A Historical
Cross-Disciplinary Perspective
on the Professional
Doctorate in
Occupational Therapy
Doris Pi e rce, PhD, OT R / L, is Associate Pro f e s s o r, De p a rtment of Occupational T h e r a p y, Creighton Un i ve r s i t y, 2500 California Plaza, Omaha, Nebraska 68178.
Claudia Peyton, PhD(Cand.), OT R / L, is Chairperson, De p a rt m e n t of Occupational T h e r a p y, Creighton Un i ve r s i t y, Omaha, Ne-b r a s k a .
This article was accepted for publication May 28, 1998.
Doris Pierce, Claudia Peyton
Key Words: education, graduate, occupational
therapy • history
Clinical doctorates are emerging in occupational therapy. By examining the development of clinical doctorates in medicine, dentistry, psychology, pharmacy, nursing, and physical therapy, implications can be drawn for the future of occupational therapy education. These histories offer us a sense of the distinct purpose and curricular structure of the professional doctorate, its successes and problems, its general sequence of unfolding, the political dynamics surrounding it, and the potential it holds for supporting the profession’s capacity for service to patients.
Pi e rce, D., & Peyton, C. (1999). A historical cro s s - d i s c i p l i n a ry per-s p e c t i ve on the profeper-sper-sional doctorate in occupational therapy. Am e r i-can Jo u rnal of Occupational T h e ra py, 53,6 4 – 7 1 .
B
ecause the professional doctorate is a new degree for occupational therapy, there may be confusion about h ow it is distinguished from a re s e a rch doctorate. The most common misconception is that the pro f e s s i o n a l doctorate resembles or attempts to replace the re s e a rc h doctorate. Table 1 illustrates the key differences betwe e n p rofessional and re s e a rch doctorates (Un g e r, 1996).The Doctor of Medicine: Historically Established
and Influential Model of the Professional
Doctorate
Professional doctorates emphasize sophisticated practice competencies rather than re s e a rch and knowledge pro d u c-tion. The best known professional doctorate is the Do c t o r of Medicine (MD). Unlike currently emerging pro f e s s i o n-al doctorates, curricula in medicine have such a long histo-ry that they have been well-established as the norm for a first professional degree and entry into practice. Both det i s det ry and pharmacy have clearly modeled detheir pro f e s s i o n-al doctorates after medicine. The history of these three pro-fessional doctorates offers important insights into how their curricular stru c t u res may influence the deve l o p m e n t of occupational therapy within a rapidly changing and c o m p e t i t i ve health care enviro n m e n t .
The Lengthy History of Medicine’s Professional Doctorate Fo r m a l i zed medical education can be traced as far back as 1900 B . C .in Egypt and the 5th century B . C .in Greece. In m e d i e val times, the first Eu ropean medical schools we re c reated within monasteries and cathedral schools, empha-sizing service to others. When universities we re organize d in the 12th and 13th centuries A . D ., they included thre e
s t rongly allied professional schools: medicine, law, and the-ology (Bullough, 1966).
The first medical schools we re begun in the Un i t e d States in the late 1700s. In the early 1800s, the MD typical-ly re q u i red a baccalaureate degree with a short appre n t i c e-s h i p, a preparation e-still practiced in e-some countriee-s t o d a y. A small percentage of students chose to complete an additional 4 to 8 months of postprofessional training. Large numbers of physicians doctors we re graduated from short, poor quality p rograms. Schools, subsisting directly on tuition, vied with each other to attract students (Kaufman, 1976).
Although medicine struggled to upgrade its education-al standards during this period of its history, it lacked the p ower to accredit schools or license graduates. During the 1860s, some schools who adopted the recommended cur-ricular reforms of the American Medical Association (AMA) (3 years of pre l i m i n a ry study with a qualified pre-c e p t o r, 2 full years of pre-course work, and 4 months of pre-clinipre-cal study in a hospital) we re quickly closed by low admission numbers, as students flocked to schools with shorter and easier programs. The quality of care provided by American
physicians at this time was regularly ridiculed in the pre s s ( St a r r, 1982).
In 1873, medical education was re vo l u t i o n i zed by an e n d owment that created Johns Hopkins Hospital. T h i s model medical setting was based on Eu ropean-style medical training, which emphasized laboratory experiences, re-s e a rch, hore-spital rotationre-s, and affiliation with a unive r re-s i t y for undergraduate degree acquisition in the basic sciences. In 1910, the AMA accepted the recommendations of the Flexner Re p o rt, funded through the Carnegie Fo u n d a t i o n for Teaching, endorsing the Johns Hopkins approach and e l e vating medical education to a re q u i red 4-year course of study (Gr i t zer & Arluke, 1985). With this new standard established, the numbers of U.S. medical schools plummet-ed quickly from 155 to 31. Schools also changplummet-ed from a variety of sizes and types to schools that we re primarily we l l e n d owed, in large cities, and attached to major unive r s i t i e s and that charged high levels of tuition (Gr i t zer & Arluke, 1985; Kaufman, 1976).
Since the Flexner Re p o rt, the field of medicine has con-tinued to increase in status within American culture . Curricula still reflect the basic tenets of the Johns Ho p k i n s model. The MD degree usually re q u i res a baccalaure a t e d e g ree for admission, 4 years of study emphasizing hospital experience, and a 1-year internship. For specialty cert i f i c a-tion, residencies of 3 to 5 years are re q u i re d .
The History of Dentistr y’s Professional Doctorate: Modeling on Medicine
The emergence of the Doctor of Dental Science (DDS) closely shadows the history of the MD. Although va r i o u s types of dentistry have been practiced through the ages, the first dental school was established in 1840 at the Ba l t i m o re College of Dental Su r g e ry in Ma ryland. The new doctor-ate in dentistry re q u i red approximdoctor-ately the same curricular s t ru c t u re as did the MD of the time: 2 years of instru c t i o n , with 4 months of each year spent in didactic work and the remaining 8 months in practical work in a dental office. Similar to medicine, dentistry struggled to upgrade pro f e s-sional educational standards with little change from the mid-1800s to early 1900s. In 1908, the Dental Fa c u l t i e s Association of American Un i versities was formed to addre s s this issue, and proposed a 4-year curriculum for the D D S .
Howe ve r, this goal was not re a l i zed until 1926, thro u g h acceptance of William Gi e s’ Re p o rt on Dental Ed u c a t i o n , funded by the Carnegie Foundation. Dental education then u n d e rwent a complete reorganization, similar to medicine’s response to the Flexner Re p o rt (Ring, 1985). Cu rre n t l y, dental education generally re q u i res 2 to 4 years of liberal art s and basic science course work before admission, a 4-ye a r p rogram of study, and a 1-year clinical re s i d e n c y. Sp e c i a l i-zations in dentistry are usually pursued in advanced mas-t e r’s degree programs emphasizing re s e a rc h .
Pharmacy’s Professional Doctorate: In Transition From an Optional to a Required Professional Doctorate
The Doctor of Pharmacy (PharmD) is a present-day exam-ple of a profession that is drawing on medicine’s historical-ly established curricular model to move from baccalaure a t e to professional doctorate education as the first pro f e s s i o n a l d e g ree. Pharmacy has decided to move to all-PharmD edu-cation in an effort to enhance practitioner competencies and reflect growth in the knowledge base of the pro f e s s i o n . The principal supporting argument has been that the Ba c h-elor in Pharmacy curriculum, which emphasizes vo c a t i o n a l and technical skills, cannot adequately pre p a re pharmacists to respond to the increasing numbers of medications and the constant state of flux in today’s health care systems com-p a red with most baccalaureate com-programs, which ave r a g e 125 credits over 4 years. Ba c c a l a u reate programs in phar-macy presently re q u i re approximately 180 credits over 5 years (Gans, 1990).
Ph a r m a c y’s change to the PharmD has not been with-out controve r s y. The Un i versity of Swith-outhern California (USC) started the first PharmD program in the 1950s ( Ma rx, 1992). Like the earliest MD programs, the Ph a r m D was initially offered as optional training for ambitious grad-uates of baccalaureate programs. Opposition to the PharmD came primarily from schools defending their ow n b a c c a l a u reate programs in pharmacy and from organiza-tions that employ large numbers of pharmacists, such as the National Association of Chain Drug St o res (Gu e r re ro , 1992; Ma rtin, 1990).
By the 1960s, several schools offered the postpro f e s-sional PharmD. At first, the PharmD consisted of 1 year of didactic course work and one additional clinical ye a r. T h e s e Table 1
Distinctions Between Research and Professional Doctorates
Characteristic of Degree Research Doctorate Professional Doctorate
Also known as Academic doctorate Clinical doctorate (term used in health professions only) Degree designation and examples Doctor of Philosophy (PhD) Doctor of profession (e.g., Doctor of Jurisprudence [JD],
in field of study (e.g., PhD in physics) Doctor of Medicine [MD], Doctor of Physical Therapy [DPT])
Purpose Research and knowledge; Advanced practice competencies; clinical leadership development competencies
Average program length 6 years, after bachelor’s and master’s degree 4 years, after bachelor’s degree
Distinctive curricular features Dissertation; original research Mentored advanced clinical experiences for autonomous practice competencies
curricula soon evo l ved into 2-year postprofessional pro-grams with a re q u i red clinical rotation component (Ma rx , 1992). This stru c t u re of two matriculating pharmacy de-g rees, one at the baccalaureate level with immediate contin-uation to the postprofessional PharmD, still exists in some schools. Many programs awarding the two degrees have bridged them into a PharmD curriculum that is similar to the Johns Hopkins model of medical education.
As in medicine and dentistry, professional associations in pharmacy have had an active role in shaping the move to the professional doctorate. In 1977, the American Ph a r m a-ceutical Association adopted a policy in support of the PharmD (Gans, 1990). After decades of debate, the A m e r i-can Association of Colleges of Pharmacy (AACP) voted in 1992 to support the PharmD as the sole first pro f e s s i o n a l d e g ree for the field (Bu t t a ro, 1992). The AACP support e d an identified societal need for pharmaceutical care, which was envisioned as a necessary increase in pharmacist–patient interactions (AAC P, 1994). Mo re autonomous pro f e s s i o n a l roles we re envisioned for pharmacists, such as home infu-sion care, delive ry of drug information, product deve l o p-ment, and consultation. These complex new re s p o n s i b i l i-ties we re considered to be strong indicators that pro l o n g e d education and advanced clinical preparation we re impera-t i ve. The impera-transiimpera-tion impera-to all-PharmD educaimpera-tion is scheduled by the AACP for completion by the year 2005.
As of 1997, there we re 79 accredited pharmacy pro-grams in the United States. Of these, 57 offer the Ph a r m D as a first professional degree, and 58 offer the PharmD as a p o s t p rofessional degree (AAC P, 1997). PharmD graduates a re re p o rted to be invo l ved in considerably more adva n c e d l e vels of pharmacy practice than are those who are bac-c a l a u reate edubac-cated, and do less presbac-cription pre p a r a t i o n , h a ve more interaction with patients, have more manage-ment re s p o n s i b i l i t y, do more teaching, and participate in m o re collaborative clinical re s e a rch (Fjortoft & Engle, 1 9 9 5 ) . Many schools now offer the postprofessional, or nont r a d i-tional, PharmD for baccalaure a t e - p re p a red pharmacists who wish to acquire the PharmD credential (Delfino, 1990; Milito, 1995; Trinca, 1994). For the student interested in pharmacy re s e a rch, 54 pharmacy schools and colleges offer an advanced Master of Science (MS) in a reas such as phar-m a c o l o g y – t ox i c o l o g y, phar-medicinal chephar-mistry, or pharphar-maceu- pharmaceu-tical administration. The MS is the academic path to the Doctor of Philosophy (PhD), which is offered by 35 schools and colleges of pharmacy.
Implications for Occupational Therapy Derived From the Professional Doctorates of Medicine, Dentistry, and Pharmacy
The professional doctorates of medicine, dentistry, and pharmacy offer a broad context in which to ground the questions facing occupational therapy re g a rding our ow n p rofessional doctorates. The success of these three fields in their adoption of similar curricular models emphasizing a
p re l i m i n a ry degree, advanced education, higher standard s for entry, re s e a rch-based practice, and extended clinical in-ternships recommends this approach to practitioner educa-tion as one that has proven effective. In the health care mar-ketplace, graduates of all three of these fields appear to b e facilitators of change.
Pharmacy provides a potent example of a health pro-f e s s i o n’s response to today’s demands pro-for sophisticated practice competencies by upgrading education to the leve l of the professional doctorate. Like occupational therapy, pharmacy was faced with a steadily increasing, we l l a b ove -a ver-age number of credits -and ye-ars re q u i red to complete -a b a c c a l a u reate (Ru n yon, Aitken, & Stohs, 1994). The health c a re system re q u i res that practitioners graduate pre p a red to autonomously provide client-centered service. As in medi-cine and dentistry, the first professional doctorates in phar-macy started at innova t i ve universities as optional postpro-fessional degrees. The potential for an entry - l e vel doctorate became evident as more students chose to matriculate imme-diately from the entry - l e vel baccalaureate to the postp ro f e s-sional program before entering practice.
Even drawing on the experience and curricular models in medicine and dentistry, pharmacy will have spanned 50 years from the first postprofessional doctorate to mandated a l l - PharmD education. During that time, curricula we re changing. During the period in which the postpro f e s s i o n a l doctorates we re optional advanced programs, curricula lengthened, produced new areas of clinical knowledge, de-veloped the new focus on pharmaceutical care, and re a c h e d for higher standards than they previously did. Gi ven 50 years to mature, the professional doctorates became ve ry dif-f e rent dif-from the baccalaureate programs and d r a m a t i c a l l y raised the level of preparation of practitioners. Howe ve r, if this transition had been accomplished more quickly, would the visions of baccalaureate and professional doctorate edu-cation have been as differentiated in pharmacy as they are today? Would the impact on the field, in terms of know l-edge base growth and enhanced clinical competencies, have been as great? These are important questions for occupa-tional therapy.
A powe rful set of political dynamics can also be observe d in the three histories. Professional doctorates we re initially c reated by innova t i ve universities. Foundation invo l ve m e n t was catalytic in the change process. The new curricula we re then validated within the field through strong, effective pro-fessional associations of educators. Decisions we re debated for many years, with resistance from groups with ve s t e d i n t e rests in baccalaureate education. The move to the pro f e s-sional doctorate has enhanced the voice and power of the practitioners in medicine, dentistry, and pharmacy. Lastly, the curricular stru c t u re of the professional doctorate, cons i s t-ing of a liberal arts degree, 3 years in course work, and 1 ye a r of internship, is re c o g n i zed as an adequate time frame for p rofessional development by financial aid support stru ct u res.
Unique Resolutions of Mission: Professional
Doctorates in Psychology and Nursing
Psychology: Two Missions, Two Doctorates
In psyc h o l o g y, the creation of the Doctor of Ps yc h o l o g y ( PsyD) occurred against the backdrop of the pro f e s s i o n’s s t ruggle to identify the specific purpose of advanced edu-cation in the field. As a discipline, psychology has pursued two competing aims: the search for universal laws of behav-i o r, and the development of clbehav-inbehav-ical behav-interventbehav-ions (Ba r ro m , Shadish, & Mo n t g o m e ry, 1988). Pe r i o d i c a l l y, this division of purposes has erupted as a rift in the profession, as in the secession of clinical psychologists from the American Ps y-chological Association (APA) in 1917 and again in 1937 ( Frank, 1984).
In 1949, the Boulder Model of advanced education in p s ychology was accepted. It posited that to become skilled clinicians, psychologists must be trained as re s e a rc h e r s . This moved the profession to an emphasis on the PhD as the entry - l e vel, first professional degree, strengthening psy-chology in its competition with psyc h i a t ry. Ps yc h o l o g y’s commitment to PhD preparation continues today. Howe ve r, PhD curricula we re criticized for not meeting the pract i t i o n-e r’s nn-en-ed for sophisticatn-ed clinical prn-eparation, so by thn-e latn-e 1960s, the first clinically oriented professional d o c t o r a t e s we re established in psychology (Frank, 1984). This was the beginning of the Ps y D .
T h i rty years after the establishment of the PsyD, there a re now more than 30 PsyD programs (APA, 1996). T h e PsyD emphasizes advanced clinical practice and attracts stu-dents with different priorities than does the PhD. Ps y D graduates tend to be employed in positions of greater clini-cal responsibility and lesser re s e a rch productivity than are graduates of psyc h o l o g y’s PhD programs (Ba r rom et al., 1988). The PsyD and PhD provide different types of edu-cational experiences and produce different types of sophisti-cated professionals in psyc h o l o g y. This division fits the f i e l d’s two societal missions: development of knowledge and d e l i ve ry of serv i c e s .
Nursing: Eight Doctoral Degrees
Like medicine, dentistry, and pharmacy, the primary mission of the field of nursing is service delive ry. Howe ve r, the pri-m a ry doctorates in nursing have been PhDs. PhD pro g r a pri-m s in nursing have tended to focus on advanced practice know l-edge rather than on discove ry of knowll-edge per se. In re c e n t years, nursing has added several different professional doc-torates, some of which emphasize re s e a rch and know le d g e d e velopment. Thus, the purposes of doctorates in nursing appear less clear when contrasted with other fields.
The emphasis of the first generation of nursing doctor-ates was on the preparation of nursing faculty members. In 1923, the Go l d m a rk Re p o rt recommended stre n g t h e n i n g nursing education (Ma rtin, 1989). The first doctoral pro-gram was a Doctor of Education (EdD) in nursing, begun a t
Columbia Un i versity in 1924. The first PhD program in nursing was established at New Yo rk Un i versity in 1934. With large numbers of nurses returning from World War II with GI Bill benefits, the number of PhD programs in nurs-ing grew quickly durnurs-ing the 1950s. Concomitantly, the de-mand for doctorally pre p a red nursing faculty members also g rew (Forni, 1989).
In the 1960s, the first professional doctorate, the Doctor of Nursing Science (DNS), was established, with a focus on psychiatric nursing (Fl a h e rt y, 1989). The DNS was, and continues to be, a postprofessional program (Ma rt i n , 1989). The introduction of the DNS stimulated discussion of the difference between the PhD and the professional doc-torate. The PhD was identified with re s e a rch competency and the DNS with expert nursing practice ( Peplau, 1966). In 1971, the clinical PhD was introduced (Ma rtin, 1989). Schlotfeldt (1966) argued that nurses we re better served by PhDs in nonnursing disciplines. Others introduced va r i o u s forms of the postprofessional nursing doctorate, including the Doctorate of Nursing Science (DNSc), Doctorate of Science in Nursing (DSN), and Doctorate of Nursing (DN or DNurs) (Fl a h e rt y, 1989; Pearson, Borbasi, & Go t t , 1997). Since the start of nursing’s professional doctorates, d i f f e rentiation of doctorates in nursing has been debated ( Ma rtin, 1989; Ziemer et al., 1992). The degree of empha-sis placed on re s e a rch versus clinical preparation in the field’s PhD and professional doctorate programs varies from one educational program to the next.
The creation of nursing specialty roles with board cer-tifications of nurse practitioners, nurse anesthetists, nurse m i d w i ves, and others has further complicated the nursing d e g ree picture by pushing all nursing programs tow a rd g reater clinical specialization (Bigbee, 1996). A plethora of s p e c i a l i zed clinical master’s degree programs in nursing has emerged to produce practitioners to fill these new ro l e s (Cotton, 1997). Curricular emphasis is placed on theories of re s e a rch utilization in nursing practice (Funk, Tornquist, & Champagne, 1995; Phillips, 1986). Se rving as the pre l i m i-n a ry degree to the PhD ii-n Nursii-ng, these clii-nical specialty m a s t e r’s degrees also increase the pre s s u re on nursing’s re-s e a rch doctorate programre-s to focure-s on clinical applicationre-s.
Although debate around the role of clinical doctorates within nursing education flourishes, nursing’s pro f e s s i o n a l associations have not yet reached a formal resolution with re g a rd to differentiation of doctoral degrees (Fl a h e rt y, 1989; Ma rtin, 1989; Pearson et al., 1997). Requiring a baccalau-reate degree for entry - l e vel practice is as yet an unre s o l ve d issue in nursing largely because the majority of re g i s t e re d nurses do not have bachelor’s degrees. Despite strong inter-ests in clinician preparation, the profession of nursing ap-pears to endorse the PhD over the professional doctorate as the more desirable terminal degree (Ma rtin, 1989; Ziemer et al., 1992). Numbers of PhD programs have increased rapid-ly compared with clinical doctorate p rograms (Fl a h e rt y, 1989). As of 1997, there we re 56 PhD programs and 10
p o s t p rofessional doctorate programs in the field of nursing ( National League of Nursing [NLN], 1997). In t e re s t i n g l y, many schools of nursing have demonstrated a pattern of establishing a professional doctorate first, then adding a PhD program after several more years of building pro g r a m s t rength. Often, the professional doctorate program is eve n-tually closed.
The recent addition of an eighth doctorate in nursing, the Nursing Doctorate (ND) is intended to be a first pro-fessional degree. It is structurally consistent with pro f e s s i o n-al doctorates in other hen-alth care fields (Forni, 1989; New-man, 1997; Peyton, 1997). Students enter ND pro g r a m s with a baccalaureate and a cluster of pre requisites; they then complete 3 years of course work and 1 year of clinical ro t a-tions. T h e re are now four ND programs in the Un i t e d States (NLN, 1997).
Implications for Occupational Therapy Derived From the Professional Doctorates of Psychology and Nursing
Ps ychology and nursing have re s o l ved the question of how doctoral education can best fulfill their pro f e s s i o n s’ com-mitment to society in ways unique to their disciplines. Both began with adherence to the PhD but found that re-s e a rch preparation at the doctoral level needed to be com-plemented with advanced clinical education to best meet emerging challenges in the health care environment. In this w a y, these two fields echo the conclusion that can be drawn f rom the experience of medicine, dentistry, and pharmacy: The professional doctorate is an effective degree stru c t u re for the development of advanced clinical knowledge and c o m p e t e n c i e s .
It is evident that as the five professions ove rv i ewed thus far have matured, they have each answe red in the same way the question of whether disciplinary or extradisciplinary doctorates better serve the needs of their profession. Ta b l e 2 illustrates the different purposes that are served and depths of disciplinary knowledge that are provided by dis-c i p l i n a ry and extradisdis-ciplinary postprofessional dodis-ctorates c u r rently available to occupational therapists. As Table 2 s h ows, the disciplinary degrees provide greater depth of educational preparation pertinent to the profession and enhance the potential of graduates to contribute to occu-pational therapy’s knowledge base.
One of the arguments against the establishment of pro-fessional doctorate programs in occupational therapy is that they will compete for students that might have gone i n t o PhD programs. True, all doctoral programs compete for stu-dents. Howe ve r, for practitioners interested in adva n c e d competence, the professional doctorate in occupational therapy is preferable to an extradisciplinary Ph D .
Nu r s i n g’s history also raises some warnings for occu-pational therapy. The re l a t i ve difficulty that the field of nursing has had in establishing a clear direction for its clin-ical doctorates raises the daunting question of whether
enhancing professional status through the upgrading of d e g ree levels for practitioners may not be more difficult in p redominantly female professions (Ba i l e y, Tisdell, & Cer-ve ro, 1994; Pa valko, 1988). Will occupational therapy, like nursing, see a confusion of purposes in doctoral education, as indicated by a proliferation of professional doctorates and PhD programs emphasizing clinical education? Do we h a ve the strong professional associations of educators who we re so instrumental in the adoption of the professional doc-torates in medicine, dentistry, pharmacy, and psyc h o l o g y ?
The New Professional Doctorates in Occupational
Therapy and Physical Therapy
Professional Doctorate Programs in Occupational Therapy Similar to pharmacy, the number of credit hours and ye a r s re q u i red to complete an entry - l e vel degree in occupational therapy has grown well beyond that of the typical bache-l o r’s degree (Ru n yon et abache-l., 1994). The fiebache-ld has thre e s t rong disciplinary re s e a rch doctorate programs and an i n t e rd i s c i p l i n a ry re s e a rch doctorate shared between occu-pational therapy and physical therapy. Enter the scene, two n ew clinical doctorates in occupational therapy.
Nova Southeastern Un i versity in Florida began offering its Doctorate of Occupational Therapy (Dr OT) in 1994. This postprofessional program emphasizes clinical pre p a r a-tion, specializaa-tion, and re s e a rch. Re q u i rements include 90 c redit hours beyond the baccalaureate, a clinical rotation of 6 to 12 months, and a dissertation demonstrating original clinical re s e a rch. Two students had graduated by the spring of 1998. This program does not mirror the traditional Jo h n s Hopkins model of clinical doctorate preparation exe m p l i-fied by the MD, DDS, PsyD, PharmD, or ND but blends both clinical and re s e a rch intents.
Creighton Un i ve r s i t y’s Doctorate of Oc c u p a t i o n a l Therapy (OTD) program began in 1995. This postpro f e s-sional program focuses on advanced clinical pre p a r a t i o n . De g ree re q u i rements include 72 credit hours beyond the e n t ry - l e vel degree in occupational therapy and three semes-ters of clinical rotations. Like the early optional Ph a r m D p rograms, a small percentage of recently graduated occupa-tional therapists go directly into the OTD program after their baccalaureate or master’s first professional degre e . Howe ve r, the program primarily attracts more experienced therapists. At this point, there have been 7 graduates in 1997, 9 in 1998, and 13 anticipated for 1999. The OTD at Creighton resembles in stru c t u re the traditional pro f e s s i o n-al doctorate as it was first offered in medicine and is cur-rently offered in pharmacy as an advanced postpro f e s s i o n a l d e g re e .
Professional Doctorate Programs in Physical Therapy As might be expected from the shared roots of the two pro-fessions, the emergence of the clinical doctorate in physical therapy is similar in many ways to that of occupational
t h e r a p y. Physical therapy has several established PhD pro-grams. Most of these programs are in keeping with the tra-ditional understanding of a re s e a rch doctorate. In contrast, t h e re are now five new clinical doctorate programs in phys-ical therapy.
The first Doctorate in Physical Therapy (DPT) was o f f e red at USC in 1992 as a postprofessional program pro-vided to its clinical faculty members. It has the traditional curricular stru c t u re of a clinical doctorate, with both didac-tic semesters and advanced clinical rotations. Howe ve r, unlike occupational therapy, physical therapy has move d quickly to re s o l ve accreditation issues and establish clinical doctorates as first professional degrees. At USC, an entry -l e ve-l DPT was added to the stru c t u re of the postpro f e s s i o n-al DPT program within 2 years of the pro g r a m’s start. T h e e n t ry - l e vel DPT continues today as the primary offering in physical therapy at USC.
The DPT at Creighton Un i versity began as an entry -l e ve-l program in 1993. It draws a -large app-licant poo-l, ad-mitting only students with bachelor’s degrees in other fields. The first class of 47 DPTs graduated in 1996. Class size has steadily increased since then to 55 students entering in 1997. The DPT at Creighton includes six semesters of didactic content and two semesters of clinical experience. The focus is clinical and generalist. Similar entry - l e vel DPT pro g r a m s a re also offered at Sl i p p e ry Rock College in Pe n n s y l va n i a and Loma Linda Un i versity in California. These DPT grams reflect the traditional curricular stru c t u re of the pro-fessional doctorate, as seen in MD, DDS, PsyD, Ph a r m D , and ND.
A more uniquely stru c t u red clinical doctorate in phys-ical therapy is offered at the Un i versity of St. Augustine in Florida. It is a postprofessional DPT requiring the follow-ing: 33 to 38 credit hours of didactic work via distance education, 7 to 12 credit hours for a scholarly project or e d u c a t i o nal product that is defended to a committee, docu-mentation of 2,000 clinical hours after entry into the field, and clinical rotations of 1 to 5 credit hours.
Implications for the Professional Doctorates of
Occupational Therapy and Physical Therapy
Despite the recency of the emergence of professional doc-torates in occupational therapy and physical therapy, in-sights can be drawn from their history. Parallels in the emer-gence of clinical doctorates in the two professions are (a) the need for advanced practitioner preparation as a response to an increasingly complex health care environment, (b) the p re s s u re of preparing practitioners for entry into a pro f e s-sion with only 2 1/2 years of preparation, (c) a clear fit of the clinical doctorate curriculum with the pro f e s s i o n s’ com-mitment to match practitioner preparation with adequate depth in the professional knowledge base, and (d) initial clinical doctorate programs starting up as postpro f e s s i o n a l d e g re e s .
The primary contrast between the clinical doctorates of occupational therapy and physical therapy is that occu-pational therapy’s are postprofessional whereas physical t h e r a p y’s are entry level. In occupational therapy, there is c u r rently much discussion about the level at which entry into the field should occur (Hughes, Brayman, Clark , De l a n e y, & Mi l l e r, 1998; Joe, 1998) The emergence of the clinical doctorate in occupational therapy at a postpro f e s-sional level, rather than as a first profess-sional degree, may h a ve been due to the unavailability of accreditation of e n t ry - l e vel clinical doctorates at the time they we re initiated in occupational therapy. It appears that the scope of the Ac c reditation Council on Occupational Therapy Ed u c a t i o n ( AC OTE) was limited by language in its agreement with the U.S. De p a rtment of Education re g a rding a c c re d i t a t i o n of baccalaureate and master’s degree programs. This issue can and should be re s o l ved in the near future, opening the way for AC OTE accreditation of first professional degre e clinical doctorates in occupational therapy.
One question that is common to both occupational therapy and physical therapy is how to differentiate betwe e n the professional doctorate and the master’s degree. In nurs-ing, occupational therapy, and physical therapy, the master’s Table 2
Postprofessional Doctorates Pursued by Occupational Therapists
Characteristic Research Research Research Professional Professional
of Degree Disciplinary Multidisciplinary Extradisciplinary Disciplinary Extradisciplinary Purpose
Examples
Average years to com-plete (no prerequisites) Years of disciplinary work (no prerequisites) Research into development of original knowledge pertinent to occupational therapy Doctor of Philosophy (PhD) in occupational therapy or occupational science 10–14 10–14
Research into and development of original knowledge pertinent to multiple disciplines PhD in rehabilitation sciences 10–14 4–8
Research into and development of original knowledge pertinent to outside discipline PhD in psychology, anatomy, education, etc.
10–14 4–8 Advanced practice knowledge pertinent to occupational therapy Doctor of Occupational Therapy (OTD) 5–7 5–7 Advanced practice knowledge pertinent to outside discipline Doctor of Education (EdD) 9–13 4–8
d e g ree has been pulled away from its traditional re s e a rc h focus and tow a rd entry - l e vel professional education with a s t rong clinical focus. En t ry - l e vel master’s education pro-grams must fit all basic patient treatment skills into an al-ready crowded curriculum. Pre d i c t a b l y, when comparing the curricula of master’s degree programs that have evo l ve d a clear emphasis on clinical education with the curricula of p rofessional doctorates specifically designed to provide a d-vanced practice competencies, there is going to be some confusion re g a rding the essential differe n c e s .
Summary
Occupational therapy education is at a critical juncture . Our knowledge base and the demands of the health care e n v i ronment are rapidly increasing beyond the capacity of our baccalaureate programs. A move to the postbaccalaure-ate level for the first professional degree is being stro n g l y d e b a t e d .
The histories of the professional doctorates of medi-cine, dentistry, pharmacy, psyc h o l o g y, and nursing are replete with implications for occupational therapy’s pro f e s-sional doctorates. By grounding our deliberations in the historical perspective offered by the experiences of these other fields, we are provided with a broader context within which to reflect on the important decisions ahead in occu-pational therapy education. How might the pro f e s s i o n a l doctorate support our potential to meet the needs of patients within the complex health care environment of the f u t u re? If we do move to postbaccalaureate entry into the field, which degree might best meet our need for practi-tioner preparation, the entry - l e vel master’s degree or the p rofessional doctorate?
The professional doctorate offers a successful and ac-cepted degree stru c t u re for the preparation of adva n c e d practitioners. It creates a clinical scholar who can autono-mously operate as a change agent in health care systems and s e n s i t i vely interpret the human condition presented by pa-tients. The professional doctorate bears serious considera-tion in occupaconsidera-tional therapy as an educaconsidera-tional opconsidera-tion. ▲
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