Rhett Harris

November 19, 2017

Problems within the shift of Occupational Therapy to a Clinical Doctorate

Throughout its history, Occupational Therapy (OT) has undergone several shifts in

its entry level requirements. Since its beginning in the early part of the 20th century, OT

has been a viable and reliable source of recuperation and treatment for various diseases

and disabilities. The American Occupational Therapy Association, or AOTA, is the

organization that oversees all qualifications, certifications, issues and challenges within the

field and scope of OT in the United States but their influence has great effect upon the

entire profession worldwide. This degree is currently available at a Masters and doctorate

level which means that to enter practice, one must have obtained at least a Masters degree

with an option of a doctorate. The AOTA has issued a statement that describes their current

intentions for the profession. They have said that by 2025, the entry-level of education will

move from a two-point entry level degree to a one-point entry level doctorate only.

Occupational Therapy is already a very professional medium of rehabilitation and should

be kept as a two-point entry instead of shifting to a one-point doctorate, as is being

considered at the present time.

The statement issued by the AOTA says the following:

In response to the changing demands of higher education, the health care

environment, and within occupational therapy, it is the position of the American

Occupational Therapy Association (AOTA) Board of Directors that the profession should

take action to transition toward a doctoral-level single point of entry for occupational
therapists, with a target date of 2025. Support of high quality entry-level doctoral

education for occupational therapists will benefit the profession, consumers, and society

(2015).

There are some threats and potential pitfalls that face the profession in regards to

this shift. A few will be mentioned shortly.

The first threat is that there could be decreased diversity in the profession (AOTA,

2015). Ted Brown and his colleagues have explained in their journal that a doctorate

degree can be far out of reach for those that are underprivileged or financially challenged

(2015). If Occupational therapy was made into only a doctorate degree then that would

mean extra years of tuition, textbooks, fees and campus housing for students. This would

absolutely discourage people from pursuing a doctorate level degree in OT. The cost of the

program would just be too high, not to mention other vital expenditures such as food,

passes for campus parking, class fees, transportation and other financial responsibilities.

Many people today are discouraged from attending college for these reasons already.

Making occupational therapy only available at a doctorate level would certainly discourage

even more from pursuing what could be a very excellent career path.

Another possible problem could be that there would be a decreased number of

applicants to the Occupational Therapy Program and could therefore create a shortage in

OT services (AOTA, 2015). This could spell bad news especially upon those who are already

in the profession because they would have to turn patients away from their services and

practices because they are simply not able to accommodate them. If this becomes the case,

many people will have to forfeit this form of therapy for something that may be less
effective or possibly not as viable for their recovery and treatment. This would not help

create or maintain a good reputation of the profession or therapists.

It is also possible that occupational therapists will be so busy that they will not be

able to properly treat patients or take sufficient time to treat them because they will have

to move so quickly between appointments. In many cases, people that are being treated

could receive services that are rushed, sloppy or not thorough, resulting in patient

dissatisfaction with occupational therapy and its professionals. These drawbacks would be

one effect of therapist lowered availability. That is not to say that the therapists wouldnt

be trying to give the best care available, it means that they would be spread so thin that

they couldnt give the time and labor necessary to each individual or client. Recipients of

OT services would certainly feel that their needs are not being met and that they are not

getting the best of the services that they are paying for (in many cases).

If this push were to be made as soon as they are saying, then many schools would be

negatively affected because they would have underprepared staff, students and materials

to properly educate the soon-to-be doctors of Occupational Therapy. Unfortunately, there

are only a few universities (about 3%) that could even offer a doctorate occupational

therapy degree (Wells & Crabtree, 2012). This is because many OT programs in the United

States are not qualified or adequately equipped to teach OT at a doctorate level (Brown et

al., 2015). It's possible that several schools would have to stop their OT program simply

because they are not able to teach the required credentials. This could, in turn, make tuition

even higher because of the lack of availability that students would be able to receive. It is

important that there be some level of competition to enter the program but not so much
competition that such a small number of applicants would get a spot in the program. It is

also important that there is growth and expansion of knowledge in the profession. To be

more economical and efficient, the AOTA should take a better look at the material and

coursework in current university studies instead of just going straight to a higher degree

that is much more costly and takes more time to complete. There are ways to adjust

coursework that makes it more consistent and concentrated. If the credentials are handled

this way, then students can still give a meaningful contribution to the society and the

profession without the extra cost and time.

Not only would students be affected. Other groups would be affected by this change

from a two-point entry to a one-point entry. One of these groups would be occupational

therapy assistants. The credentials could possibly change for them as well from a two-year

associate's degree to a four-year bachelor's degree (McCombie, 2016). Unfortunately for

many of the occupational therapy assistants (OTAs), it would not mean a salary increase

either considering their increase in time and money to obtain credentials. These assistants

would be doing exactly the same things that they have already been doing, so unlike

regular OTs, the OTAs would be mostly negatively affected. It would take longer complete

their degree be a larger cost to them. Randy McCombies findings show that most

occupational therapists and occupational therapy assistants agree that a shift in the

credentials for an occupational therapist would not be beneficial. From the research that

was conducted, 56.5% of OTAs disagreed that the shift from Associates to Bachelors would

be beneficial. Exactly 50% of regular occupational therapist agreed that this would not be

beneficial (McCombie, 2016). From this study alone, we are shown that the shift in OTAs
credentials are definitely not necessary in conjunction with shift in credentials of OT. It is

unfortunate that OTAs have to suffer such drastic consequences with almost no other

benefits besides having a bachelor's degree instead of an associates. Certainly, this fact

alone would also discourage people from obtaining this degree.

This shift is not only affect OTAs but it could also affect other countries OT

credentials. Many other countries do not have the same credentials as the United States.

One example is Australia, whose entry level degree is a bachelor's with an option to do a

masters (Farnworth, Rodger, Curtin, Brown, & Hunt, 2010). Canada, as well, has followed

the United States in OT credentials of an entry-level master's degree and an optional

doctorate (Brown, Crabtree, Wells, & Mu, 2016 p. 307). These are only two examples of

countries that would be affected. In reality, the United States leads in requirements for

occupational therapy entry levels. This means that whatever decisions or changes are made

in the United States will almost undoubtedly affect all countries that offer the degree

(Brown, Crabtree, Wells, & Mu, 2016). Returning to the example of Australia, most masters

level programs require a doctorate level to teach. This has been an issue in Australia

because there are only a few people available to teach at a masters level. On the other

hand, there is an increasing need of occupational therapist in their medical fields

(Farnworth et al., 2010). This could create a shortage of occupational therapists in the

country when the demand is on the rise, therefore, the patients of Australia would have

difficulty getting proper therapeutic care. If the United States does the same thing, then a

similar problem would present itself. Universities would require professors with more

experience and knowledge when those people are already immersed in the profession,
making them unavailable to teach. Students could be discouraged from taking courses

because of the workload, competition to enter the course and the general cost of the course

itself.

The shift from Masters to clinical doctorate could bring some possible benefits. The

benefits that the AOTA has spelled out must be carefully considered. They are, in some

ways, somewhat justifiable. However, the cost to benefit ratio needs to be addressed. There

are specifically three things that the AOTA is looking at as benefits of the shift. Although

these benefits are good things, they seem ambiguous to the threats that are presented at

the same time. One of these benefits would be to meet society's changing expectation of

doctors and those who are in doctorate-level professions (AOTA, 2015). Although there are

no specifics about how societys expectation of the medical field is changing in the AOTAs

statement. Joseph Wells and Jeffery Crabtree also admit in their study that it is impractical

just think that society's expectation is changing for just one discipline of healthcare (2012).

This brings one to believe that there is a changing expectation surrounding the medical

field when, in reality, there may not be such a change or a very slight change. It is the

authors opinion that this is the board's ploy to exaggerate data in order to push their

agenda. It would seem that if occupational therapy standards are rising, then everybody

else's would be as well in all healthcare systems regardless of what that practice may be

and, in many ways, that is simply not the case. Medical technology and discovery may be on

the rise but that does not necessarily mean that therapists have a sudden need to be on top

of every decision made in health care.

 The next possible benefit that the AOTA Board is facing is that there would be an ...

increase[d] perceived credibility to participate in and influence health policy discussions

with payers and legislators (AOTA, 2015). It is important to note that any medical field

should always be in the mindset of having more informed and more qualified professionals

(Case-Smith, Page, Darragh, Rybski, & Cleary, 2014). What will be highlighted is that there

would be a perceived credibility not real credibility to influence such decisions. To a

critic, this seems like a desperate attempt to create more influence in the medical field then

what a degree truly reflects. And as mentioned before, it is a small benefit compared to the

costly risks and potential threats that are facing this shift from a two-point

Masters/Doctorate to a one-point Doctorate. This is not to say that an occupational

therapist cant have important influence on medical care; obviously they can. It is not

totally necessary to require that they have doctorate degrees to have better perceived

credibility.

Here are some other things to consider.

Most opinions about moving from a two-point to a single-point entry in

Occupational Therapy has only come from those that are already in the practice (Fisher &

Crabtree, 2009). This becomes a problem, because those that may be entering the field or

those that are considering it have not had much of a voice, if any, in this major decision.

Lives will be affected by the choice of career and study. It is important that those people are

able to have a say in decisions that are being made for the professions they are pursuing.

Patients should also be heard as to what they believe would be best for their own

treatment. Results cant lie. What may help one person may not help another. In general,
patients know what has been beneficial to them and what hasnt. Because they are

receiving treatment from occupational therapist, they should be able to give informed and

pertinent feedback on the current state of occupational therapy.

When the cost, time and competition is made higher, without the possibility of

gaining more, many are discouraged or made unable to pursue such a path. Perhaps the

most difficult part of this shift is that there is increased schooling, time, cost and

competition without increased pay or salary (Brown et al., 2015). The very thing that

influences most to pursue a profession is for monetary gain. It is true that many will still

pursue it but many will not that probably would have if the change hadnt been made.

Because of this fact, many will succumb to extreme financial distress, mental health issues,

destruction of healthy lifestyle habits and possible failure of self, simply because they were

trying to make the cut to become a doctor in Occupational therapy. In colleges today, this

is already a serious issue and should be mitigated wherever possible.

In conclusion, The American Occupational Therapy Association (AOTA) and its

affiliates should seriously reconsider their decision to change the entry-level degree for

Occupational Therapy. The profession should be kept as a reachable profession for those

who may be underprivileged. The possibility of shortages to the profession must be

considered carefully. Future students and their opportunities for success could be

diminished significantly because of the financial strain of a doctorate degree, not to

mention decreased diversity to the profession. Negative effects upon OTA credentials are

already in place to be effective and reliable and need not be changed. The effects on other

countries could be extremely detrimental with their fragile and thin OT programs. It is the
opinion of the author, to continue to offer occupational therapy at both the Masters and

Doctorate level to mitigate these significant and possibly detrimental hindrances and to

continue to increase the availability of Occupational therapy services.

References

AOTA American Occupational Therapy Association. (2015). Update on the entry-level

degree for the occupational therapist dialogue. Retrieved from

www.aota.org/AboutAOTA/Get-Involved/BOD/News/2015/update-entry-level-degree-o

ccupational-therapist-dialogue.aspx

Brown, T., Crabtree, J. L., Mu, K., & Wells, J. (2015). The next paradigm shift in occupational

therapy education: The move to the entry-level clinical doctorate. American Journal of

Occupational Therapy, 69, 1. Retrieved from

https://byui.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&db=edo&AN=110629133&site=eds-live

Brown, T., Crabtree, J. L., Wells, J., & Mu, K. (2016). The entry-level occupational therapy

clinical doctorate: The next education wave of change in canada? Canadian Journal of

Occupational Therapy, 83(5), 306. Retrieved from

https://byui.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&db=edb&AN=120612899&site=eds-live

Case-Smith, J., Page, S. J., Darragh, A., Rybski, M., & Cleary, D. (2014). THE ISSUE IS... the

professional occupational therapy doctoral degree: Why do it? American Journal of

Occupational Therapy, 68(2), e55. Retrieved from

https://byui.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=tru
 e&db=edo&AN=94770628&site=eds-live

Farnworth, L., Rodger, S., Curtin, M., Brown, T., & Hunt, S. G. (2010). Occupational therapy

entry-level education in australia: Which path(s) to take? Australian Occupational

Therapy Journal, 57(4), 233-238. doi:10.1111/j.1440-1630.2010.00862.x

Fisher, T. F., & Crabtree, J. L. (2009). Generational cohort theory: Have we overlooked an

important aspect of the entry-level occupational therapy doctorate debate? American

Journal of Occupational Therapy, 63(5), 656-660. Retrieved from

https://byui.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&db=cin20&AN=105435319&site=eds-live

McCombie, R. P. (2016). Attitudes of occupational therapists and occupational therapy

assistants toward the entry-level bachelor's degree for OTAs. Open Journal of

Occupational Therapy (OJOT), 4(1), 1. Retrieved from

https://byui.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&db=edb&AN=113208065&site=eds-live

Wells, J. K., & Crabtree, J. L. (2012). Trends affecting entry level occupational therapy

education in the united states of america and their probable global impact. Indian Journal

of Occupational Therapy, 44(3), 17-22. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=103039048&site=eh

ost-live