There are too many occupational therapy educational programs in New York State

There is an alarming increase in the number of accepted applicant and developing occupational therapy programs in New York State. The current entity responsible for the accreditation of these programs is the Accrediting Council for Occupational Therapy Education (ACOTE), a function of the American Occupational Therapy Association (AOTA).

According to data provided by AOTA and ACOTE, there are 22 accredited occupational therapy masters-level degree programs in NY State and 12 accredited associates-level occupational therapy assistant degree programs.

There are two additional developing masters-level degree programs, ten applicant doctoral-level programs, and one applicant masters-level program. Of the developing and applicant programs, approximately half are new and the other half are existing accredited programs that are seeking to add an additional degree level.

The question that is never asked is “How many occupational therapy educational programs can be reasonably supported in a single state?” California has 11 accredited occupational therapy programs and 6 accredited occupational therapy assistant programs. Florida has 12 accredited occupational therapy programs and 21 accredited occupational therapy assistant programs (half are from a single educational entity, an interesting issue unto itself). Pennsylvania has 18 accredited occupational therapy programs and 12 accredited occupational therapy assistant programs. Texas has 11 accredited occupational therapy programs and 19 accredited occupational therapy assistant programs.

New York currently has more occupational therapy educational programs than any other state. Even more are being developed.

In contrast, there are large swaths of the country where there is very little opportunity for students to pursue an occupational therapy degree locally. New Mexico has one occupational therapy program and two occupational therapy assistant programs. Nevada has one occupational therapy program and one occupational therapy assistant program. Montana has nothing.

This issue is important on several levels.  People living in low-access areas have decreased access to occupational therapy as a service. Additionally, these areas also represent some historically under-represented population groups. The occupational therapy profession already has a severe problem with diversity; the overwhelming majority of the profession is white and female.  Maldistribution of educational programs contributes to this problem.

Education deserts are defined as geographic localities where college opportunities are few and far between. As reported, “Place still matters; in fact, the majority – 57.4 percent – of incoming freshmen attending public four year colleges enroll within 50 miles from their permanent home.” Also, distance education does not mitigate structural problems with access because of poor broadband availability in many of these rural areas (Hillman & Weichman, 2016). Clearly, there is a severe problem with occupational therapy education deserts - so what is AOTA and ACOTE doing to address this problem?

Applicant programs are required by ACOTE to demonstrate that fieldwork agreements are sufficient in scope and number to allow completion of graduation requirements in a timely manner. It is commonly repeated that there are inadequate numbers of available fieldwork sites even for existing programs – so much so that in recent years three has been a ‘relaxing’ of standards with the allowance of ‘emerging’ fieldwork sites and doctoral capstone experiences where the onsite supervisor does not even need to be an occupational therapist. Also, new fieldwork supervision models have been proposed for part time ‘faculty-led’ supervision and even single supervisors overseeing multiple students. The occupational therapy literature is replete with studies that document concerns with fieldwork capacity (Evenson, et.al., 2015; Roberts & Simon, 2012; Stutz-Tanenbaum, Hanson, Koski, & Green, 2015).

 In such a context, it is difficult to understand how and why all of these new educational programs in saturated areas are being granted developing status. This is an area for AOTA and ACOTE to have some transparency over because the disconnect between the stated concerns in the literature and the unfettered approval of new programs in overly-saturated geographies is startling.

This is also disturbing given the propensity for occupational therapy academicians, a population responsible for all of this maldistribution, to lecture the profession about equity and justice (Hemphill, 2015). The occupational therapy profession needs to have a look in the mirror over this issue.

 Additionally, ongoing concerns that have been expressed during the profession’s ‘doctoral debate’ led to a newly developed memorandum of understanding between AOTA and ACOTE. There are still concerns about the inherent conflicts of interest present when an educational accreditation function is housed within a membership organization. These also require transparent discussion in that accreditation decisions are not at full arms-length from a group that benefits from increased membership from students.

For all of these reasons, ACOTE and AOTA need to have more open conversations about these concerns with the broad community of stakeholders that are being impacted by the severe maldistribution of educational programs.

In particular, there needs to be immediate attention given to the problems that are being caused in places like New York State where the artificially inflated supply is far outstripping the actual demand.

References: See embedded links, and…

Evenson, M.E., Roberts, M., Kaldenberg, J. Barnes, M.A., & Ozelie, R. (2015). National Survey of Fieldwork Educators: Implications for Occupational Therapy Education. American Journal of Occupational Therapy; 69 (Supplement_2):6912350020p1-6912350020p5. doi: 10.5014/ajot.2015.019265.

Hemphill, B. (2015) Social Justice as a Moral Imperative, The Open Journal of Occupational Therapy: Vol. 3: Iss. 2, Article 9.Available at:http://dx.doi.org/10.15453/2168-6408.1150

Hillman, N. and Weichman, T. (2016). Education Deserts: The Continued Significance of “Place” in the Twenty-First Century. Viewpoints: Voices from the Field. Washington, DC: American Council on Education

Roberts, M. E., & Simon, R. L. (2012). Fieldwork challenge 2012. OT Practice, 17(6), 20.

Stutz-Tanenbaum, P., Hanson, D. J., Koski, J., & Greene, D. (2015). Exploring the complexity of the academic fieldwork coordinator role. Occupational Therapy in Health Care, 29, 139–152.

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