Running head: FACULTY PERCEPTIONS 1

Faculty Perceptions of the Occupational Therapy Profession Transitioning to an Entry-Level

Doctorate as Expressed by Touro University Nevada Occupational Therapy Program Faculty: A
Phenomenological Study




Touro University Nevada
Johnny Rider, Ian Sande, Josh Hensley, Gary Pearson









FACULTY PERCEPTIONS 2

The profession of occupational therapy (OT) is currently discussing a move to the clinical
doctorate as the entry-level degree. As of January 2014, 5 schools in the U.S. offer entry-level
occupational therapy doctorate (OTD) programs (AOTA, 2001). Ongoing discussions are
prevalent across the country within the American Occupational Therapy Association (AOTA),
OT programs, and by practicing clinicians, faculty, and students. Current research has provided
perceptions by practicing OTs but there is a need for additional perspectives from faculty with
advanced practice in research, teaching, curriculum design, and clinical practice. The purpose of
this study is to review literature on the discussed transition and to gather current perceptions
from the faculty at Touro University Nevada. Results will provide information to assist the
profession in creating a future that reflects the opinions and concerns of practicing therapists,
students, and faculty. This study will promote more discussion among diverse practitioners to
include faculty with a wide range of credentials and clinical practice along with practicing
therapists. Additional populations that should be included are current students, potential students,
healthcare administration and patients/clients.
Literature Review
Research available on the transition to entry-level clinical doctorate is limited. This article will
provide additional data from the faculty at Touro University Nevada to be used in conjunction
with current research and to demonstrate the need for more evidence. Six articles were found to
be relevant to our question. One addressed the shift from a bachelors degree to masters degree
level and was completed in 1987 (Pierce et. al) but the model presented was still applicable to the
next transition to the entry-level clinical doctorate. The other 5 articles specifically addressed the
clinical doctorate becoming the entry-level requirement from practitioners perspectives. They
used mostly survey formats and compiled major questions and concerns that needed to be
FACULTY PERCEPTIONS 3

researched more fully. Occupational therapy programs across the country were also included in
the studies reviewed by way of questionnaires and surveys. Discussions provided a rationale for
and against the transition, but lacked support. Lack of diversity of participants and expression
through impersonal surveys limited the responses. There was a distinct population missing from
the data; current faculty within the profession were not surveyed or interviewed directly.
Although major themes found in our literature review coincide with themes identified within our
study, additional perceptions will only solidify the need for more studies and research to be
completed before the transition. Our search criteria included only peer-reviewed journal articles
published after the year 2000. We included one research article from 1987 (Pierce, et. al) because
the theme was still relevant to our research question. It also provided a model to view possible
effects of the change.
Perceptions of Practicing Occupational Therapists
Survey results from practicing occupational therapists conclude that recent graduates of
occupational therapy programs do not perceive the OTD to be financially valuable and most are
not interested in obtaining this degree (Smith, 2007). Survey answers revealed flaws in the
research due to close to 50% of respondents answering with a Neutral response indicating that
they did not have an opinion for questions asked in the survey. Examples of the neutral responses
include: OTD will help obtain reimbursement by third party payers for patients with direct
access and OTD will enhance an OTs ability to practice independently without a referral,
indicating less than adequate information to make any inferences. Although this survey was not
looking specifically at the transition to an entry-level doctorate as the requirement to practice,
beliefs and perceptions of recent graduates can provide insight when combined with faculty
perceptions.
FACULTY PERCEPTIONS 4

Possible Effects of the Transition
Pierce, et. al (1987) developed Occupational Therapy Interacting With The Environment: A
Model to describe areas that might be affected by the change to entry-level Masters degree as
seen in other professions who had done the same thing . While this model coincides with
occupational therapy trends, it leaves much to be desired. Questions regarding whether or not the
change will decrease the amount of therapists in the workforce, shortage of faculty, and impacts
on the number of applicants are not addressed. These are common questions surrounding the
issue of transition and need to be addressed. Although Pierces research was completed over 20
years ago, it provides a great perspective on the outlook of transition to a higher degree
requirement for practice and many of the factors are generalizable and can be applied to current
discussions on transitioning to an entry-level OTD requirement. Another survey by Dickerson
and Trujillo (2009) examined practitioner perceptions. Six hundred practitioners responded to the
survey out of two thousand and two sent. The majority of them did not approve of moving to the
doctoral level for entry-level requirements. The survey found the perceptions of those with a
post-professional OTD as being more able to meet the demands of management, have more
credibility, and be more current in treatment and evidence-based practice (Dickerson & Trujillo,
2009). Similar concerns were noted regarding the lack of rewards associated with an entry-level
clinical doctorate and financial difficulty. A major limitation of this study was the low response
rate and the survey was aimed at the grass root therapists who were not members of the
American Occupational Therapy Association (AOTA) and may be less concerned with current
professional issues. The surveys were sent to 7 states only, limiting the global representation of
the profession in this study.
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Fisher and Crabtree (2009) examined two pertinent issues that have been raised as concerns. The
two issues are whether the entry-level doctorate would make the occupational therapy profession
out of reach for people who are at a financial or social disadvantage, and whether or not there
will be sufficient numbers of applicants applying to institutions that offer an entry-level OTD in
order to be financially viable. These were found to also be themes in faculty perceptions at Touro
University Nevada and research is needed to support or refute these concerns. Although many
have expressed similar concerns, there seems to be a very robust market for postsecondary
education and beyond, as exhibited by increasing enrollments from most sectors of the
population (Fisher & Crabtree, 2009). In dismantling the arguments against the entry-level
doctorate requirement in occupational therapy, this article states that close examination exposes
these arguments as concerns to be addressed, not barriers however, and that our profession can
successfully overcome them as we develop strategies to minimize potential gaps in education.
U.S. News and World Report has consistently listed occupational therapy as one of the best of
the top 31 careers and therefore more people will be interested in enrolling in occupational
therapy programs regardless of the entry-level degree requirement according to this logic
(Graves, 2012). Royeen and Lavin (2007) have provided perspectives of the clinical doctorate
for health practitioners in a contextual format and then organized according to dilemmas,
delusions and de facto realities that need to be acknowledged. Their prediction is that within less
than a generation, the majority of health care practitioners in allied health, including
occupational therapists, will be degreed at the level of the clinical doctorate. They believe that
reimbursement will require services provided by a signature authority of someone educated at
the clinical doctorate level greatly impacting the need for practitioners at this level of education
and training. Internal and external policy issues are discussed for nursing, physical therapy, and
FACULTY PERCEPTIONS 6

occupational therapy. Once again, discussions are based on prior questions posed in other
qualitative studies as well as current trends. Dilemmas and delusions of the transition are
presented but no consensus is reached other than the fact that more research is needed and
studies need to be completed to validate the concerns. Rationale is provided that the clinical
doctorate is here to stay, whether or not it is needed. The profession continues to move in the
direction of the entry-level clinical doctorate despite the lack of evidence cited by Royeen and
Lavin (2007).
Level of I nterest
Griffiths & Padilla (2006) obtained information about the current status in decision making with
regards to the selection of clinical doctorate degree in occupational therapy as a viable entry-
level degree to be offered at academic programs in the Unites States. Questionnaires were
utilized in a similar manner to a survey conducted regarding the entry-level Doctor of Physical
Therapy discussion. One hundred fifty occupational therapy programs in the U.S. were surveyed
with 111 of them responding. Of the 111 respondents, 29 institutions were in favor of the entry-
level OTD and 82 did not favor the entry-level OTD. Of the 29 schools that were in support, 24
of those were private institutions. Factors that support the development of the entry-level OTD
included coexistence of physical therapy program, enhanced preparation of graduates, and
improved student recruitment into the profession of occupational therapy. Improved student
recruitment as a support is in direct contradiction to what was identified in faculty interviews at
Touro University Nevada and illustrates the need for further research on specific themes
discovered to validate perceptions. Factors listed as impeding the development of the entry-level
OTD included limited resources, philosophical objections, and lack of demand from students and
employers. Although there is a growing level of interest for the entry-level OTD, only 26% of
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institutions thought it was viable as of 2004 (Griffiths & Padilla, 2006). Limited resources were a
common concern within institutions.
Surveys and questionnaires do not allow for additional factors that may support or impede the
development of the entry-level OTD programs. For this reason, more research was conducted at
Touro University Nevada within the occupational therapy faculty to provide a more
comprehensive and open-ended format to express perceptions without limiting individual and
unique contributions that may have not been explicitly asked in a survey. Research available on
this topic is in unanimous agreement that further research is necessary as the discussion
continues. More quantitative research is needed to validate perceptions and opinions expressed
throughout current studies and surveys. Current research is limited to surveys and questionnaires
and more open-ended qualitative research is also desired.
Design
A phenomenology design was used for this study. The studys intent was to explore Touro
University Occupational Therapy program faculty perceptions of the occupational profession
transitioning to an entry-level doctorate requirement. The data was collected by conducting
individual 20 to 30 minute interviews with 6 different full-time faculty members, 5 female and 1
male, of the Occupational Therapy Department at Touro University Nevada. The interview
consisted of 6 initial questions relating to the possible shift in the profession from entry-level
masters degree to an entry- level doctoral degree for new occupational therapists. The questions
asked interviewees their opinions about possible benefits and negative impacts if the transition
were to take place, concerns expressed among their academic peers, and perceptions in the field
as licensed working occupational therapists. The interviews took place in each faculty members
office, with one interviewee and two researchers asking questions with two different researchers
FACULTY PERCEPTIONS 8

transcribing the responses. The transcripts from each recorder were then triangulated to produce
a higher level of validity. From the triangulated transcript general themes from responses were
generated using a phrase count from responses by interviewees.
An important characteristic of this design was to interview staff members with a variety of
different degrees, work experience, and backgrounds, to accurately reflect the OT profession as a
whole. Criteria for interviewees included: full-time faculty at Touro University Nevada,
registered and licensed occupational therapists and possessing or pursing a doctoral degree.
A critical assumption of this study was that interviewees would give the opinions from their
personal academic and clinical experience. It is assumed that their background, work experience,
and degrees possessed, would impact their answers and opinions regarding the research topic.
The design utilized is likely to yield results due to the fact that our intent was to find the
sentiments of Touro University faculty regarding the profession transitioning to a different
standard for practice. The phenomenology design is specifically used for this purpose. This
design will add a new element to the research currently available because faculty perceptions
have not been adequately documented.
Role of the Researcher
At the time of this study, all of the researchers were enrolled in a Master of Science degree in
Occupational Therapy program at Touro University Nevada. Informed consent was obtained
verbally from each of the participants. IRB approval was not obtained, but departmental approval
was secured through the instructor of the research course that all four of the researchers were
enrolled in at the time of study completion.
The study was done with the future of the profession in mind and the topic was of particular
interest due to the limited amount of research currently available. The overall aim of the research
FACULTY PERCEPTIONS 9

study was to further understand the implications of an entry-level OTD program requirement for
the profession of occupational therapy through faculty perceptions.
Data Collection Procedures
Six Occupational Therapy faculty members were interviewed by the researchers to obtain their
perceptions based on the topic of an entry-level occupational therapy doctorate requirement. The
data was collected through one interview lasting roughly 30 minutes with approximately 6 semi-
structured questions, allowing the participants to expound on each question. By using the process
of an interview, the individuals personal experiences were able to be expressed freely and
information not directly inquired about could also be expressed
A convenience sample was used due to the faculty being readily available to the researchers. At
least 2 members of the research team attended each interview and there were 2 transcribers at
each interview. Each interview was administered with one interviewee present in a private office
allowing all responses to be confidential. The faculty members were chosen based on their
credentials associated with the field of occupational therapy. (See Table 1.1). Each member of
the faculty has a different degree and credentials, allowing for a wide array of backgrounds.
In this study, the interviewers asked the faculty members 2 central open-ended questions and 4
sub questions. The questions were designed to gain an understanding of their opinion regarding
entry-level requirements for occupational therapists and to provide a rationale for their opinion
from their experience and expertise as a student, clinician, researcher, and faculty member. (See
table 1.3 for interview questions). The sub questions asked became more focused as certain
elements were identified during the interview process and more defined questions were
warranted. The interviews were administered between January 7, 2014 and January 16, 2014. All
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interviews were scribed by 2 researchers during the interview. Each interview occurred at Touro
University Nevada in the faculty members office.
Data Analysis Procedures
To find related themes and opinions the researchers used the scribed text from each interview to
identify significant statements as to how the faculty members perceived the questions. All of the
researchers identified discrete chunks of data related to the research questions to find meaning
units by highlighting significant themes related throughout the papers. The meaning units were
compared to find central themes related throughout the interviews. These themes were then used
to write a description of what the interviewees experienced.
Methods for Verification
A triangulation approach was used to verify the main themes attained from the interviews. Each
researcher identified themes from the transcripts based on the perspectives of the interviewees.
The chunks of data found correlated with the majority of the current literature available. Member
checking was used to verify the findings. Researchers typing the interviews reviewed the
transcripts with faculty members.
The study was unique in that the perceptions were based on Touro University Nevada faculty
members. For replication of this study, different results may be found by interviewing faculty
members from other institutions.
Findings
Characteristics of the participants have been outlined in Tables 1.1, and 1.2. All participants
were current faculty at Touro University Nevada and had varying clinical experience as well as
academic credentials. Several core themes emerged from the interviews including (1) an entry-
level doctorate does not mean you have better skills as an entry-level therapist, and (2) an entry-
FACULTY PERCEPTIONS 11

level doctorate would mean less diversity among student populations, create more hardship
financially, and decrease accessibility, (3) as a profession Occupational Therapists need to be
equal at the table in terms of patient care and Occupational Therapists need to be viewed as equal
medical professionals with Physical Therapists when it comes to providing treatment and
evaluations, (4) having an entry-level doctorate will increase the level of leadership,
administrative skills, management skills, entrepreneurship, and research skills among working
professionals, (5) there is already a shortage of Occupational Therapists, if the standard becomes
more difficult, it will further decrease the amount of working therapists, (6) a post-professional
doctorate would be a better option and alternatives need to be explored, (7) transitioning to the
entry-level doctorate will make Occupational Therapy a more prestigious profession in the health
care field and a closer partner with Medicare, making it easier to get paid, and create more access
to primary care and patients, (8) having an entry-level doctorate does not mean a therapist will
get paid at a higher rate and the level of patient care will still be the same for a practicing
clinician with an entry-level doctorate as compared to an entry-level masters degree.
Five out of six faculty members interviewed expressed concerns that requiring an entry-level
doctorate for practice would not give therapists better skills as clinicians.
having a doctorate degree doesnt lead to being a better clinician. Most
reasons for wanting an entry-level doctorate are external, such as wanting to be
at the same table as P.T.
Five out of six interviewees also conveyed that an entry-level doctorate would mean less
diversity among student populations, create more financial burden, and deny general
accessibility.
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How many of your cohort would spend more on this profession? Financially its
a burden, and you have to weigh it. If its one more year to be an O.T. than you
may go to dental school, or be a pharmacist. People start to weigh their options.
Many faculty members expressed concerns regarding future occupational therapists as being at
the same level in terms of patient care. Many other professions are requiring an entry level
doctorate in order to practice. When it comes to giving medical opinions and clinical assessments
occupational therapists will be viewed as less educated, less knowledgeable, and less qualified.
The other area of concern in relation to this is patient access and reimbursement. Having a
doctoral degree would open up avenues for future occupational therapists to work in new
burgeoning areas of practice, as well as create greater access to patients where Medicare would
require a doctorate for reimbursement.
In the political legislation realm it would put us on the same footing. When
talking to Medicare and Medicaid you are telling them these services are needed.
Another perceived benefit articulated by those interviewed was the increase level of leadership,
administrative skills, management skills, entrepreneurship, and research skills. The profession of
occupational therapy would greatly benefit by the future workforce opening their own clinics,
engaging in research studies to further evidence-based practice in the discipline, in addition to
creating more leaders to deal with legislation, policy, and advocacy.
Having taught entry level doctoral students, the students that come out of O.T.D.
programs are stronger. They are more willing to develop more programs, more
practice areas, and leadership levels are a big quality. Another benefit is
generally there is more knowledge and skills with either research or publication
presentation.
FACULTY PERCEPTIONS 13

Some of the negative opinions cited were in reference to the current shortage of
Occupational Therapists, and if the standard to practice becomes harder to obtain, it will
further decrease the amount of working professionals. Not only will the amount of future
applicants to programs diminish, but the encumbrance on new programs will be too great.
Finding individuals who currently have the qualifications to teach at the doctoral level in
Occupational Therapy will be tenuous. There will also be unforeseen burdens placed on
programs who are trying to get accreditation such as physical space, and where to put all
the new incoming students if an extra year of education is required. An additional
concern communicated was just having a doctorate degree does not mean a therapist will
get paid at a higher rate; in addition, the standard of care for patients will still be the same
for a clinician practicing with an entry-level doctorate as one who possesses a masters
degree. There is an apprehension that prospective occupational therapy students will look
at the current job market and see that pay for a certified occupational therapist with a
doctorate is not as high as pay for a doctoral level education in another field.
Other opinions were conveyed in regards to other options being explored besides just the
entry level doctorate, where a post professional doctorate is preferable.
A post-professional doctorate means you have already been working in the
field, and it makes sense. As a profession, if we transitioned to the entry-
level doctorate as the requirement, we would shoot ourselves in the foot,
we need to have options for people to get into the profession. Post
professional gives you more life experience and relevance in the field.
A post-professional doctorate gives the profession more well-rounded practitioners and is
an option for students wanted to further their education. Individuals who already have
FACULTY PERCEPTIONS 14

work experience in the clinical setting coming back to school will have a better
understanding of where they want to expand their practice, whether it is in research,
entrepreneurship, administration, or teaching.
Conclusions and Recommendations
Further research is necessary due to the limitations of this study. Limitations such as the small
number of people interviewed, the fact that it was a convenience-based sample of Touro
University Nevada faculty only, and the geographic location of the school, are all restrictions that
could be addressed with further research. Additionally, there could be varying perceptions
regarding the entry-level OTD depending on whether or not the faculty members are teaching at
a master's entry-level degree program vs. an established entry-level OTD institution. Further
research needs to be done on the various themes that were found in this study in order to assess
the validity of each of the proposed impacts. For example, one theme that came up was whether
it was financially feasible for the entry-level OTD due to the increased cost of tuition and
therefore an increased student debt load and the unequal return on investment. Further research
can be done to increase the understanding of the average debt increase of the entry level master's
degree program vs. the entry-level OTD and whether or not those with an OTD are more likely
to have higher status employment such as rehab manager or more likely to own a private clinic
and how this will affect enrollment and future compensation.
One important finding to note is that even though all the participants from this study consisted of
faculty from one program; there was still a wide degree of variability in perceptions, with regards
to the amount of support either for or against the requirement transitioning to an entry-level
OTD.

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Appendices: Tables 1.1, 1.2, 1.3
Degree Participants
PhD 2
DHS 1
Post Professional
OTD
1
Entry-level OTD 1
MS pursuing ScD 1
Table 1.1
Years Practicing Participants
1-5
6-10 2
11-15 1
16-20
21-25 1
26-30
31-35
36-40
1

1
Table 1.2
Questions
Purpose
Statement:
The purpose of this phenomenological study will be to explore faculty
perceptions of the occupational therapy profession transitioning to entry-level
doctorate as expressed by Touro University Nevada Occupational Therapy
Program faculty.
Central
Questions:
1. What is your opinion regarding entry level requirements for
occupational therapists transitioning to the doctoral level?
2. Please provide rationale for your opinion including your experience and
expertise as a student, clinician, researcher and faculty.
Sub
Questions:
1. What central themes does the faculty discuss as future
benefits/restraints?
2. What are the perceptions in the field (as clinicians) and as faculty for
entry-level OTD as opposed to post-professional OTDs?
3. What benefits, if any, do you foresee wee an entry-level OTD?
4. What negative impacts, if any, do you foresee with an entry-level OTD?
Table 1.3


FACULTY PERCEPTIONS 16

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