Occupational therapy education: How to navigate in a Perfect Storm
A little over four years ago I stated that there are too many occupational therapy educational programs in New York State. At the NYSOTA conference legislative information session in 2023 I stood up and suggested that we should all stop taking jobs at these institutions that were seeking to develop new programs. I thought that if we did not take those jobs that the problem would be solved.
That was not realistic or correct, even if the intention was good.
Well karma tends to strike when you make public pronouncements, so I thought I should expand on my perspectives on this topic.
At current count there are still ~22 occupational therapy programs and ~11 occupational therapy assistant programs in NY. Most of the programs are delivered at the master's level. There are a very small number of entry level doctoral programs, but some of the current master's programs are attempting to transition to the doctoral level.
In the Upstate NY region in particular (the area I am most concerned with as it relates to my current geography!) there have been many new programs in the last ten years - leading up to my statement four years ago linked above. There are additional complicating factors that need to be added to the analysis: the changing economy that places severe upward wage pressures for entry level health professionals (especially damaging the OTA level), flat reimbursements in early and primary education that constrict service provision, severe staffing problems in long term care following COVID. There is also the shortage of qualified faculty - a severe problem in the context of an expanding number of schools offering occupational therapy programs. I suppose we should also add in the long-predicted demographic enrollment cliff that higher education is experiencing. There are so many problems.
Here we can see a chart from AOTA indicating a 31% increase in the available number of seats in occupational therapy programs along with a 36% drop in applications.
Here is another chart demonstrating the severe drop in number of applicants to occupational therapy programs.
That is why I label this problem as the occupational therapy profession's version of 'The Perfect Storm.' The definition of such a situation is when many bad things are all happening at the same time. In this context I have previously railed against occupational therapy doctoral mandates and mandatory degree escalation. I have previously argued that the solution was for ACOTE/AOTA to do something to control the number of approvals granted to developing educational programs. The counter-argument to that has consistently been that an accreditor does not have the right to restrict program development (an antitrust argument) and that it was up to the market to dictate the number and quality of occupational therapy programs.
That is a fine argument, and it actually comports with my free-market inclinations, except that the accreditor has a monopoly on collecting accreditation fees. There are also several other elements that must be present for a market to correct. For example, good information for consumers must be plentiful - and the AOTA decision to promote a mandatory doctorate introduced such confusion among consumers that it is still a regularly asked question at any enrollment event if a doctoral degree is required as of 2027. We have an endless barrage of external shock in the form of pandemics and inflationary pressures, and we also have very imperfect competition - the final topic I want to spend some time on.
In the context of occupational therapy education, imperfect competition comes in the form of limited resources and inadequate faculty qualifications. A resultant death spiral can occur if we do not pay attention to it - in a scenario where too many schools compete for students but lack the sufficient resources to attract and retain adequate faculty, you get significant variability in quality of education and declining enrollments. As student numbers decrease, schools face financial strain due to decreased tuition revenue - a particularly vexing problem in the kinds of institutions that house many occupational therapy programs in New York State. That impacts the institutions' ability to invest in faculty, facilities, or to meet new ACOTE standards - leading to a downward spiral in quality and competitiveness.
To address these challenges stakeholders may need to consider strategies to rationalize the market. Rationalizing the market could involve program consolidations or mergers to reduce duplication and ensure that resources are allocated more efficiently. We are already seeing that in higher education on the macro level. The principle needs to be applied at the micro level as well. Some occupational therapy programs need to merge/close.
Quality standards also need to improve. Perhaps the recent glut of programs who seem unable to pare down their credits to meet the credit requirements for a master's degree are a reflection of this need for improvement. This is dangerous territory though - for example, setting requirements for faculty qualifications is a double edged sword in the context of a known faculty shortage. Still, strict adherence to quality standards, whether that takes the form of student outcomes or program accreditation in general, is something that we all need to insist on.
The profession also needs to align supply with demand. On the level of individual programs there needs to be an adjustment of program capacity as well as an analysis of offering specialist training in high demand areas. That is hard to do when programs are required to produce generalist practitioners - but what are the demands of the future? I have made this argument previously - do we need an endless number of doctoral capstones directed at developing OT in areas that will never pragmatically actually hire an occupational therapist? Or do we orient our top-trained practitioners into the areas of future growth and future demand? What schools are equipped to do this best?
Overall, rationalizing the occupational therapy education market involves balancing supply and demand dynamics, improving quality and efficiency, and promoting innovation to ensure that programs produce competent and well-prepared practitioners who can meet the needs of patients and healthcare systems.
So I no longer leave this to competent 'others' to solve. I made those arguments in good faith but ACOTE won't fix this and I think it is more complicated than simply not supporting the 'new' programs. We all work in fine institutions and we all have the best intentions with our individual programs - but I think that educators need to develop new tactics to rationalize the market.
That is what everyone will see out of me in my future efforts.
That is a fine argument, and it actually comports with my free-market inclinations, except that the accreditor has a monopoly on collecting accreditation fees. There are also several other elements that must be present for a market to correct. For example, good information for consumers must be plentiful - and the AOTA decision to promote a mandatory doctorate introduced such confusion among consumers that it is still a regularly asked question at any enrollment event if a doctoral degree is required as of 2027. We have an endless barrage of external shock in the form of pandemics and inflationary pressures, and we also have very imperfect competition - the final topic I want to spend some time on.
In the context of occupational therapy education, imperfect competition comes in the form of limited resources and inadequate faculty qualifications. A resultant death spiral can occur if we do not pay attention to it - in a scenario where too many schools compete for students but lack the sufficient resources to attract and retain adequate faculty, you get significant variability in quality of education and declining enrollments. As student numbers decrease, schools face financial strain due to decreased tuition revenue - a particularly vexing problem in the kinds of institutions that house many occupational therapy programs in New York State. That impacts the institutions' ability to invest in faculty, facilities, or to meet new ACOTE standards - leading to a downward spiral in quality and competitiveness.
To address these challenges stakeholders may need to consider strategies to rationalize the market. Rationalizing the market could involve program consolidations or mergers to reduce duplication and ensure that resources are allocated more efficiently. We are already seeing that in higher education on the macro level. The principle needs to be applied at the micro level as well. Some occupational therapy programs need to merge/close.
Quality standards also need to improve. Perhaps the recent glut of programs who seem unable to pare down their credits to meet the credit requirements for a master's degree are a reflection of this need for improvement. This is dangerous territory though - for example, setting requirements for faculty qualifications is a double edged sword in the context of a known faculty shortage. Still, strict adherence to quality standards, whether that takes the form of student outcomes or program accreditation in general, is something that we all need to insist on.
The profession also needs to align supply with demand. On the level of individual programs there needs to be an adjustment of program capacity as well as an analysis of offering specialist training in high demand areas. That is hard to do when programs are required to produce generalist practitioners - but what are the demands of the future? I have made this argument previously - do we need an endless number of doctoral capstones directed at developing OT in areas that will never pragmatically actually hire an occupational therapist? Or do we orient our top-trained practitioners into the areas of future growth and future demand? What schools are equipped to do this best?
Overall, rationalizing the occupational therapy education market involves balancing supply and demand dynamics, improving quality and efficiency, and promoting innovation to ensure that programs produce competent and well-prepared practitioners who can meet the needs of patients and healthcare systems.
So I no longer leave this to competent 'others' to solve. I made those arguments in good faith but ACOTE won't fix this and I think it is more complicated than simply not supporting the 'new' programs. We all work in fine institutions and we all have the best intentions with our individual programs - but I think that educators need to develop new tactics to rationalize the market.
That is what everyone will see out of me in my future efforts.
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