FAQs: AOTA Board of Directors Position Statement on Doctoral-Level Single Point of Entry for Occupational Therapists

These will be updated as more questions arise, and we'll indicate the date that new items are added. Latest update: November 10, 2014.

In response to the changing demands of higher education, the health care environment, and within occupational therapy, AOTA’s Board of Directors has issued a position statement 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. See the Position Statement here.

Q: Why did the Board feel it was necessary to issue this position statement?

As a leadership body, it is the responsibility of the Board to identify important strategic issues that it believes the profession should address. In this instance, two separate advisory bodies appointed by the President, the Future of Education Ad Hoc Committee and a Board subgroup reviewing the committee’s report, recommended that the Board consider the issue of doctoral-level entry for the profession. After extensive consideration of evolving changes in the health care system, higher education, and the profession itself, the Board came to consensus on the issue and now seeks a broad, profession-wide dialogue to address whether such a move will best position the profession to meet the growing needs of society and fulfill its potential in the 21st century.

Q: Does this statement mean the profession is adopting doctoral-level single point of entry?

The Board does not have the authority to make this decision. The Board’s responsibility is to identify the importance of the issue for our members, facilitate discussions, and assure that established processes for considering such questions are followed with transparency and broad community participation. 

Q: What are the next steps?

The Board is holding a series of discussion meetings in various forums throughout the next year with AOTA volunteer leadership groups, general members, and external groups such as NBCOT and AOTF. Click here for a schedule of meetings.

Q: How do I share my opinion on this?

The Board has set up a forum on OT Connections for members to share feedback and ask questions. We encourage members to participate in the meetings mentioned above, and we will be holding an open forum discussion on April 17 in Nashville, during AOTA’s 2015 Annual Conference and Expo.

Q: What about students who are currently in or just entering a master’s program? Should they be doing anything differently?

No decision has been made to change entry-level requirements. If ultimately any change were made to mandate doctoral-level entry for occupational therapists, it would apply only to future graduates after an appropriate transition for educational institutions.

Q: How would current practitioners be affected by any change in entry-level requirements for occupational therapists?

Currently practicing occupational therapists who have previously graduated at the bachelor’s or master’s level would be unaffected.

Q: Who makes the final decision, and when will it be made?

AOTA has a process for determining professional policies and standards. The Board and other leadership groups in the profession may take positions on particular issues, but only the Representative Assembly can establish official professional policies or standards for occupational therapy. Typically, the Assembly only creates a policy after an extended period of dialogue and input from all key stakeholders.

Ultimately, the only body with regulatory authority to mandate the entry-level degree is the Accreditation Council for Occupational Therapy Education (ACOTE®). ACOTE is recognized as the accreditation agency for occupational therapy education in the United States by both the United States Department of Education (USDE) and the Council on Higher Education Accreditation (CHEA). USDE and CHEA regulations require that all actions and decisions of the accreditation agency must be made independently from the parent association(s). Historically, ACOTE has been careful to consider the positions and policies of the profession’s leadership groups when determining entry-level degree requirements.

Q. If the entry-level degree changes to a doctorate, what happens to schools that don’t have a doctoral program?

At that point ACOTE would be able to accredit only doctoral-level programs. Historically, ACOTE has been sure to allow schools a generous time period to transition to new requirements. For example, when the profession transitioned to post-baccalaureate entry educational programs were allowed 7 years to comply with the new requirements; only a handful of programs chose not to make the transition.

Update June 5, 2014:

Q. Why should we consider a single entry-level degree to the profession?

The stated purpose of the national certification exam and entry-level education is to ensure the competence of entry-level practitioners (Source: www.nbcot.org/public; www.acoteonline.org). The existence of two entry-level degrees (master’s and doctorate) as the requirement for eligibility to sit for a single certification exam and licensure to practice as an occupational therapist creates inconsistencies. How can two different degree levels meet the single requirement for competent practice?

• Many prospective students and practitioners contact AOTA and express confusion when choosing educational pathways to the profession. To put it simply, they do not understand why there are two degree options. There is a single set of student learning outcomes and competencies established through certification for entry-level practice. It seems that either one degree level is “under” qualified or one level is “over” qualified for entry-level practice.   
• Over the years AOTA has had legislators and regulators question the profession’s need to have two entry degree levels. Shouldn’t there be different student learning outcomes if there are two degree levels? If so, wouldn’t the higher degree have more skills at entry level?
• Employers have similar questions: Do I need doctorally prepared new graduates or do I need master’s prepared? What is the difference? Why should I pay more for a doctorally prepared OT if I can pay less for a master’s level?
• Payers have mostly handled the question by reimbursing based on a licensed professional and avoided the degree question. If the payers’ reimbursement is not based on degree level, why have two levels?
• 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.
• The question has been posed that other health care professions (e.g., nursing) have more than one entry-level degree, so why can’t occupational therapy? We found that professions with more than one entry level are in the minority, primarily for the reasons stated. The majorities of professions either have a single entry-level degree or are in a period of transition to achieve this goal. The profession that is most frequently identified is nursing, and they continue to debate the same issues facing occupational therapy (http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education).

In deliberating this complex issue we concluded that while there may be some benefits to the two entry-level-degree model, they did not outweigh the inconsistencies created when you have two different degree levels qualifying graduates for a single set of entry-level competencies.

Q. Why consider the doctorate as the single entry-level degree?

The profession has “sanctioned” the entry-level doctoral programs since the first OTD program was accredited in 1998. At that time, the profession offered three different degree levels for entry to the profession. This position of the OTD was reinforced by the Representative Assembly in 1999 when it adopted Resolution J, making it the official policy of the Association that the entry to the professional level of practice in occupational therapy be at the post baccalaureate degree level. Currently there are 6 accredited and 13 applicant or candidate entry-level doctoral programs. The view of some that we should sanction the master’s degree as the entry level neglects to recognize that entry-level doctoral programs exist and are proliferating. While this is not a compelling argument in and of itself for moving to the OTD entry level, it is an important point of consideration in the discussion.

Master’s programs in occupational therapy have a high credit load compared to most master’s-level programs. Students in combined bachelor’s/master’s programs typically take a minimum of 5 to 5.5 years post-secondary study to complete the entry-level requirements. Students in graduate master’s programs typically take a minimum of 6 to 6.5 years of post-secondary study. The United States Department of Education defines a professional doctorate as “a doctorate that is conferred upon completion of a program providing the knowledge and skills for the recognition, credential, or license required to enter professional practice. The degree is awarded after a period of study such that the total time to the degree, including both pre-professional and professional preparation, equals at least six full-time equivalent academic years.” (retrieved http://nces.ed.gov/ipeds/news_room/trp_technical_review_02072006_18.asp). Many of the existing master’s programs meet or exceed the USDE minimal requirement for a professional doctorate.

The current high credit load in master’s programs makes it very difficult to add additional content, especially with the current trends in state policy to limit the credit loads of degrees to control costs. However, the educational programs are being asked to address changes in the health care delivery system, such as the increased focus on primary care, interprofessional care teams, and specialization in practice, all of which will require increased content in the entry-level academic programs (Institute of Medicine, 2010; Interprofessional Education Collaborative Expert Panel, 2011; National Committee for Quality Assurance (NQF), 2013). The practice community has argued that other areas of the curriculum do not currently meet the needs of their practice areas and are petitioning ACOTE for increased content.

The majority of health professions are either at the doctoral level, transitioning to the doctorate, or are debating the issue. The studies on the development of the professions have identified that as professions have “matured” they have moved to higher degree levels (http://www.carnegiefoundation.org/previous-work/professional-graduate-education). More often than not, the primary issues are related to autonomy and perceived power.

When considering whether to recommend doctoral as the entry-level degree, we examined what has changed since we moved to the master’s entry level and considered what might have happened if we had not done this. At that time concerns were raised regarding costs, access, diversity, and faculty shortages, with little perceived gain in competency as an entry-level therapist. Then, as now, we saw the advantages of a more advanced degree in terms of where the health care system and the profession were going. The profession ultimately made the transition successfully and holds a respected position as a member of health care teams, which is reflected in both public policy and practice. However, we know the health care system continues to change with the evolution of new delivery models and approaches to care, and this environment presents both opportunities and dangers. For example, occupational therapy was initially excluded from an important national initiative to develop an assessment on interprofessional behaviors because we were not a “doctoral” profession. While this is but one example, we are deeply concerned that we could be seriously disadvantaged in the emerging health care environment if we don’t have the educational equivalent of our peers in other health care professions.

Update July 1, 2014:

Q: How will moving to doctoral entry-level requirement impact diversity in the profession?

What can we learn from physical therapy? As reported in the APTA 2012-2013 Aggregate Data Report, the transition to the DPT in physical therapy had no significant impact on diversity (race/ethnicity) in the student population. There has been a slight growth in the percentage of males in the programs over the last 3 years. No other diversity data is reported.

Source: American Physical Therapy Association (APTA) (2014). 2012-2013 Aggregate Program Data: PT Programs. Author: Alexandria, VA.  Retrieved from http://www.capteonline.org/AggregateProgramData/

What can we learn from speech/language/hearing? The data collected on race/ethnicity in the student population in a 2012 study did not show a significant difference between the doctoral-level audiology and master's-level speech pathology students. The data on gender indicated significantly more male students in the doctoral-level audiology programs.

Source: American Speech, Language, Hearing Association. (2013). HES CSD Education Survey National Aggregate Data Report: 2010–2011  Academic Year. ASHA: Washington, DC. Retrieved from http://www.asha.org/uploadedFiles/2010-2011-CSD-Aggregate-Data-Report.pdf#search=%22student%22

What can we learn from the limited data on OT programs? In 2010 the federal reporting requirements changed to identifying ethnicity (Hispanic/Non-Hispanic) and race as two different criteria. Previously, “Hispanic/Non-Hispanic” had been identified as an option under the race criteria. As a result it is difficult to compare data collected prior to 2010. The following table provides a comparison of the 2003-2004 data versus the 2013-2014 data. While a direct comparison is not possible secondary to the changes in report format, there does not appear to be a significant impact on race/ethnic diversity over this time period. This is the time period over which the majority of programs transitioned from bachelor's to master's degrees.

Table 1: Change over the last 10 years in ethnicity/race

The profession will benefit from continued dialogue about diversity as we think more about the potential of moving to doctoral entry. The Board welcomes comments on this issue.

Update July 2, 2014:

Q: What information did the board consider before making its recommendation?

The board examined multiple issues, and they summarized the pros and cons in this table. Additional advantages and/or disadvantages may be identified as the profession participates in dialogue about this complex issue.

Update July 14, 2014:

Q: What would be the impact of moving to a doctoral entry-level degree on fieldwork?

In its deliberations on the entry-level-degree for occupational therapy, the Board of Directors identified concerns that the doctoral entry level may place increased strain on the ability of academic programs to find an adequate number of fieldwork Level II sites. In order to address this question the Board initially reviewed the current requirements.

The ACOTE standards for the master’s-entry-level degree and the doctoral-entry-level degree have the same requirement for fieldwork Level I and II. At both the master’s- and doctoral-degree levels the students must successfully complete a total of 24 weeks of FW Level II. The student can complete Level II fieldwork in a minimum of one setting if it is reflective of more than one practice area, or in a maximum of four different settings. The goal of Level II fieldwork is to develop competent, entry-level, generalist occupational therapists. Successful completion of FW Level II is a requirement for licensure in a number of states.

In addition to the FW Level II requirements, a doctoral student must successfully complete a doctoral experiential component. The required length of this doctoral experiential component is a minimum of 16 weeks. The goal of the doctoral experiential component is to develop occupational therapists with advanced skills (those that are beyond a generalist level). The doctoral experiential component shall be an integral part of the program’s curriculum design and shall include an in-depth experience in one or more of the following: clinical practice skills, research skills, administration, leadership, program and policy development, advocacy, education, or theory development.

Because of the difference in the breadth and depth of the doctoral experiential component it is not clear how often (if at all) programs would be utilizing existing FW Level II sites for the experiential placements each semester. The goal for the doctoral experiential component allows academic programs to identify and utilize placement sites not used to meet the fieldwork Level II requirements. Indeed, it was identified that the existing OTD programs often utilize sites where OT services are not provided, with the focus on advocacy and program development in emerging areas of practice.  However, there is no data reported at this time on the percentage of placements in these settings. 

The Board of Directors recognizes that the availability of sites to meet the experiential component requirements of the current ACOTE doctoral standards could be a potential barrier to implementing a doctoral entry-level requirement. It is a question we hope to explore more when we meet with the Accreditation Council on Occupational Therapy Education in August and with the participants in the joint meeting of the Academic Leadership Council and Academic Fieldwork Coordinators Forum in October. In the meantime, we have asked staff to identify strategies to gather further data on the “potential” impact if the programs were to all transition to the doctorate.

Update July 28, 2014:

Q: What information points to a trend in health-related professions transitioning to the entry-level clinical doctorate?

The Board of Directors and the Ad Hoc Committee on the Future of OT Education conducted an environmental scan of similar health professions that are moving toward the entry-level clinical doctorate, utilizing the following information sources.

Physical Therapy

The Commission on Accreditation in Physical Therapy Education (CAPTE) will require all programs to offer the DPT degree effective December 31, 2015. Source: http://www.apta.org/pteducation/overview

American Physical Therapy Association (APTA). (2011). Today’s physical therapist: A comprehensive review of a  21st-century health care profession. Alexandria, VA: Commission on Accreditation in Physical Therapy Education.

Physical Therapy Data

Pharmacy

In 2000, the American Council on Pharmaceutical Education (ACPE) announced the conversion to the Doctor of Pharmacy (PharmD) as the sole entry-level degree for the profession of pharmacy. Source: https://www.acpe-accredit.org/about/history.asp

Nurse Practitioner

The American Association of Colleges of Nursing has taken the position that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree by the year 2015. Source: American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing. Available at http://www.aacn.nche.edu/DNP/pdf/DNP.pdf.

Audiology

Beginning in 2007, the Doctor of Audiology (AuD) has been the entry-level degree required for the clinical practice of audiology. Source: http://www.audiology.org/education_research/education/students/Pages/audfacts.aspx

Nurse Anesthetist

The American Association of Nurse Anesthetists is requiring the DNP (or DNAP--Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist programs by the year 2025.  

American Association of Nurse Anesthetists. (2007). AANA Position on Doctoral Preparation of Nurse Anesthetists. Source: http://www.aana.com/newsandjournal/News/Pages/092007-AANA-Announces-Support-of-Doctorate-for-Entry-into-Nurse-Anesthesia-Practice-by-2025.aspx 

Additional health professions requiring an entry-level clinical doctorate:

Doctor of Medicine (MD)

Doctor of Psychology (PhD or PsyD)

Doctor of Osteopathic Medicine (DO)

Doctor of Dentistry (DDS)

Doctor of Chiropractic (DC)

Doctor of Podiatric Medicine (DPM)

Update November 10, 2014:

Q: What's the next step?

The Accreditation Council for Occupational Therapy Education (ACOTE^®) has established a task force to work alongside stakeholders to collect and evaluate evidence to identify the optimal entry level(s) of education for ethical, accountable, and efficient practice to meet society's occupational needs. Read more here.