AOTA Board Position on Entry Level: What about other stakeholders?

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My thoughts on why occupational therapy is anything but ordinary

AOTA Board Position on Entry Level: What about other stakeholders?

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Recently the AOTA Board of Directors Issued a position statement regarding entry level at the OTD level. I have a number of concerns about the Board's action and the statement itself:

  • More than a dozen years ago, AOTA clarified the distinct roles of the Board of Directors and the Representative Assembly. The Board, like all Boards of Directors, is the governing body of the professional association. The Representative Assembly is the body which makes policy for the profession. There is a process for position statements (or other official documents) to be developed, reviewed (including member feedback), and then adopted by the Representative Assembly. I am deeply concerned that the Board of Directors has seen fit to issue any position statement on a professional issue. I fail to see how the issuance of this statement pertains to the Board's governance of and responsibilities to the association.
  • The Centennial Vision is cited as a basis for recommending entry level at the doctoral level. I question whether all of the aspects of the Centennial Vision have been considered.  Specifically, "globally connected" and "diverse profession."
  • The move to masters entry level continues to have an effect on our relationships with practitioners and practice in other countries. A practitioner and educator in one country put it most simply as "American arrogance." There continue to be "multiple entry levels" in OT globally. The only place where we seem to be "confused" about it is here in the US.   OTs with bachelors or, sometimes,  masters equivalent practice provide community-based and primary care OT, often without an order or involvement of a physician, in Australia, Canada, Great Britain and Scandinavian countries. We could learn much from these therapists. Masters entry level continues to be a barrier for experienced and expert occupational therapist from other countries to be able to practice in the United States.If entry level at the doctorate were to become established by ACOTE and NBCOT, and adopted by state regulation, it would be virtually impossible for practitioners from other countries to practice in the US.  If occupational therapy is to be truly globally connected, then consideration of entry level education belongs within the purview of WFOT and not a unilateral decision of any one WFOT member association.
  • The cost of higher education continues to escalate, to the point that it has now become a focus of a White House initiative. How will moving to a doctorate increase the diversity of the profession when it extends the duration of the educational process? Already, most post-professional OTD programs exist at private institutions.   Degree programs at public institutions must be approved by boards which are often state-level bodies appointed by legislatures or governors. These bodies, already concerned about costs of degree programs to both the institution and the student, and concerned about "degree creep," are skeptical of programs which already exist at a masters level being proposed at a doctoral level, especially a clinical doctorate. So what happens if a doctoral entry level is approved and many of the current educational programs located in public institutions do not receive approval to move to the doctorate. How will OT become more diverse if the options to obtain a degree at a public institution are reduced?
  • Finally, we are getting ahead of ourselves. In many practice settings in this country, the practice of occupational therapy is rote, technical skills. I agree that changes in demographics, health care and health care policy and payment demand complex clinical reasoning and higher level skills, but perhaps we should start by demonstrating complex reasoning and skills commensurate with our current education. The CEO of one the largest OT employers in the country has proposed lobbying legislators to reduce the educational and licensure requirements for OT because he "has people who need OT" and he doesn't have enough OTs. As long as he measures productivity in terms of minutes or units, rather than meaningful outcomes for the patient or for society, it's unlikely that he will be interested in doctoral level OTs.

I know most of the AOTA Board members personally, and I respect that they gave thoughtful consideration, individually and collectively, to their decision to issue the position statement. But I think the action and the statement itself is ill-advised.  AOTA's history as a professional organization is dominated by a focus on ourselves and those we serve, and a lack of  attention to the interests of other stakeholders. So I find myself once again asking the question--how does this position affect the interests of stakeholders beyond practitioners and patients? What about OTs in other countries whose opportunities to share their expertise with us are further limited? What about potential OTs with modest finances who will not be able to afford an entry level education--or graduates who will feel forced to take positions that are exclusively technical to pay off crushing educational loans? What about the decision makers at institutions of higher learning who decide the fate of existing and future educational programs? What about the growing consolidation of employer entities in post acute settings who can wield significant political and economic pressure on both education and on licensure? There are many more external stakeholders to consider. There is also an internal issue to resolve- the role of the AOTA Board of Directors in regard to issuance of position statements on professional policy.

  • Hi Carol,

    Thank you very much for sharing your thoughts and perspectives on the issue of moving to a single point of entry for the occupational therapist.

    I have reviewed the currently approved articles of incorporation, the Bylaws, the Administrative Operating Procedures and the policy manual.

    The Board has not established professional standards or policy which is the function of the Representative Assembly as a designated body of the Board. It has not called for any action item by the Assembly. It has not established standards for educational programs or affected the policies, rules or procedures for conducting accreditation reviews or making accreditation standards which is delegated to ACOTE as an Associated Advisory Council of the Board and has autonomy in those functions.

    The Board issued an opinion that relates to the strategic direction of the profession and current trends in practice and education and has called for member input and dialogue.  By the nature of the statement it is an opinion on current association policy. I see all of this as clearly within the purview of the Board of Directors.

    While in a legal sense all documents approved by a body of the Association are “official” the statement issued does not match any of the titles of types of official documents that are routinely reviewed and approved by the Representative Assembly or a body of the RA.

    I would be interested in hearing more detail about your concern over issuance of a position statement by the Board of Directors and how you see it in conflict with the approved description of roles or responsibilities of the Board.

    Again, thank you for your thoughtful comments describing your concern over having a single point of entry for the occupational therapist at the doctoral level. I appreciate your perspective and your experience very much.


    Brent Braveman

  • Carol, I really appreciate you bringing up the challenges that a change in USA entry level education will create for international relationships, and the perceptions of US OT by internationally trained OTs. From my perspective, considering impact on global connections is an essential part of the discussion of entry level education going forward. Sue

  • I couldn't have said this better myself!  I have many of the same concerns.  I received my OT degree overseas and would not have been able to practice in the US if these changes had been implemented when I graduated.  Also, a PhD will not make a difference in the day-to-day patient treatment that I provide or the salary that I am paid.

  • Well said!