Requiring Professional Athletic Training Programs at
the Post-Baccalaureate Level: Considerations and
Concerns
Full Citation:
Pitney WA. Requiring professional athletic training programs at the post-baccalaureate level: considerations and
con-cerns.
Athl Train Educ J
; 2012. 7(1):4-10.
William A. Pitney, EdD, ATC, FNATA
Northern Illinois Universtiy, DeKalb, IL
Dr. Pitney is the Editor-in-Chief of the Athletic Training Education Journal and an Associate Professor in the Department of
Kinesiology and Physical Education at Northern Illinois University. Please address all correspondence to
wpitney@niu.edu.
ATHLETIC TRAINING EDUCATION JOURNAL
© National Athletic Trainers’ Association
www.nataej.org
ISSN: 1947-380X
DOI: 10.5608/070104
E
ditorialO
ver the last two decades discussions have ebbed and flowed related to whether athletic training should move to professional programs at the post-baccalaureate level. Looking back at my own beliefs I had been very much opposed to such a move; but now I simply find myself conflicted, unsure of the most appropriate direction for our profession. The reason for my conflict is that I cannot discount the positive nature that such a move might bring to the profession; nor can I discount the negative implications such a move may have. As I have listened intently to proponents of post-baccalaureate professional programs and taken time to reflect, I believe I have come to better understand the issues. This editorial serves to articulate what I believe are some positive considerations for moving toward a Post-Baccalaureate Professional Education program, heretofore referred to as an Entry-Level Masters (ELM) programs. I will also share some of, what I believe, are substantial concerns should our profession move in that direction.Positive Considerations
There are many positive aspects of moving to an ELM postulated by not only faculty who direct ELM programs, but also those who do not. These positive aspects include, but may not be limited to: 1) improving the professional preparation of students, 2) selecting more highly qualified students to enter the profession, and 3) aligning our professional programs with our peer health care professions (eg, physical therapy, occupational therapy).
Improving the Professional Preparation of Students
Wilkerson, Colston, and Bogdanowicz,1 presented an excellent
argument supporting ELM programs, and a large portion of their argument pertained to the potential improvement of the professional preparation of students. In their article, they stated that many health professions require a substantial level of
pre-professional preparation in the basic sciences, allowing students who then enter the post-baccalaureate programs to grasp both the basic and advanced discipline specific knowledge.1 Moreover,
they argued that a majority of baccalaureate level programs in athletic training emphasize proper performance of procedures along with knowledge related to evaluating the circumstances associated with the appropriateness of a procedure. In sum, the credit hour restrictions on baccalaureate level programs prevents a full complement of pre-professional knowledge that allows students to attain a thorough understanding of “foundational scientific concepts, fundamentals of the discipline, and theories that are supported by research evidence.”1(pg. 39)
Another component to improving the professional preparation of students is the emphasis on research a student would gain at the graduate level. Although I have been fortunate to work with some exemplary undergraduate students who have completed research projects, the fact is that research is most often an extracurricular requirement for most undergraduates across all ATEPs. Understanding the research process, I believe, is critical not only for making proper clinical decisions, but also expanding the knowledge base for our profession—an argument also made by Wilkerson and colleagues.1
Selecting More Highly Qualified Students to Enter the Profession
Athletic training programs are currently required by the Commission on Accreditation of Athletic Training Education (CAATE) to have limited admissions procedures for applicants vying for entrance into a program. Though not the only requirement, a standard prerequisite for many programs is a minimum grade point average (GPA) commonly ranging from between a 2.5 and 3.0, depending on the program. This is a common requirement because the GPA is often associated with higher level analytic ability, and/or the ability to produce higher quality outcomes related to one’s academic courses. The GPA is not a perfect measure, but it is a common measure of student quality.
Moving our professional programs to ELMs would require students to gain admission into the university’s graduate schools. My informal perusal of graduate school GPA requirements revealed a 3.0 GPA as a common, minimal standard. Many believe, therefore, that the students entering the professional programs would be of higher quality than we currently have now in the profession. As an educator for over 16 years, I have found that those students with higher GPAs tend to perform well academically. The writing quality tends to be better, the nature of the questions asked in class tends to be better, and the qualitative nature of their academic responsibility tends to be better.
I have often listened to colleagues and clinicians argue that those with higher GPAs are “book smart” but sometimes lack the “hands on” skills. My question is, why don’t we want students with both? I believe we need academically gifted practitioners with the highest quality skills so all our patients receive the best care. Perhaps moving to ELMs would move us this direction. Another comment I often hear is that graduate students tend to be more emotionally mature as compared to undergraduate students. Perhaps having a pre-professional undergraduate experience provides time for a student to “find himself or herself” and make a solid career decision and commit wholeheartedly. My experience has been that many of my more mature, non-traditional students perform quite well with interactions with others and deal with conflict substantially better than their traditional aged peers when it arises.
Aligning Athletic Training Professional Programs with Peer Health Care Professions
The health professions we consider our peers (eg, physical therapy) have moved to post-baccalaureate models, yet we have not. Other disciplines have recognized the need to have pre-professional education to adequately prepare health pre-professionals. A profession isn’t required to do what others are doing, but when the public views the level of education across health professions and sees differences, it fuels how we are ultimately perceived. The perception may well be that we are not as highly educated as our peer health professions. Over time, this may ultimately erode our professional role in the healthcare market.
Concerns
So what happens should AT move toward an ELM model? Key concerns, as I see them, include: 1) lack of qualified faculty, 2) negative economic impact on students, and 3) economic impact on some faculty from the reduction of programs.
Lack of Qualified Faculty
A principle used by many institutions of higher education is that faculty teaching within a program must have a degree higher than that which students are enrolled, meaning faculty teaching in a master’s program must have an earned doctorate. Moving to an ELM would likely necessitate having faculty with a doctoral degree teaching in these programs. I am not sure whether the
athletic training profession is at a point where this is possible. Thus, a potential negative impact is having ELM programs with few qualified faculty to deliver quality education.
That argument made, it’s clear that some current ATEPs are at institutions of higher education that do not offer graduate degrees. I suppose it is possible, that were the profession move to ELMs, we may see some doctoral trained faculty at these institutions take roles elsewhere. Even so, this is certainly a negative ramification that needs to be considered.
Economic Impact on Students
Should we move to an ELM, students who are committed to becoming an athletic trainer would now have to spend 5-7 years in school to earn a degree that would allow them to sit for the BOC examination—an increase of 1-2 years for most students. Moreover, the cost of graduate school is often substantially higher than at the undergraduate level. Unless having a master’s degree in athletic training results in higher wages that are competitive and commensurate with our peer health care professions, many students could carry student loan dept for a considerably longer period of time.
Impact on Faculty from the Reduction of Programs
As aforementioned, many current ATEPs are at institutions that do not grant a graduate degree and, thus, these programs would not be able to transition to offering an ELM. My concern here is the fate of the faculty at these programs. Certainly the ATEPs that failed to transition to the ELM would be dissolved. The potential outcomes of this are likely to be for them to retool and teach in another program area in the institution, relocate to teach in an ELMs program, or move from a role in higher education to a clinical position.
Future Directions
I must admit that a year ago I was adamant that moving to requiring an ELM to sit for the BOC exam was the wrong direction to go. Now, however, I am leaning toward being accepting of such a requirement as the advantages for the profession (and ultimately the patients we serve) make a lot of sense to me. I believe I would be more confident in moving toward ELMs if there were supporting data from well designed studies on which to base the decision. That notwithstanding, sometimes the right decisions are the ones that are most difficult.
To further the dialog related to this critical issue, I have invited Jolene Henning, EdD, ATC and John Hauth, EdD, ATC to comment on this issue. I have been impressed with their ability to articulate the fundamental matters at hand and am pleased they have agreed to share some of their initial thoughts.
REFERENCE
1. Wilkerson GB, Colston MA, Bogdanowicz BT. Distinctions between athletic training education programs at the undergraduate and graduate levels. Athl Train Educ J. 2006; 1(2):38-40
Invited Commentary Jolene Henning, EdD, ATC
High Point University
It is important for the readership to understand my background relative to this issue and appreciate those experiences that impact my perspective. For 7 years I directed a very successful entry-level master’s (ELM) athletic training education program (ATEP) that was housed in a traditional Department of Kinesiology within a School of Health and Human Performance at a large, public, research-intensive institution. I am now the program director at a dynamic and rapidly growing private institution with fewer than 5000 students and housed within a School of Health Sciences as a Department of Athletic Training. Our program is beginning the process of transitioning from an undergraduate (UG) ATEP to a 3+2 clinical master’s degree (a term preferred in health professions to describe entry-level clinical degrees). I offer this background to the readership to expose a broad scope of educational policy that I have personally navigated relative to establishing the clinical master’s degree in both public and private institutions and to demonstrate credibility relative to this debate.
I am often asked to explain the difference between the students who graduate from an UG ATEP and those who graduate from an ELM. This is a fair question because technically all ATEPs are held to the same accreditation standards and are required to teach and evaluate the same education competencies and proficiencies. However, due to the gross imbalance between the number of UG (n=343) and the number of ELM (n=25) ATEPs it is difficult to make any meaningful objective comparisons on differences in program outcomes and how these entry-level clinicians may provide different levels of care. Therefore, my commentary is largely anecdotal and based primarily on analysis of my own programs’ outcome data.
Positive Changes
A Stronger Foundation to Build Upon
In my observations, the level of critical thinking that occurs in ELM students allows for much greater depth of content and quicker application of information than typically occurs in an UG ATEP. In an ELM you are essentially starting the professional education process with students that have the general critical thinking skills that your seniors have when they graduate. In addition, ELM students have already completed foundational undergraduate courses such as anatomy, physiology, physics, chemistry, exercise physiology, biomechanics, and nutrition. This rich foundation allows an ELM ATEP to devote the entire curriculum to athletic training-specific content which in turn allows for a higher level of proficiency in skill performance and a more sophisticated approach to patient care and clinical reasoning.
Focused Curriculum and Focused Students
I have heard countless educators lament the challenges of delivering a professional degree program within the confines of undergraduate education requirements. Obstacles such as meeting general education or core requirements, institution-imposed limits on credit hours within a major, course scheduling conflicts during clinical education experiences, etc. all impact a program director’s ability to design an efficient and effective ATEP.
While I fully support a holistic undergraduate education grounded in the liberal arts, the beauty of the ELM is that you gain control of your curriculum and how/when it is delivered. As previously mentioned the ELM model allows for your entire curriculum to be focused on athletic training. In addition, you can be more creative in when your classes are offered in order to maximize patient care exposures. For example, you can require students to have a clinical experience course in the morning during rehabilitation hours in the university athletic training clinic. Alternatively, you can offer block scheduling where students are in class for 8 weeks and then in clinical experiences for 8 weeks. My point is that the graduate model of education allows more freedom and creativity in how you structure your curriculum. Faculty need to be prepared, however, that moving to the ELM may require you to develop a year round (24 month) curriculum.
Students also lament the challenges of majoring in athletic training and wanting to fully engage in the “college experience” (eg, Greek life, study abroad). Anecdotally, many students opt out of the athletic training major not because they “can’t handle it,” as is often attributed to them, but because they appropriately want to be a 19 year old college student and often times are not ready to make a career decision at that age. I fully support UG students experiencing to the fullest level the personal growth and development that comes from engaging in liberal arts education and the myriad of extracurricular activities. Students who enter an ELM have gotten the undergraduate experience “out of their system” and are ready to focus on career preparation. The greatest shock for me returning to teaching in an undergraduate ATEP was realizing that many of the students did not actually want to be athletic trainers. If we want to understand why athletic trainers leave the profession one factor may be because we are asking students to commit to a career path at an age when they may be ill-equipped to do so. In an ELM, students have specifically chosen athletic training as a career. This level of focus and commitment eliminates many of the frustrations that faculty express about preparing students who are using athletic training as a stepping stone. Anecdotally, students who graduate from an ELM are less likely to leave the profession.
Major Threat
Technicians versus Practitioners
While my previous comments have been primarily anecdotal, I believe the strongest evidence to support moving to a clinical master’s degree are the significant external threats to our profession. The US Bureau of Labor Statistics’ Standard Occupational Classification (SOC) system classifies athletic trainers as “health technologists and technicians” rather than “health diagnosing and treating practitioners” www.bls.gov/oco/ oco1002.htm. The SOC system is used by federal statistical agencies to classify workers into occupational categories for the purpose of collecting, calculating, or disseminating data. All workers are classified into 1 of 840 detailed occupations according to their occupational definition. The US government perceives our peers as health care technicians who largely have associated degrees. This is distressing on a national and local level. Nationally, it seems that this classification would be a major road block when communicating with legislators about our qualifications as health care providers when those we consider to be our peers have clinical graduate degrees and are classified as practitioners. I view the ELM degree as a major link in being successful at changing legislation related to third party reimbursement. On a more local
level if university administrators and state legislators were aware that their four- year state institutions were preparing technicians (a rank often reserved for community colleges) it is possible that UG ATEPs could be on the chopping block during these times of financial strain.
If we change…then what?
If the Strategic Alliance (NATA, CAATE, BOC, NATAREF) decides to change the entry-level degree requirement to the ELM (ie, clinical Master of Athletic Training – MAT) then there are major logistical issues to consider; however, logistics should not be a prohibitive factor in making this decision.
Avoiding Degree Inflation
We must avoid creating a perception of inflating the degree without a change in substance. ELM courses cannot simply be UG courses relabeled with graduate level course numbers. Many educators viewed the addition of evidence-based practice concepts in the 5th edition of the competencies as an indication that it is time to move to the ELM degree. Frankly, I agree with that and would argue that simply modifying those competencies to a higher level of application would demonstrate a legitimate progression worthy of the ELM classification. I have often used the argument that entry-level clinicians should be consumers of research rather than producers of it. I would like to modify this statement slightly. I believe that entry-level clinicians should be able to answer clinical questions that are meaningful to their patient care. While this statement still implies that they are consumers of the literature they also need the skills necessary to contribute to the literature when evidence is lacking. CAATE should require a capstone experience for all students that examines some aspect of clinical outcomes– whether that be a small scale clinical research study examining patient outcomes, or completion of a systematic review or meta-analysis. This will provide a solid foundation for evidence-based practitioners as well as generate a wealth of scholarly contributions to our knowledge base.
Impact on the Graduate Assistantship Model
I often hear the argument that if we move to the ELM then we would lose graduate assistants. I have heard this argument stem from two different camps; one focused on the impact that the loss of graduate assistants would have on providing athletic training services within departments of athletics and the other focused on the impact it would have on post-professional accredited master’s degree programs.
First, I will address the impact on athletic training services within departments of athletics. To be transparent, I wear two hats on this issue that allow me to view this debate through two different lenses. First, I completed a one year graduate assistantship at a major Division I institution where I would have completed a master’s degree in parks and recreation – a degree that would not have advanced my knowledge in athletic training or improved my clinical practice. While I gained a tremendous amount from the mentoring and independent clinical practice, I quickly realized that I wanted a master’s degree that would make me a better clinician. So I completed an NATA-accredited post-professional master’s degree and a traditional graduate assistantship. During 10 years of teaching I have observed the majority of newly certified athletic trainers select an assistantship based on the clinical experience
they will get and not the content of the master’s degree – much like I did the first go around. By making the ELM the required degree to enter the profession of athletic training it opens up the opportunity to transition graduate assistant positions into accredited residency programs through the recently endorsed approval process from the NATA. The residency model seems like the best of both worlds: a program gets a more mature student who has made a commitment to the profession of athletic training, and the student receives a structured system of mentoring and advanced knowledge.
The second arm of this argument is the impact the ELM would have on post-professional accredited master’s degree programs. The primary concern related to the impact on post-professional programs seems to be how the athletic training research enterprise would be impacted if students were not available to complete a master’s thesis and contribute to our knowledge base. As a graduate of a post-professional master’s degree I don’t doubt that those individuals make valuable contributions to the literature; however, the reality is that there are only 15 NATA accredited post-professional (ie, advanced) master’s degrees in athletic training resulting in a relatively low number of theses being completed on an annual basis. However, if we move to the ELM with a required project focused on advancing evidence-based patient care, imagine the number of valuable systematic reviews that would be written or the increased number of trained students available to collect data for large scale multi-site clinical trials. A subsequent argument that I hear is that students will not be able to pursue a doctorate without completing a thesis. Students who have the drive and intellectual curiosity needed to pursue a doctorate will seek out opportunities to engage in research. For example, I have coordinated summer research experiences for several ELM students who were then accepted into highly revered doctoral programs in athletic training. In addition, it seems feasible that the NATA-accredited post-professional master’s degree programs may be able to transition to the doctoral level to help address the faculty shortage discussed in Dr. Pitney’s commentary. Forty percent (n=6) of those institutions that offer the post-professional master’s degree already have doctoral programs.
Conclusion
In summary, there are many logistical considerations to explore if athletic training moves to the ELM. I have presented those issues that I feel are most pertinent at this time. It would behoove the Strategic Alliance to commit funds to conducting a detailed SWOT analysis specifically focused on the future of athletic training education in order to provide the membership with a richer description of the evidence to support such a move. I thank Dr. Pitney for the opportunity to weigh in on this very important issue and look forward to stimulating conversations with colleagues across the country.
Invited Commentary John M. Hauth, EdD, ATC
East Stroudsburg University
Athletic Training Education Reform: Where is the Cheese?
I appreciate the opportunity to further the dialog on whether or not the profession of athletic training should mandate a move to graduate professional education (Entry-Level Masters [ELM]).
Wilkerson, Colston and Bogdanowicz1 stated in their article
comparing undergraduate and graduate professional degree programs that this discussion will be highly controversial but should not be avoided. There is no question that this type of change would have a large ripple effect on the profession and therefore we must not rely solely on anecdotes and assumptions to guide our decision making. This will be the most important decision we have ever made as a profession. It is a serious matter that requires a thorough analysis of our current model of education, health care and higher education trends, and various economic models.
We can learn a little about how to prepare for such a change by reviewing the parable presented by Spencer Johnson in his book
Who Moved My Cheese. In this story, four imaginary characters attempt to find what they want - “Cheese” - by dealing with the changes that occur in their life – represented by a “Maze.” The characters: Sniff, Scurry, Hem and Haw, all respond to change based on their past experiences and values. Their responses to these “life” changes include fear, resistance, denial, adaptation, impulsiveness and purposeful action.
The discussions and debates regarding whether or not the professional preparation of the athletic trainer should move from the predominately baccalaureate level entry point to a form of graduate professional education (ELM) will cause us all to experience a variety of feelings. I would like to suggest that we all read or reread Johnson’s book on how to deal with change as we prepare to engage this essential process. For me, the most common symptom has been extreme angst and tremendous concern for the longevity of a profession I love. This is a much more complex decision than it may appear on the surface. In the commentary that follows, I will focus my thoughts on what I see are some of the advantages and challenges to adopting an ELM only path to certification. I will also respond where appropriate to some of the comments Dr. Pitney has shared and those that have been advanced by Drs Wilkerson, Colston and Bogdanowicz.
General State of Affairs – Education Modeling
I believe there is no sense arguing that the state of affairs in athletic training education today is best described as dysfunctional, maybe even broken. While the NATA, its Executive Education Committee (ECE), Board of Certification (BOC®) and Commission on Accreditation of Athletic Training Education have worked extremely hard to facilitate the reframing of our professional education programs and post-professional components into coherent, evidence-based curricula, we still seem to suffer from an identity crisis and lack of a well defined career ladder. The inability to clearly articulate how a young professional in our field can advance and eventually find their “Cheese” haunts many athletic training educators.
Through the efforts of many fine people, we have made excellent modifications to our educational model over the past 30 years. Most of this has been achieved by instituting incremental changes and isolated revisions to our professional, post-professional and continuing education programs. It is apparent to me that the time has come for us to take purposeful action on the larger education model by closely examining the data and considering all of the options (not just ELMs) for change. In the Executive Summary
of the Vision Quest2 document, the broad vision was defined
as “positioning athletic trainers in health care delivery models where they can fully utilize their knowledge, skills and abilities.” In order to achieve this, a more global structural solution must be developed and implemented. In my opinion, a comprehensive model of professional and post-professional education that ensures sustainability and a competitive edge in an ever-changing healthcare system and flat economy must be adopted.
Concerns Related to Requiring the ELM
While I agree that the current model needs to be reengineered, I cannot accept at this time that the ELM is our only answer. Based on my experience and a review of the higher education, health care and economic literature, I do not believe that the ELM will be the panacea for all of the issues that we face. In fact, I believe it will create other, more substantial problems. Unfortunately, the current dialog has been isolated to what the entry-level degree requirement should be for the profession. This is shortsighted and fails to address the sustainability and advancement questions posed earlier. An example of the misinformation (lack of information) on this topic comes from our own section in the Bureau of Labor Statistics,3 athletic trainers “advance” by
switching teams or sports, eventually becoming athletic directors or practice administrators or moving onto sales and marketing positions. It is clear to me and others that our next move (ELM or otherwise) must result in a comprehensive model that connects entry-level certification to advanced practice opportunities (credentials?). We cannot provide our future students with a ladder that has but only one rung to climb and no “cheese” to find. We need to be very careful how we identify our “peer” group. There are health profession programs that have maintained an entry to practice point at the bachelor’s level (or lower) while building sustainable and rewarding practitioner and academic options at the master and doctoral levels (eg, nursing). Pardon the double negative, but I haven’t been totally convinced that there isn’t value in holding onto our bachelor degree programs as an entry point into the profession and exploring the possibility of this model or some variation in athletic training.
There is danger in narrowly defining our peer group as only physical therapy and occupational therapy. A close examination of the literature and discussions taking place in those professions (education) would suggest that the “grass isn’t always greener.” There is obviously an advantage to recruiting and accepting mature students; those with a related pre-professional degree should, but do not always, outperform a four year athletic training student. I, like many others, have a 20 to 30 year history that suggests the bachelor’s model can work quite well. In fact, when melded with a post-professional graduate program, appropriate graduate assistantship and research opportunity, it can result in a “Genius.” My point is that we don’t have the data to clearly demonstrate that such a change will make a difference when it comes to patient outcomes or employer satisfaction, and it would be almost impossible to measure.
In regards to preparation, we may need to take a closer look at the entry-level expectations and foundational skills and consider re-reshaping this so that there is a little more room for those bench sciences that Wilkerson and colleagues mention.1 Restricted
the undergraduate level have struggled to keep up with the competency and domain creep that is largely natural in an emerging health profession program. Everything is on the table; remember this is going to be controversial!
Cost of Education: “It’s the Economy, Stupid”
Don’t be offended; I used this quote to remind us all that in March of 1991, President George Bush enjoyed a 91% approval rating after invading Iraq. By August of 1992, 64% of Americans disapproved of Bush’s job performance due to the recession; and by November, Bill Clinton had unseated the once “unbeatable” incumbent. The fact is that in 1996, 2000 or even 2006, the ELM might have made some economic sense. It may have been worth rolling the dice to see if we could gain traction in the legislature and reimbursement arena. But it is 2012, just four years removed from a staggering 2008 recession that has left us, our students, and their parents adjusting to a new set of rules in higher education, double digit unemployment, and a flat recovery. This economic challenge is my greatest concern for the future of athletic training education programs and our profession at-large.
Here are a few additional facts regarding student loans and the potential consequences of adding two years of graduate tuition loans to the backs of our young professionals. Experts warn that student loans will create the next credit bubble due to unsustainable tuition increases, declining state support and unprecedented borrowing by students. According to several sources, 1) student loans exceeded $100 billion for the first time in 2011, 2) total student loans outstanding exceeded $1 trillion for the first time in 2011, 3) Americans now owe more on student loans than on credit cards and, 4) students are borrowing twice what they did a decade ago. And students have no choice but to accept all of the risk for this debt. The government has provided themselves and other lenders with an unchecked ability to collect student loan debt; bankruptcy is not an option.4 There
is no question that this debt will place a tremendous burden on our young people as they look to launch careers, start families and find their “cheese.” Some suggest that the student loan credit bubble will further slow the economy due to its effect on a generation of consumers unable to purchase homes, cars, etc. 4
The issue is complicated.
Concerns Related to Requiring the ELM
In athletic training, and athletic training education specifically, the “Cheese” is defined differently based on our role. Students, parents, practitioners, faculty members, administrators and patients all come with their own set of values and expectations. The delivery of patient-centered care and evidence-based practice should be at the forefront for practitioners, educators, insurance companies and patients. An affordable, quality education that promises a suitable return on investment will continue to be the primary concern of prospective health profession students and their parents. We must be willing to work towards a purposeful change that balances the patient-center principles we embrace with the economic reality of our students and parents.
We must remember that when physical therapy, occupational therapy and speech pathology made their moves to graduate professional education (ELM or DPT) they already had the political, economic and reimbursement positions we are still trying to achieve. There is no strong evidence that simply moving
to a graduate professional degree entry point will secure these positions. There is very strong evidence that increasing the cost of our students’ education will sentence them to a lifetime of wage slavery. For them, and us, “It’s the Economy”!
To further examine this aspect of the graduate professional degree debate, let’s see what is being reported in various physical therapy publications and professional discussion boards about salaries, clinical education and the entry-level degree. There is a growing concern that “physical therapy salaries are not in step with education costs” and that “with declining reimbursement, there is little to believe that the educational investment can be recaptured.”4 A variety of discussion board comments from
students and practitioners alike suggest that physical therapy schools are, and will, continue to lose the best and brightest students to other professions. Dr. Tina Whalen, Department Head of Rehabilitation Sciences at the University of Cincinnati stated “since PT programs have gone to the graduate level, there has been a flat curve in salaries for practicing PTs. Starting salaries are often in the low to mid 50s.”5
The most recent salary survey for physical therapists6 suggests that
the average salary for PTs with a DPT is $70,543; approximately $6000 less than the average for all PTs in the survey. The reality is that salaries in physical therapy and similar professions are tied to experience and not the education level of the practitioner. In 2008, the DPT averaged $58,925 and the MSPT averaged $68,735.50. The reality is that the DPT (and similar professional degrees) may have only served to increase the loan debt of their students. Interestingly, there is some discussion about how DPT programs could help their students improve the ROI associated with their education costs by (1) having DPT students spend a terminal year in an internship where they can be subsidized, (2) allowing DPT students to challenge the PTA examination in year two so some reimbursement for their services can be realized, (3) allowing PT students to graduate with a master’s degree after two-plus years so they can challenge the PT examination and then complete their internship and earn the DPT.7
The point here is that if physical therapy and similarly designed programs are wrestling with these types of problems despite having had a good political and economic status, what will it be like for our students should we ask them to take on another two years of education? Can we reasonably ask students to take on an additional 40K, 50K, 75K or more of student loan debt? Can we ask them to do this without a comprehensive model which ensures advancement and ease of access to insurance reimbursements? Can we ask them to do this without substantial improvements in starting salaries? Can we ask them to do this on the off-chance that all of these things will happen if we move to an ELM? More importantly, will they pursue athletic training as a career choice if nothing else has changed and the entry-point is the same as it is for PT or OT? Will the pre-professional rehabilitation sciences student and their more than savvy, informed consumer parents pursue athletic training when things like return on investment and lifetime earnings are presented? We have to be ready for the tough questions and the possibility that we could, in fact, choke off the supply of our own good students. If this happens, who will be there to take our place? Who is preparing now to assume that role due to declining reimbursements and the need to explore new markets? We have expanded so what is stopping someone else from stealing our “Cheese”?
The Future
For nearly three decades I have been blessed to work as an athletic trainer and teach in an undergraduate athletic training education program at a small- to-moderate size state university. I offer this commentary and the associated questions with the hopes that we will band together and create a sustainable model of education that will allow our graduates to well respected, well paid, patient-centered practitioners, who are integral members of the health care, wellness and sport communities. In the end, I hope we will all find the most important “Cheese” – happiness. There will be much more on this topic in the future and I look forward to a civil and constructive discourse with my colleagues in this wonderful profession.
REFERENCES
1. Wilkerson GB, Colston MA, Bogdanowicz BT. Distinctions between athletic training education programs at the undergraduate and graduate levels. Athl Train Educ J. 2006; 1(2):38-40
2. National Athletic Trainers’ Association. Aligned for the Future: Executive Summary of Vision Quest. Available at http://www.nata.org/sites/default/files/Vision-Quest-Report-Executive-Summary.pdf. Accessed March 21, 2012
3. Bureau of Labor Statistics. U.S. Department of Labor. Athletic Trainers: Occupational Employment Statistics, May 2010. Available at http://www.bls.gov/oes/current/ oes299091.htm. Accessed March 19, 2012
4. Student loans outstanding will exceed $1 trillion this year.
USA Today: Money. Available at http://www.usatoday. com/money/perfi/college/story/2011-10-19/student-loan-debt/50818676/1. Accessed March 19, 2012
5. Positive impact: Salary report for 2008. Advance For Physical Therapy and Rehabilitation Medicine. Available at http://physical-therapy.advanceweb.com/Article/Positive-Impact.aspx. Accessed March 18, 2012
6. Good news reflects steady or slightly rising salaries, and some variation on region. Available at http:// physical-therapy.advanceweb.com/Archives/Article-Archives/2011-Salary-SurveyResults.aspx. Accessed March 18, 2012
7. PT education: O brother, where art thou? MyPhysicalTherapySpace.com. Available at http://blog. myphysicaltherapyspace.com/2012/02/pt-education-o-brother-where-art-thou.html. Accessed March 19, 2012
