Education at the crossroads: for today's practice, the DPT.

Eyewitnesses of major events often differ in their recollections. So it is with those of us who observed and participated in the APTA House of Delegates voting that targeted 1990 as the year when all professional (entry-level) education programs would be at the postbaccalaureate level. (The fact that the deadline came and went suggests that all did not go well.) But even though we who witnessed the voting may have different recollections, few of us would disagree on one key point: The manner in which we proceeded to achieve postbaccalaureate education was " less than ideal"--a euphemism that fails to convey the chaos, angst, and counterproductiveness that surrounded the action. Almost 20 years later, we are about to learn the truth of George Santayana's admonition that "those who cannot remember the past are condemned to repeat it." We face the new millennium arguing again about degrees and professional education.

By the year 2002, all physical therapist education programs will be at the postbaccalaureate level. At that time, thanks to the Commission on Accreditation in Physical Therapy Education (CAPTE), there will be no accredited programs at the bachelor's degree level. This decision was based not on a need to self-aggrandize or on a political agenda, but on a moral authority derived from educational need and from the expectation that a profession serves society before it serves itself:

During the past 3 decades, critics have accused physical therapists of being motivated by self-interest in the movement to postbaccalaureate education. Anyone involved with baccalaureate education programs, however, knows that these programs place restrictions on reasonable educational reforms--reforms that would serve the needs of our patients and employers. For too long we have attempted to overcome limitations inherent in undergraduate education by burdening students with unrealistic course loads; for too long we have expected employers to train our not-quite-ready-for-practice graduates for the complexities of practice in a relatively unforgiving world.

Physical therapist education in today's world requires a firm foundation in liberal arts and the humanities. More importantly, the move to graduate degree programs after the attainment of a bachelor's degree is a recognition that the professional component of education has grown from the days when practice was primarily within hospitals and other institutions and was often based on prescriptions. Today, practice requires a greater knowledge of measurement, clinical decision making, and patient management--and the ability to work in a variety of settings with patients and clients who have a range of conditions not previously seen. Programs claiming to educate practitioners for contemporary practice cannot do so within the confines of baccalaureate education. Neither can they do it in good conscience within the equally stifling confines of master's degree education.

The truth is that the depth and breadth of our educational efforts have long been at the graduate level, regardless of the degrees we have been awarding. If we have learned anything from tour generations of Medicare rules and regulations, it is that any rule, no matter how noble, can be circumvented when self-interest gets in the way. So it has been with the development of master's degree education programs.

The naive assumption of those such as I who advocated postbaccalaureate education back in 1979 was that students would be better prepared intellectually for professional education if they obtained undergraduate degrees first. (After all, that is why we called it "postbaccalaureate.") At the time that CAPTE's Task Force on Accreditation Standards reviewed the data, approximately half of the master's degree programs did not require undergraduate degrees. In addition, the task force found that there were master's degree programs in which professional education lasted not much longer than a year. The permutations on degree programs boggled the mind. With the first number representing undergraduate years and the second number representing professional education, we saw 4 + 1, 4 + 2, 3 + 2, 3 + 3, and 4 + [is greater than] 2 programs. In my view, only the last configuration was meaningful.

The purpose of moving to postbaccalaureate education is to allow for better education, not to replicate overcrowded undergraduate programs in which too little time is spent preparing therapists for the complexities of practice. When you examine what it takes to educate physical therapists today--and again I emphasize depth and breadth and the need to prepare practitioners not just to be responsible, ethical decision makers but to be responsible, ethical members of society--there is inadequate time within what most institutions consider appropriate course-load limitations for master's degrees. I urge educators and interested parties to examine the credits given for most master's degrees, in particular for professional preparation degrees such as the master's degree in social work, and compare them with current physical therapist education programs. This is, of course, assuming that courses given in physical therapy programs are assigned credits that reflect what occurs in the curriculum. Physical therapist educators often undercredit courses in an effort to make a curriculum work while they deny themselves and their students adequate credit for what is being taught. To an extent, we have moved from overwhelming constraints on undergraduate education to the artificiality of master's degree education. We have moved from one box to another, and neither one allows us to do what is right.

What kind of profession and what kind of educators endorse the master's degree as the reward for 2 or 3 years of full-time education past the bachelor's degree? This is not a rhetorical question. The education of therapists bears little or no resemblance to that given to persons who attain other professional master's degrees, but it is very much in line with other professional doctorates being given by many of the same institutions that offer the professional master's degree in physical therapy. Those who question the professional doctorate in physical therapy (DPT) can enhance the credibility of their dissent by addressing this issue with data. In my view, giving anything less than a professional doctorate can be seen as violating truth-in-advertising standards. Those institutions offering the master's degree are either educating too little or giving the wrong degree.

When we first considered postbaccalaureate education, there were many detractors. One of their arguments was that it would drive up costs, increase the salaries of therapists, and give ammunition to our "enemies." In the time since the debate about the move to postbaccalaureate began, we did see salaries rise--but that rise was in response to demand, not to the degree of the job applicant! As a chief of clinical services in an urban hospital, I see no reason to offer new therapists more salary because of the degree that they hold. We look for competence, and if therapists educated at a given institution have a better record of preparedness, we would hire them first and, if necessary, consider salary adjustments to the level allowable. But salary does not relate to the degree itself.

Critics of the DPT suggest the world will see us as moving to this degree so we can be called "doctor" (an appellation that has lost some of its luster in the recent decade) as part of an ongoing effort to self-aggrandize, drive up costs, and satisfy egos that mushroom with credentials. But if we avoid doing the right thing because some people may have inappropriate motivation, we will allow the basest of human emotions to dominate our debates and we will sacrifice our vision in endless self-flagellation.

We need to prepare physical therapists to exemplify the highest standards of health care, to use evidence, to skillfully apply techniques, to be thoughtful and effective--and to do so within the confines of a health care system that can promise us nothing but chaos for the foreseeable future. The DPT can offer the freedom we need, but only if we first have an open dialogue about what form the DPT should take.

Next month, Dr Rothstein discusses upgrade paths for the DPT and the use of the DPT as an advanced clinical credential.