Analysis of occupational therapy leadership statements on student debt and the doctoral mandate

The occupational therapy profession is joining the credential inflation bandwagon through the mandate of its membership organization AOTA and its educational accrediting subgroup ACOTE.  Proposals are in place to advance the entry level for occupational therapists to the doctoral level.  A companion proposal to advance the entry level for occupational therapy assistants to the baccalaureate level has been made but is in temporary abeyance.

It is important to analyze the statements of the leaders and future leaders of these groups in order to understand their positions on these topics.  Additionally, it is important to hold leaders accountable for their statements.



1. When queried about the impact of credential inflation in the occupational therapy profession to the doctoral entry level, AOTA President Elect Wendy Hildenbrand made several statements related to costs that require analysis.  She stated 

I’m not a fan of the escalating cost of higher education generally, nor do I want our occupational therapy students to accrue high debt or max out loan ceilings while pursuing their professional goals. That said, each student is making an intentional albeit costly personal and professional investment when entering our occupational therapy programs whether wanting to be an occupational therapist (OT) or an occupational therapy assistant (OTA) (Emphasis mine)

These statements are interesting because they represent a logical contradiction.  A contradiction is when you make one statement and then make an opposing statement that cannot be true at the same time.  In this case, she states that students should not accrue debt, but then states that students can accrue debt because it is their own personal choice.  The logical leadership actions that would flow from each condition are polar opposite:

Statement	Logical Leadership Action (LLA)
Students should not accrue debt	Create conditions to prevent debt
Students can accrue debt based on freewill choice	Create conditions for students to choose debt

Do students purposely and deliberately take on these debt loads?  To do so would require some degree of higher thinking and choice.  Deliberation implies weighing and choosing.

In a recent study published by the Journal of Financial Aid (Andruska et al, 2014), the majority of students were aware that they owed student debt, but nearly 40% underestimated the amount of student debt that they owed.  The study indicated that 'loan confusion' increased with each successive year in college, probably based on the increasing numbers of loans that students had.

Thirteen percent of students did not think that they had student debt, when in fact they did.

Based upon this kind of data, it is inaccurate to state that students intentionally assume debt.  That is not possible, because intention would require informed deliberation, and clearly there are students who grossly misunderstand the debt they are incurring.

Additional analysis should also be considered.  Although it is factual that students incur debt, and in fact they sign their names on loan papers, it is also true that those same students end up making rather stark life choices once they are faced with the debt that they have incurred.  It is unlikely that so many students would place themselves in unfavorable positions intentionally where they have to make such stark life choices.  This again goes to the issue of intentionality and deliberation based on full information.

Consider the report written by the group American Student Assistance (2015) that indicates the following:
• 27% of respondents to ASA’s survey said that they found it difficult to buy daily necessities because of their student loans;
• 63% said their debt affected their ability to make larger purchases such as a car;
• 73% said they have put off saving for retirement or other investments; and
• The vast majority—75%—indicated that student loan debt affected their decision or ability to purchase a home.
Survey respondents indicated that in addition to limiting their ability to make major purchases, student loan debt also impacts their important life decisions:
• 30% responded that their student loan debt was the deciding factor, or had considerable impact, on their choice of career field;
• 47% indicated it was the deciding factor, or had considerable impact, on their decision or ability to start a small business;
• 29% indicated that they have put off marriage as a result of their student loans;
• 43% said that student debt has delayed their decision to start a family.

It is unlikely that when students are entering into their choice-making process that all of them are fully aware of the future impact of their choice to take on debt.

In summary, the idea that students intentionally take on debt is not a full or accurate description of the student loan context.

3. Dr. Hildenbrand made this additional statement

As noted in Brent Braveman's post, I do not know of any data to suggest a professional with an entry level OTD will secure a higher salary than a professional with an MOT. Manager friends near me do not utilize a pay differential based on type of entry level degree; they base pay differentials on experience and responsibilities. However, I do not recall that earning a higher entry-level salary is the rationale for this mandate nor is more money automatically attached with earning any kind of “D”. (emphasis mine)

Dr. Hildenbrand should be aware that the AOTA Board of Directors published a FAQ document that used the argument of higher salaries as one reason to support the entry level OTD. Under the question "Why should be support a single entry level degree to the profession" AOTA wrote

"While it is still not common practice, some academic medical centers are now only employing doctorally prepared practitioners or offering salary differentials based on entry-level degree. These centers are responding to the perception that a higher degree equates to higher skill. This follows the logic of our current medical system, where physicians are largely seen as having more knowledge than other providers and are recognized as team leaders."

It is important for the people who are going to be leaders of this profession to be acutely aware of the arguments that have been advanced in favor of the proposal, particularly when the arguments have no merit or basis in fact.

4. Finally, Dr. Hildenbrand states that her opinion  is not informed by evidence, but by her personal feelings:

While this is not a data driven answer, I believe we have to consider the common good and future of our profession – moving from a “me” to “we” focus that extends out 10 years…50 years – to envision the difference.  Personally, it is my belief that a “we” focus will develop the profession and expand our reach and impact as leaders and change agents in health systems, schools, and social programs along with greater involvement in population health, health and wellness arenas, and policy work. (emphasis mine)

Dr. Hildenbrand then elaborates on all her points.  I encourage readers to go view her statements in full so there is no confusion about the context of what I am quoting.

Summary:
The issues of student debt, student intentionality related to debt, the impact of that debt, and the revisionist denial that higher salaries was used as an argument to support degree inflation should be studied by all occupational therapists.

Leaders should be challenged to make logical, fact-filled, consistent presentations of their positions if they expect the profession to accept the proposals being made.  Failure to meet these basic communication requirements has resulted in a significant loss of faith in the professional association leadership and their decision-making abilities.

References:
American Student Assistance. (2015). Life Delayed: New Study Shows Student Debt Impacts Financial Security of Borrowers Across All Institution Types, Credentials. Business Wire (English). 

Andruska, E. A., Hogarth, J. M., Fletcher, C. N., Forbes, G. R., & Wohlgemuth, D. R. (2014). Do You Know What You Owe? Students' Understanding of Their Student Loans. Journal Of Student Financial Aid, 44(2), 125-148.