Review of the Postbaccalaureate Degree for Professional Entry into Physical Therapy

Review of the Postbaccalaureate Degree for Professional Entry into Physical Therapy JOYCE L. MACKINNON The American Physical Therapy Association has endorsed the postbaccalaureate entry-level degree for the physical therapy profession. This article reviews the purpose of entry-level professional training and contrasts various options of educational systems with degree structures. Professional, economic, political, and educational factors are considered. After analysis of these variables, the Master of Physical Therapy degree is my recommendation for the postbaccalaureate entry-level degree for physical therapists. Key words: Education, graduate; Physical therapy. In 1983, the American Physical Therapy Association House of Delegates reaffirmed their support for and endorsed the postbaccalaureate entry-level degree for the physical therapy profession. 1 The purpose of this article is to review the intent of entry-level training and present options of educational systems with degree structures. The variables that influence these options, such as professional, economic, political, and educational considerations are analyzed in this article. BACKGROUND In 1979, the APTA House of Delegates adopted a policy stating that entry-level education for the physical therapist result in the award of a postbaccalaureate degree. 2 This policy was the culmination of several years of data collection and study performed in large part by the Task Force on Evaluation of Education for Entry Level for Physical Therapists. The Task Force, appointed in 1976 by the Board of Directors of the APTA, was charged to review current physical therapy education levels and make recommendations for future entry level, that is, the initial point of entry into the profession. The Task Force's work was based on several assumptions. 2 Physical therapy is a profession, and, therefore, physical therapy education is professional education. This education is usually housed in a college or university and should have academic and clinical components based on specific competencies. Entry-level education should be considered in a societal context and reflect past, present, and future trends. The task force also identified major issues that affect physical therapy. 2 These issues were categorized in three areas: Ms. MacKinnon is Coordinator of Physical Therapy, Dorothea Dix Hospital, Raleigh, NC, and Assistant Professor, Division of Physical Therapy, Department of Medical Allied Health Professions, University of North Carolina, Chapel Hill, NC 27514 (USA). This article was submitted March 9, 1983; was with the author 19 weeks for revision; and was accepted January 4, 1984. 1. Health-care delivery, including manpower needs and changing patterns in the provision of health care, cost, and quality assurance programs. 2. The physical therapy profession in terms of its development and expansion; the expectations of students, employers, and clients; and its accountability. 3. The higher education priorities such as use of resources, institutional objectives, academic concerns, and educational alternatives. Moreover, the task force examined factors specific to the physical therapy profession, including the trend toward practice without practitioner referral, the increasing sophistication and proliferation of professional knowledge, and the variety of settings in which physical therapists practice. A concept of great importance evolved from the deliberations of the task force professional autonomy. As defined by the task force, a professionally autonomous person is one whose skills and knowledge of his area of practice enable him to function independently from the immediate direction of others. 2 He can discover innovative solutions to particular problems and is completely accountable for his practice decisions. This concept was crucial to the task force's recommendation that physical therapy entry-level education be directed toward achieving professional autonomy and should be at the postbaccalaureate degree level to reach this goal. Before recommending an appropriate postbaccalaureate entry-level degree, I will discuss and review the evolution of education for allied health professionals, the general purpose of entry-level education, and the traditional educational degrees. Physical therapy education does not exist in a void; therefore, economic, professional, political, and educational influences are also considered. Evolution of Education for Allied Health Professionals Physical therapy is a profession. 2 A profession is composed of people with specialized knowledge obtained through education that allows them to provide specific services in an exclusive manner to a public that accepts this exclusiveness. 3 Various allied health professions evolved as a need for a specific service was identified. An individual, was designated to fill that need and learned the necessary skills through onthe-job training, usually in a hospital. Eventually, as the result of an increasing knowledge base, this training became more formalized and was moved from a hospital to a university. 938 PHYSICAL THERAPY

EDUCATION Some form of registration or licensure frequently accompanied this process. A number of reasons explain why this evolution occurred. Some of these reasons are in the interest of public welfare; others tend to be in the interest of the profession. By placing an allied health profession's training (eg, physical therapy) in an educational setting, forming a professional organization, and requiring some form of licensure or registration, the health and welfare of the public should be protected by ensuring a minimum level of competency of practitioners and eliminating the obviously unqualified. The exploitation of trainees should be prevented, and standards of care should be increased. 4 In addition, physical therapists can structure their educational settings, professional organization, and licensure procedures to control the number of people entering the field, protect economic interests, ascertain who may practice a specific skill, and provide professional status. 4 A final stage in the evolution of professional education is the tendency to require a higher educational degree for entry level into the profession. Professionals with associate-level degrees begin to urge the adoption of entry level at a bachelor's degree stage (eg, nurses). Professionals with a postbaccalaureate entry degree are prone to move toward a postbaccalaureate degree (eg, physical therapists and occupational therapists). This phenomenon seems to reflect the increased preparation time required for the profession. Purpose of Entry-Level Education As previously stated, the purpose of entry-level education is to provide an individual with the necessary knowledge, skills, and competencies to practice initially in his chosen profession; physical therapists must decide what knowledge base and which competencies and skills are essential compared with desirable. 5 Entry-level education, which is normally considered to produce a generalist, should be viewed within an educational system. Room may exist within the system for students to develop some specialized competencies without compromising their broad-based educational requirements. The system should continue to have continuing education offerings available. True specialization, however, could be recognized by an advanced degree that would differ from the entry-level degree and would be an acknowledgment of expertise in a specialty area or could be handled by the APTA sections' specialization protocol. Providing mechanisms such as those just suggested could create a career ladder with specified credentials at each level that would encourage and acknowledge professional growth for physical therapists. TRADITIONAL DEGREES To choose an entry-level degree for physical therapy education, therapists should be familiar with the traditional meaning of degrees. The degree is an academic rank conferred by an institution of higher education to denote proficiency in scholarly pursuit. 6 Therapists must remember that licensure allows a person to practice physical therapy but that the degree selected for entry level denotes competency in the practice of physical therapy. A person who holds this degree should be able to pass the licensure examination. When creating an appropriate postbaccalaureate degree for entry level, teachers of physical therapists must provide a postbaccalaureate program that is not merely a baccalaureate program with extra hours. Degree options for entry at the postbaccalaureate level are as follows: 1) Master of Arts (MA), 2) Master of Science (MS), 3) Master of Arts in Physical Therapy (MAPT), 4) Master of Science in Physical Therapy (MSPT), 5) Master of Physical Therapy (MPT), 6) Diplomate or Specialist in Physical Therapy, 7) Doctor of Physical Therapy (DPT), and 8) Doctor of Philosophy (PhD). The certificate currently used in physical therapy education to denote graduate education without a degree is not included in the above list because it is not recognized as a standard, traditional degree. Master's Degree "The first postbaccalaureate or graduate degree, representing not less than one nor more than two years of full-time study beyond the baccalaureate, is recognized with the master's degree." 6 A trend exists for the master's degree to become the first postbaccalaureate entry-level degree. 3 The terms "art" and "science" are used as modifiers of the master's degree. The Master of Arts degree can be used for degrees in the humanities or social sciences or can be broadened to include all the liberal arts. The Master of Science degree can be specific to the theoretical sciences or can also accompany the applied sciences. Both degrees have a tendency to be used universally to denote scholarly research. A master's degree in a specific profession can be entitled to include that profession (eg, Master of Physical Therapy). In general, increased standardization of the master's degree exists in professional fields compared with liberal arts. Therefore, the master's degree in a professional field is often afforded more prestige than one in liberal arts. 6 Intermediate Degree The intermediate degree ordinarily appears at a level beyond the master's and has been called by various titles such as Specialist or Diplomate (eg, Specialist in Education). 6 This degree usually requires at least two years of graduate study. 6 The intermediate degree is not common, but it could be an option for the physical therapy educational system to use to recognize specialization in a specific area of physical therapy. Professional Doctorate The next option available for entry level would be the professional doctorate (Doctor of Physical Therapy). This degree frequently requires at least two to four years of course work beyond the bachelor's degree and combines liberal arts, sciences, and professional skills. Often a strong research component is required. Examples of the professional doctorate are Doctor of Pharmacy, Doctor of Medicine, and Doctor of Jurisprudence. As with a master's degree, qualifying and comprehensive examinations are sometimes required and a language requirement may or may not be imposed. 6 Doctor of Philosophy The Doctor of Philosophy is the highest entry-level degree that can be considered. This degree generally necessitates at least two to four years of course work beyond the bachelor's degree, although students may take much longer to complete the degree. A dissertation, a lengthy treatise on an original research topic, is required. The doctorate usually focuses on Volume 64 / Number 6, June 1984 939

the ability of the student to perform independent work. Almost invariably, qualifying and comprehensive examinations are required, and a reading comprehension test in one or two languages may or may not be mandated. 6 PROFESSIONAL DEGREE STRUCTURES To make an informed choice on an appropriate entry-level degree, physical therapists should look at other professional degree structures to view trends and public expectations. Some degree structures are quite rigid, others provide options, and still others are in various states of transition. Medicine and Dentistry Most of the health professionals look to the medical model for guidance and role structure. The usual educational route for physicians is four years of undergraduate work where certain prerequisites must be completed. After a highly selective screening process, the students are admitted to medical school, and emerge four years later with a Doctor of Medicine degree. They complete a year of internship in a hospital and finish their training as a resident in a specialty for a predetermined time. As with physical therapy, permission to practice medicine is granted by licensure; the degree structure allows a person to take the licensure examination. Some medical schools will accept a student after only three years of undergraduate work, and some medical schools offer a combined MD and PhD program. 7 Dentistry follows the same path as medicine through the awarding of a Doctor of Dental Surgery degree after four years of specialized study. Internship is not required for dentists, although some dentists do participate in specialization residencies. Occupational Therapy Occupational therapy has a degree structure similar to physical therapy. Four entry-level routes are now open to occupational therapists that permit them to sit for the registration examination. Thefirstoption is a Bachelor of Science degree in Occupational Therapy. The second is a master's degree as a Master of Science in Occupational Therapy, a Master of Arts in Occupational Therapy, or a Master of Occupational Therapy. The third option is a certificate in occupational therapy. 8 The fourth option is open to occupational therapist assistants, who can sit for the registration examination on completing several years of field experience. Occupational therapy also has advanced master's degree programs for registered occupational therapists, as does physical therapy. 8 The occupational therapists are also discussing moving entry level from the baccalaureate to the master's degree. Nursing Nursing is another profession that has multiple routes to permit candidates to sit for the licensure examination. Acceptable degrees include an associate degree (two years), a diploma (three years), and a Bachelor of Science degree (four years). Nurses are attempting to upgrade their entry level by dropping the associate degree and the diploma. If nurses want further education, they can obtain a Master of Nursing, a Master of Science in Nursing, or Master of Arts in Nursing. New programs, which can be at either the advanced or entry level, offer the Doctor of Philosophy in Nursing, Doctor of Nursing Sciences, and Doctor of Nursing degrees. Psychology Psychologists major in psychology and graduate from college with a Bachelor of Arts degree. With that degree, a person can function as a technician or assistant. The person can then obtain either a Master of Science or Arts in Psychology to be a licensed psychological associate. The Doctor of Philosophy in Psychology is the profession's highest degree. Licensure requires two years of supervision postdoctorate by a fully licensed psychologist; some states also require two years of postdoctoral education before licensure. Two other doctoral degrees that are sometimes obtained by psychologists desiring licensure are the Doctor of Psychology and the Doctor of Education. A postbaccalaureate entry level seems to be the norm rather than the exception in various other professional programs. Some professionals are still struggling with problems of multiple entry levels and movement toward postbaccalaureate entry level. Other professions also dealt or are dealing with professional, economic, political, and educational considerations as they choose an entry level degree or contemplate change. SOCIETAL CONSIDERATIONS Physical therapists cannot make decisions concerning entry level in a void; economics, politics, and the educational system must be considered in addition to professional concerns. Many times, the same items can be viewed as either encouragement for expansion or barriers to growth, as I will note in the following subsections. In a global sense, societal considerations include a need to balance quantity and quality in the physical therapy profession, to understand the economic ramifications of an entry-level choice, to take into account the political climate, and to work with universities to set up viable entry-level programs. Professional Quantity and quality are major items of professional concern, and a balance needs to be reached between the two. Any postbaccalaureate degree program that ischosenmay decrease the pool of physical therapists for the following reasons: 1) the longer amount of time required to complete a degree may discourage some applicants, 2) applicants may need to perform at a higher level of academic achievement to do graduate-level work compared with undergraduate-level work, and 3) graduate work is more expensive. When all of these items are considered, the person who has the intellectual ability, monetary resources, and available time may choose to go into another career with higher financial recompense or greater rewards (not necessarily monetary) than physical therapy can provide. Quality is not linearly related to time; longer does not necessarily mean better. Physical therapists must outline basic competencies for entry-level graduates, define what will be expected of these graduates, and not merely add hours to a baccalaureate program. The trend of practice without practitioner referral will definitely influence the quantity and quality of physical therapists. The profession is in a state of change for how, where, 940 PHYSICAL THERAPY

EDUCATION and what skills are practiced. Physical therapists can anticipate some of this change, but they cannot create an educational system that will cover all possible changes. Such an effort is an exercise in futility and can lead to stagnation as a result of the perceived magnitude of the task. Another professional consideration is to provide a pathway of career mobility with recognition of competence beyond the entry level. Establishing a series of advanced degrees or some form of certification for specialization will provide this pathway. Expectations among physical therapists, consumers, and students must be matched. These expectations overlap with the quantity and quality issue. They also influence the relationship of degree and status, income, and charges for services rendered. A fourth professional consideration involves the need for further research in physical therapy. The APTA has stressed the necessity for research in the basic sciences germane to physical therapy as well as in the clinical applications of therapy; a visible commitment is the increased support of the Foundation for Physical Therapy. Because of the emphasis on research, a postbaccalaureate entry-level program would probably include a stronger research component than is currently offered in most baccalaureate programs. Economic A decision to pursue postbaccalaureate entry-level education also has economic ramifications. Postbaccalaureate programs usually include increased expenses to students and the university because of the need for additional space, equipment, supplies, staff, library, and reference resources. A postbaccalaureate program will likely necessitate a lower studentfaculty ratio, and more faculty must be hired. Because these faculty will be teaching graduate-level students, they should have credentials at the same or higher level than their students. Based on their degrees, faculty of graduate-level students should be able to command a higher salary than faculty of undergraduate students. Traditional sources of university funding include local, state, and federal funds; student tuition and fees; endowments and gifts; and auxiliary income (MacKinnon, unpublished data, 1980). The current reduction in available money throughout the university system stems from a decrease in federal funding, which influences state and local funding. Specifically, federal funding for health manpower training has been reduced although a stated need still exists for increasing the number of physical therapists. 2 Student tuition and fees cannot be indefinitely increased because therapists will be unable to recruit candidates for the profession as a result of a lack of student financial recources. Physical therapists do not routinely have the resources to make substantial endowments to university programs. Auxiliary income, the final traditional source of university funding, may be enhanced by clinical service provided by the faculty. If the faculty provides clinical services, that time will not be available for teaching or other academic responsibilities although service combined with teaching is possible. Besides the cost to the student and the university, the cost to the consumer must be studied. If physical therapists have advanced degrees, they should increase their fee for what is represented by the degree, additional knowledge, and competence. The physical therapist's price should be judged reasonable by both the consumer and third-party payers. Political In addition to economic reasons, the political climate must be recognized in determining the appropriate degree for entrylevel physical therapy education. The discussion on economics touched on the federal political climate with respect to decreased funding for health and education; however, a stated need for more allied health professionals and improved health services still exists. Federal funding and legislation affect state and local funding and legislation or ordinances. The university must also be regarded as a political force. The desire of physical therapists to convert to postbaccalaureate entry level and the choice of appropriate degree structure needs to be weighed in relation to institutional philosophy and objectives. A large factor in the acceptance of a specific graduate program is the perception by the members of the academic community of how the program reflects the university's image. If the program can be seen to enhance a university's reputation, the program will be more readily accepted than one that could injure the university's reputation; the ultimate status of a school is based on the graduates of that school. 9 Physical therapists will need to have their strategies, rationale, and data for postbaccalaureate entry level carefully thought-out before presenting the plan to the institution's administration. The physical therapists must cultivate the support of various groups, including the consumers, physicians, and other ancillary medical personnel. Educational The final societal area that will affect the choice of an entrylevel degree for physical therapists is educational. I have intertwined many of my concerns emanating from the selection of appropriate requirements for entry-level education throughout the discussions in this article. As mentioned, physical therapists need to decide on objectives or competencies for entry level. Qualified faculty must be available. The program should include a blend of general liberal arts courses, basic science courses, skill training for physical therapy practice, and an opportunity to practice these skills through clinical affiliations. 2,10,11 RECOMMENDATIONS After viewing postbaccalaureate entry level for physical therapists from a historical perspective, analyzing the needs of physical therapists and society, and looking at the traditional structure of degrees, I recommend that physical therapy postbaccalaureate entry level should result in a Master of Physical Therapy degree. A second option would be a Master of Science Degree in Physical Therapy. The reason I do not wholeheartedly endorse a Master of Science Degree in Physical Therapy is that some graduate schools have very specific requirements for all Master of Science programs, and these requirements may not be germane to physical therapy. Either of these degrees, however, would definitively convey the bearer's area of expertise and focus on the profession of physical therapy. Volume 64 / Number 6, June 1984 941

I chose an academic degree rather than a certificate to provide legitimacy and standardization to the degree. Certificates are not considered standard, traditional degrees. Also, if students possessing the degree want to continue in the educational process and obtain a higher degree (eg, a PhD), they will find that an academic degree increases their options. A doctoral degree, either professional doctorate or Doctor of Philosophy, is not recommended for entry level. If it were used for entry level, a career ladder with specific credentials would be extremly difficult to devise. Instead, the doctoral degree can be used to acknowledge advanced expertise in an academic discipline or setting. Specialization may be used to denote advanced clinical competencies. CONCLUSION The physical therapy entry-level degree should be viewed as part of an educational system. A postbaccalaureate entrylevel program should include 1) sufficient time for students to absorb the amount of knowledge necessary to practice at that level and a degree to acknowledge competence, 2) possibilities for clinical specialization, and 3) avenues to recognize further academic or research competencies (eg, a doctorate 12 ). An entry-level degree that provides these variables will ultimately produce a more professional educational system for physical therapists. REFERENCES 1. Conference draws 3,700 physical therapists. Progress Report of the American Physical Therapy Association 12(7):1,1983 2. Raising Entry Level Education for Physical Therapists. Washington, DC, American Physical Therapy Association, 1981 3. Mayhew L: Changing Practices in Education for the Professions. Atlanta, GA, Southern Regional Education Board, 1971, p 1 4. Rosenfeld M: Organizing for allied health education in educational institutions. In McTernah E, Hawkins R Jr (eds): Educating Personnel for the Allied Health Professions and Services: Administrative Considerations. St. Louis, MO, CV Mosby Co, 1972, pp 2-3 5. Rogers J: Design of the master's degree in occupational therapy: Part I: A logical approach. Am J Occup Ther 34:113-118,1980 6. Spurr S: Academic Degree Structures: Innovative Approaches. New York, NY, McGraw-Hill Inc, 1970 7. Record of the University of North Carolina at Chapel Hill School of Medicine 1981-1982 Issue. Chapel Hill, NC, University of North Carolina, 1981, pp 30,56 8. Rogers J, Mann W: The relationship between professional productivity and educational level: Part I: Review of the literature and methodology. Am J Occup Ther 34:387-392,1980 9. Mayhew L: Reform in Graduate Education. Atlanta, GA, Southern Regional Education Board, 1972, pp 3-4 10. Mayhew L: Higher Education for the Occupations. Atlanta, GA, Southern Regional Education Board, 1974, p 100 11. Rogers J: Terminology Quandry in Education. Presented at the graduate forum sponsored by the Commission on Education. San Antonio, TX, March 7,1981 12. Berelson B: Graduate Education in the United States. New York, NY, McGraw-Hill Inc, 1960, pp 220-221 942 PHYSICAL THERAPY