ACOTE itself is staffed by AOTA employees who all answer to the AOTA Executive Director, who answers to the AOTA Board of Directors.

Accreditation income generated by ACOTE amounted to over $1.4 million of revenue for AOTA in fiscal year 2014.  That level of income calls to question the actual separation between the two groups.  Source: April 2015 Report of the Treasurer downloaded from http://www.aota.org/-/media/Corporate/Files/Secure/Governance/ABM/2015/Treasurer.pdf on June 2, 2105.

I am sure that all USDE and CHEA requirements for disentanglement are legally satisfied, but people can decide for themselves what kind of real separation exists in context of the outlined financial and organizational relationships that are present.

In my opinion the American Occupational Therapy Association Board of Director's 'recommendation' to move to the entry level doctorate is a dog whistle call to academicians to begin readying for a change to an entry level doctorate.  As has been openly stated by a member of the Ad Hoc group that recommended the change, "The entry-level clinical doctorate is coming, like it or not."

When asked to explain this statement from a member of the Ad Hoc group the response from AOTA BoD members is that the 'final decision' to move to an entry level doctorate rests with ACOTE.  This is a distraction because what the 'dog whistle' accomplishes is a call to action for educators who then rush to make sure that they are competitively positioned.  No academic program wants to be the 'last program' that is offering the masters level because they will lose market position to programs who are granting a doctorate.

So in order to grant a new entry level doctoral degree there needs to be an approval from NY State Department of Education.  Enter a cabal of NY State OT academicians, who are now lobbying the NYS Board of Regents to approve the new entry level doctoral degree designation (the OTD).  One university started the process by asking the Regents to approve the new degree.  When the Regents received the request they solicited input from the State Board of OT and the New York State Occupational Therapy Association.  According to memos from the State Board, they reviewed the proposal at a 2/13/15 meeting and supported the authorization of this new degree.  Then on 4/17/15 comments were solicited from faculty and administrators from OT programs in NY as well as from NYSOTA.  The Department received eight comments supporting the proposed amendment and no comments objecting to it.

The next step will be publication of the proposed degree in the Register and there will be a public comment period.  If adopted, the proposed amendment would become effective on October 7, 2015.  The school that started this whole process will apply for a charter amendment in September 2015.  Expect all of the other NY State schools that have OT programs to also make such application shortly thereafter.

This is how the educational programs in NY State will transition to the entry level doctoral requirement, without ever receiving any official 'mandate' from ACOTE.

ACOTE does not initially HAVE to mandate the change to the entry level doctorate because academicians are already making the changes to their own programs following the AOTA BoD recommendation.   Any mandate that ACOTE announces will be ex post facto.

The reason why this process should concern everyone is that it is all happening behind the smoke and mirrors of the AOTA statement that 'ACOTE makes the decision.'

ACOTE is not making this decision; they are watching the process play out behind the scenes.  On its surface there will be an appearance that the educational system came to this point on its own and that subsequent market pressures dictated the wholesale change to the new degree level.  Nothing could be further from the truth.

AOTA made a recommendation, the dog whistle to the academic programs was blown, and then the academic programs worked collaboratively with the member associations (New York and AOTA) to enact the recommendation.  Key leaders of both NYSOTA and AOTA have been copied in on emails from the State Board about this matter.  The leaders of the member associations are fully aware of the process.  This will not be a natural evolution of degree requirements based on market demand.

NYSOTA members should take note that their member association was asked to provide comments.  Someone might ask NYSOTA where the public discussion is about this matter, and how NYSOTA could have provided informed opinions from the membership without the public discussion.

AOTA members should take note that their member association obfuscates the truth by stating that only ACOTE can make the recommendation to move to the entry level doctorate.  Someone might ask the AOTA Board or its staff why they would make such statements when they are fully aware that their recommendation has sounded the dog whistle and prompted action by the New York OT Academic Cabal.

It is important to note that members of this academic group have told me specifically that they take such action based on what they believe is both inevitable and what is best.  I disagree with this position.  More importantly, I disagree with the process by which this change will be enacted.  In my opinion this process lacks transparency and does not facilitate the participation of occupational therapists, employers, or the consuming public.

There will be an open comment period which the public and most occupational therapists will never even hear about.  The reasons why most OTs won't hear about it are related to apathy, a lack of knowledge, and because the member associations are not publicly advertising their support for the proposals that are rolling through the bowels of NY State regulatory approval.

The Board of Regents will incorrectly think that asking the Academic Cabal and the member associations will be a proper form of soliciting input.  The Regents don't really care - they view academic credentials as a nuclear arms race and they know that education programs escalate degree requirements constantly.  For them it is 'just another day.'

There are many reasons why most practicing occupational therapists disagree with an escalation of entry level degree requirements.  The pragmatic street concerns about student debt, accessibility of programs to minority applicants, and whether the public even NEEDS a higher degree for this profession will never even get a fair hearing.  The fact that most street level occupational therapists think that the entry level doctoral requirement is unnecessary will never even be heard.

What is the best way to sum this all up?  I received an email from an occupational therapy political action committee last week and it contained this quote that was attributed to Thomas Jefferson:


We in America do not have government by the majority. We have government by the majority who participate.

There is only one problem.  Thomas Jefferson never made such a statement.  It is a spurious quote, but it perfectly represents the thinking of people who would use a process to pursue their own agenda.  An entry level doctorate does not serve any public need - and is primarily supported by members of the Academy - not practitioners.

Ask the average OT on the street if the entry level doctorate is necessary and you will hear a loud and resounding response that it is a bad idea.  Escalating the entry level degree meets the needs of academic programs and their enabling cohorts that populate the ranks of leadership in the member associations.

Democracies fail when people don't participate, and most practicing occupational therapists will not participate in this process.  As a result of non-participation we do have governance by the majority of those who participate, but this is most certainly not the method that would have been supported by Thomas Jefferson.  

5 comments:

Alejandro Duran said...

Hi Dr. Alterio,
Thanks for your post. I would just like to comment on the quality of thinking indicated on this issue by the main entity leading the charge for the OTD entry level requirement: That is the AOTA Board of Directors. That Board, in April of 2014 issued a position statement giving 6 reasons for the change. Although all of them were flawed in one way or another, it's important to note that the first point made the absurdly false claim that all of the stakeholders were confused by the current system. It doesn't take much thinking to determine the statement's falsity - for example, you as an employer and professor are a stakeholder in this profession, and you are not confused. I know that NBCOT is not confused. I know that university administrators are not confused - and the list can go on and on; Though keep in mind you only need to find one stakeholder who isn't confused to prove the statement false.
It is surprising that such an absurdly false statement could get by without notice by a Board made up of about a dozen people with PHD and OTDs. To me it is very suggestive of the quality of thinking that has gone into this. A separate discussion, coming to a similar conclusion, can be had with the quality of the evidence that was used to drive this agenda.
It all gives credence to Professor Diane Powers Dirette's analysis of this profession, that it has a bandwagon culture: if the right people push an agenda, then sound reasoning and quality evidence will not be obstacles to jumping on that bandwagon.

Anonymous said...

Chris,

"The trouble with quotes on the internet is that it can be difficult to determine their veracity."
- Abraham Lincoln.

As I understand this change would allow NY Schools to offer the entry-level OTD, not to mandate it. Liberty.

Christopher Alterio said...


The ability to 'offer' the OTD will lead to the wholesale transformation of entry level OT education in the state and will kick off a 'nuclear arms race' where programs will try to offer the terminal degree in the shortest amount of time. Some programs will do it in such short terms that it will pinch the remaining MS programs to the doctoral level because they will need to do so in order to be competitive.

This will not serve students because it will increase their debt load. Nor will it serve the public because they don't need entry level OT practitioners trained at a doctoral level.

To state that this agenda only allows schools to 'offer' the degree is incorrect at best and disingenuous at worst. Liberty is not supposed to be used as a cloak for malice. Thinking people will object, but as will be seen, there will be a dearth of thinking people. As a result we will all serve the needs of the academic elites, all at the price that others will pay.

Scott Harmon said...

I would like to thank you Christopher and also Alejandro for trying to keep us OT's informed. It would seem that those who have a dog in this fight would be future OT's and they are either not informed or apathetic. OT's who are already practicing probably do not see how the move to an OTD requirement for future OT's would affect them?

That being said what would you suggest as recourse?

By the way I like this Jefferson quote:
"If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be."

He had another good one about the blood of patriots...

Scott Harmon

Christopher Alterio said...


I wanted to respond to comments that have been made elsewhere that are also important to mention here. It is technically true that the current proposal in NY to add the OTD degree restricts its use to post-professional designations only. However, the State Board of OT has stated, "The O.T.D. degree will be considered a post-licensure professional credential in New York State unless, or until such time as, the Education Law is amended to allow for a licensure-qualifying doctoral degree in the future."

Accordingly, academic programs around the state understand that this is all a 'first step' toward the entry level OTD. However, there is now a wrench in the plans because ACOTE is not supporting a single point of entry, so any change to the license law will have to happen OUTSIDE of an ACOTE mandate. That is a significant barrier.

It is not correct to characterize the proposal as 'post professional only' because that is not the intended end-game of the academic programs who are supporting this initiative.