Upcredentialing Update: Changes in allied health degree requirements

Expert Insight

Upcredentialing Update: Changes in allied health degree requirements

Last month, the accrediting body and professional association for occupational therapy reversed their previous decision to raise the degree level for entry into the profession, a decision that could impact occupational therapy education at all levels. Read on for a summary of what led to that change, and an update on upcredentialing in other allied health fields.

We explored allied health upcredentialing in an earlier study as part of the COE Forum’s annual series identifying labor market trends for portfolio growth opportunities. At the time, professional associations and accrediting bodies were raising the degree required to enter fields like occupational therapy, respiratory therapy, physical therapy, and athletic training.

The case: Upcredentialing and its reversal in occupational therapy

In April 2019, the American Occupational Therapy Association (AOTA) reversed a 2017 mandate—meant to take effect in 2027—that occupational therapists (OTs) entering the field must possess a clinical doctorate and occupational therapy assistants (OTAs) must possess a bachelor’s degree.

The next week, AOTA and the Accreditation Council for Occupational Therapy Education (ACOTE) released a joint statement supporting dual-entry degrees for both OTs and OTAs. Dual entry means OTs can enter the profession with either a master’s or a clinical doctorate, and OTAs can enter the profession with either an associate’s or a bachelor’s degree.

Disputed from the start: A timeline of recent occupational therapy entry-level degree decisions

A mandate for higher entry-level degrees

A mandate for higher entry-level degrees
• August: ACOTE mandates that by 2027 OTs will require a doctorate and OTAs a bachelor’s. 
• October: Facing negative feedback, ACOTE suspends the bachelor’s mandate for OTAs.
• December: ACOTE announces they will stand by the doctoral mandate for OTs.

Practitioners disapprove

Practitioners disapprove
• March: Practitioners send the AOTA board a petition opposing the mandates. The board invites further feedback. 
• June: The AOTA board shares the results of a member survey: In almost all cases, members oppose the mandates.
• October: AOTA’s board creates a taskforce, including representatives from ACOTE, to determine and investigate external issues surrounding entry-level education for OTs and OTAs (listed below). AOTA suspends the OT and OTA educational mandates pending further study.

Decision reversed

Decision reversed
• February: Taskforce report released.
• April: The AOTA representative assembly votes to support dual-entry degree levels for both OTs and OTAs. ACOTE agrees.

The joint AOTA-ACOTE taskforce sought to investigate the impact of raising entry-level education for OTs and OTAs on:

  • Practice settings
  • Diversity in the occupational therapy workforce
  • Salary expectations and job prospects
  • Academic programs and fieldwork
  • Consumer perceptions of the profession

The taskforce report notes many of these aspects intertwine: For example, debt load and salary expectations may affect job opportunities and decisions to enter some practice settings, including school-based programs and rural practices. Similarly, the report notes “diversity in the profession if it were to move to single entry-level degrees is an issue of concern” and that, despite the limited availability of data on this topic, “several of the concerns shaping this perception are about increased debt and cost of education.”

Debt load and salary also concerned practitioners. As part of their research, the joint AOTA-ACOTE taskforce sought feedback from OTs and OTAs, and the two most frequently cited reasons these professionals supported dual-entry degree levels were:

1. The impact of higher degrees on student debt and salary

2. A lack of evidence on the effect of a higher entry-level degree on outcomes

Upcredentialing in other allied health fields

While some upcredentialing proceeded as planned–physical therapy’s transition to the clinical doctorate as the point of entry is now in effect, as is the transition from bachelor’s degrees to master’s degrees for athletic trainers–occupational therapy isn’t the only field to rethink the move. The Commission on Accreditation for Respiratory Care (CoARC) intended to raise the entry-level degree for respiratory therapists from an associate’s to a bachelor’s in 2018, but continues to accredit existing associate’s-level programs (though they no longer accept applications for new associate’s-level programs). In a March 2019 statement, CoARC said:

“The CoARC wants to re-emphasize our commitment to support existing accredited associate degree programs. We continue to recognize the prominent role played by associate degree respiratory care programs in addressing workforce needs. We also reaffirm our position that there is the need for increasing numbers of respiratory therapists with baccalaureate and graduate education to serve as educators, researchers, managers, clinical specialists, and in other roles throughout the healthcare delivery system. The CoARC continues to work with other stakeholders to develop alternative pathways, including degree advancement, to meet this goal.”

As the national conversation on student debt and higher education’s value intensifies and the U.S. health care system’s focus on patient outcomes necessitates more allied health services and professionals, allied health professional associations and accrediting bodies are critically examining the impact of upcredentialing on the workforce and on graduate prospects. We will keep you updated if more changes occur.

Workforce-education alignment beyond allied health

Input from occupational therapy professionals helped inform AOTA and ACOTE’s mandate reversal. Beyond allied health, successful COE units and teams work to keep a constant pulse on their regions’ in-demand professions and employer perspectives. For practices to build successful employer partnerships across your portfolio, see our study Critical Disciplines to Grow Employer Partnerships.