Open letter to the NYS Board of Regents on the OTD degree

The New York Department of State's Division of Administrative Rules (DAR) publishes the weekly State Register.  This document contains newly proposed amendments to state agency rules and provides interested parties an opportunity to comment on actions before an agency adopts each rule.

The July 1, 2015 Register contains a new rule that will authorize the conferral in New York State of the degree of Doctor of Occupational Therapy (O.T.D.).  There is a 45 day comment period that will soon come to a close.

The Register states that 
The purpose of the proposed amendment is to authorize the conferral in New York State of the degree, Doctor of Occupational Therapy (O.T.D.). The proposed amendment arose from a request to confer this degree by one of the institutions of higher education in New York.  The O.T.D. degree is recognized by the Accreditation Council for Occupational Therapy Education (ACOTE) and is an authorized degree in 26 states, which include California, Connecticut, Florida, Georgia, Massachusetts, Pennsylvania, and Virginia. Adding this degree will benefit occupational therapy students and practitioners in New York by affording them the opportunity to earn a doctoral level degree. The O.T.D. degree in New York will expand practitioners’ access to higher level research and lifelong learning, which ultimately translates to better client care in the profession. Because the O.T.D. degree is a new degree in New York, it is necessary to amend sections 3.47 and 3.50 of the Rules of the Board of Regents related to requirements for earned degrees and registered degrees.  The State Board for Occupational Therapy supports the authorization of this new degree title.

The argument that this degree is necessary because it is not available to NY therapists is a canard.  Many NY State practitioners have engaged distance education to pursue the OTD degree.  Offering the degree in NY serves higher education in NY and does little to nothing with regard to overall access to educational opportunities which are already plentiful elsewhere.

What the Register does not reference is the push from the Board of the AOTA to move the profession to a mandatory entry level OTD.  As most educational programs are 'credit heavy' this will be a default elimination of the masters level degree.  As one possible example, when students are presented with an option of completing an MS program in approximately two years or a doctoral program in approximately three years it is likely that they will opt for the doctoral program.  This dynamic has been discussed from a competitive standpoint by the AOTA Board of Directors when they stated, "The current high credit load in master’s programs makes it very difficult to add additional content in specialized areas of practice. At this time the occupational therapy master’s programs greatly exceed the average credit load of other master’s programs, prompting students to ask why their colleagues in other professions are graduating with a doctorate when, in most cases, they are only in school for 1 to 2 more semesters."

This fact makes the following statement in the Register incorrect:

The amendment simply adds a new degree option and imposes no costs on any parties.

In fact there will be significantly increased costs to students who will be cattle-herded into doctoral programs.  They in turn will attempt to increase the cost to employers because students will believe that they are entitled to high pay associated with their doctoral training.  That can increase the cost to consumers.

A Regulatory Flexibility Analysis was not required and not prepared because the proposed rule states that there will be no impact on business or local governments.  This is false.  Permission to grant this degree will ultimately lead to the elimination of the masters educational level and can increase costs at every level.

A Job Impact Statement was not required and not prepared because the proposed rule states that there will be no impact on jobs or employment opportunities.  This is false.  Increased costs are likely to lead to job loss and will encourage increased attempts by employers to use lower cost or alternative providers.  This will not meet the objective of improving quality of care to consumers in the State.

The Register states that "the State Board of Occupational Therapy supports the authorization of this new degree title."  However, they do not recognize the inherent conflict of interest that many State Board members have because they are employed by institutions of higher education, which would all profit from expanding their degree offerings and escalating the entry level degree.

The Register also does not address the fact that this matter is being internally debated within the occupational therapy profession but that there are extensive flaws in the process that have been documented here and here and here.  During an open forum at the 2015 AOTA Conference the vast majority of commenters argued against the OTD.  At this time there is no consensus on whether or not the entry level OTD should be encouraged.

This proposal from the members of the Occupational Therapy Academy in NY State is in direct contradiction to the overwhelming opposition to the OTD that was evident at that AOTA forum.  This proposal is an end-around the entire process because the escalated degree requirement will ultimately lock out other degree options, and the members of the Academy know this very well because the same scenario played out when programs moved from the baccalaureate to the masters level.

The Board of Regents is well aware of degree inflation and its negative impact on economies.  There is no compelling reason to expand this educational version of a nuclear arms race to the occupational therapy profession.  Health care costs are already spiraling out of control, and it is not necessary to contribute to this trend by encouraging over-training of health care professionals.

Occupational therapists should be concerned because the evidence cited and the comments from the field do not support this change.  I understand the retort that 'this doesn't mandate anything' but in fact we all know precisely where this will lead - and we should have veracity when we are promoting such large policy shifts.

Occupational therapists should also be concerned because this initiative is timed when nearly 30% of the workforce (that is located in pediatric/educational settings) is less likely to notice because they are employed in a pattern associated with the school year calendar.  Occupational therapists should also be concerned because there has been virtually no public comment on this matter from the State OT Association.  In fact, as previously documented, there is evidence that NYSOTA and AOTA are fully aware of this initiative because they have been copied on all internal emails between academic programs who have been discussing this change.  I do not believe that most occupational therapists in the State are even aware that this is happening.

At the time of this publication, this blog stand as the only place that is publishing this information to the occupational therapy community outside of the Register itself.

Constricted publication and notice serves the needs of the few - and hardly represents a democratic process.

There is no evidence that an OTD is necessary.  It will increase student debt, it may unnecessarily lead to economic costs to the State, and it does not meet the needs of consumers of occupational therapy services.  The proposal itself does not accurately reflect the broad range of concerns that are present about this change, and it should be rejected.

Comments will close on this proposal in the near term.  I encourage everyone to provide feedback on this proposal.  Data, views, or arguments may be submitted to:

Office of the Professions,
Office of the Deputy Commissioner
State Education Department
State Education Building 2M
89 Washington Ave.
Albany, NY 12234
(518) 486-1765


Scott Harmon said…
Chris, I really appreciate you keeping us informed about this information.

While I am not a New York state OT I do have a few comments...

First, the people that would be effected by this change are the future students of OT and they simply are not aware or apathetic of this policy change. Current OT's have very little interest in this subject because they already have their degree. They are poorly informed of how this shift could possibly hurt their future employment or pay rate.

Second, it seems to me that the state has to much control over what individual schools are providing. I understand that most therapy schools are state run so they must do what the money tells them to do but...

What if there were two schools in fairly close proximity, one offering an OTD and one a bachelor in OT with the first option costing more time and money? When those programs graduate their classes are the OTD's going to make more money? Not where I am practicing and if the OTD's are paid more the small pay difference gets eaten up in taxes.

Hindsight tells me that I would choose the bachelor level OT every time. I would rather further my studies outside of OT. Maybe get an MBA or some other field of study.

I would like to see what the market will bear instead of bureaucrats dictating the policies. Local control at individual schools instead of "Central Command" giving us just one option.

Just for transparency sake, I am a BS-OT and I hire many Master and Doctorate level therapists. 20 years as a therapists has taught me that therapists learn much more after they get out of OT school than when they are in OT school.
Thanks for commenting Scott. I think you are correct about how a BS in OT along with an MBA, etc would be more valuable, but that is something that we know because of our experience. Students (and their parents) make value judgements all the time but they generally don't have the benefit of that kind of wisdom. They are very aware of the $$ they are spending. So when they see that there are competing schools that are in geographic proximity and one offers an MS and the other offers an OTD for two semesters more schooling they will opt for the OTD every time.

When NY transitioned BS to MS the schools that were 'late' to convert their programs to the masters level lost out on enrollment on a MASSIVE scale. This is why there will be a ripple effect across the State because once the OTD starts there is no stopping it - and any ACOTE decision on the matter will be moot. I suspect that everyone in Academia and in AOTA knows this because of what happened with BS to MS.

The issue is whether or not any of this degree inflation is even necessary, and there is no evidence that it is. In fact, it is probably more harmful than good. As you are aware, many of the very important tasks that OTs perform do not require doctoral level training. With the aging population we actually need OTA level trained people who are interested in working with the elderly, as one example. Although knowledge and skill is required to help a person learn how to dress themselves following a hip replacement, it certainly does not require doctoral level training. With CMS/Medicare moving toward bundled reimbursements how will the system respond to over-trained professionals providing lower-level care? It makes no sense, and we will be pricing ourselves right out of existence. I have no illusions - I know that the lobby for medical devices/implants is significantly more powerful than the lobby for rehab - so guess what will receive the first cost cuts!

I have a doctoral degree, but it was an advanced/post-professional training program. Although it has been very valuable to me, it was not required for entry level practice. I also entered the field with a BS, and it was more than enough for competency in entry level occupational therapy tasks. This degree inflation does not serve our consumers well at all. It contributes to rising health costs and is only an academic stunt that feeds an already bloated higher education system.
Unknown said…
If only they would be thorough and rigorous about actually assessment of accreditation council and weed out BS programs that take tuition and pump out DEGREES, but contribute NOTHING To the professional Field. It's unethical, and infuriating to passionate , competant professionals all around, clinically, academically, policy leaders...aaaarrrgh!!!

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