Briefing Report: That'€™s €œDoctor To You - Degree Creep in California Healthcare Professions

Wednesday, January 20, 2010


There once was a time when an undergraduate degree opened doors. Then came a period when a master’s would set you apart in the job market. Now it seems that more and more professions are strategically moving towards implementation of professional doctorates, also known as clinical doctorates, for entry into the professions.

This briefing report looks at the strategic implementation of advanced degrees in healthcare professions throughout California – a trend that has come to be labeled as “degree creep.”

What Is “Degree Creep”?

Many professional fields have long been characterized by the need for the doctoral degree – these include dentistry, medicine (e.g., osteopathy, podiatry, veterinary, chiropractic, optometry), law, pharmacy, and theology. However, the number of professions requiring a doctoral level degree for entry-to-practice has been increasing for more than a decade, especially in the allied health fields. This upward progression of academic or professional degrees in fields that, in some cases, previously only required a bachelor’s degree to practice has been described as “degree creep.”

Occupational therapy is just one of the fields in which the entry to practice degree has increased dramatically over the years. In the 1980s, a bachelor’s degree was the standard ticket to enter the occupational therapy profession. By the 1990s, a master’s degree was expected. Today, a doctorate is becoming the norm. This trend toward professional doctoral degrees in fields that have historically required a bachelor’s or a master’s degree as the entry-to-practice degree is causing concern that we are seeing “degree creep” rather than increased skills and knowledge. Some, however, argue that “degree creep” is an unfair label for professions which are responsibly addressing the need for career ladders (advanced degrees), continuing education, and a diverse workforce, while maintaining access to the discipline.

Is Degree Creep Creeping Into California?

California is not alone in experiencing the “degree creep” phenomenon, in large part because in most cases professional organizations are driving the move toward higher entry-level degrees. The professional associations themselves play a central role in deciding which degrees shall be the entry-level requirement to practice. They do this by setting standards that the states rely on when licensing people to work in a profession and by accrediting education programs that offer these degrees. Most licensing boards are required to approve schools. However, sometimes this “approval” consists of simply approving schools that are accredited by a national association. Additionally, some practice acts permit a board to approve a national accrediting body and automatically deem all schools recognized by that accrediting body as “approved.” As a result, if a professional association starts requiring a doctorate-level degree, often times schools nationwide will start to phase out non-doctorate-level degree programs so that their graduates will meet the professional association’s standards when they are ready to enter into the field.

This is exactly what happened in the field of Audiology (whose professional association began requiring the Doctorate of Audiology in 2007). When the Council on Academic Accreditation, which accredits all audiology training programs in the country, amended its program accreditation standards to require that all audiology professional training programs offer academic and clinical education at the doctoral degree level, schools began phasing out their master’s degree audiology training programs. Soon after, states like California conformed their requirements for entry level audiologists to the national education and practice standards, which in California’s case meant moving from a master’s degree to a doctorate for entry into the practice.

Similar examples can be found in other professions throughout California. For instance, the nurse practitioner profession adopted the entry-level doctorate degree in 2006, and the doctorate of nursing practice will be mandated for all advanced practice nursing graduates by 2015. The American Association of Nurse Anesthetists has followed suit, requiring the DNP (or DNAP-Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist programs by the year 2025.

Physical therapy is a field which, until 1998, only required a bachelor’s degree for entry into the profession. Over the years the requirements have increased, in large part due to a push for higher standards from the professional associations. For a sneak peak of what’s to come in the field of physical therapy, one needs to look no further than the American Physical Therapy Association’s Vision Statement for Physical Therapy 2020, which states that by 2020, all entry-level degree programs should be at the doctorate level. (It should be noted that the Doctor of Physical Therapy (DPT) was created by the American Physical Therapy Association and that California statute directly states that schools’ education programs should be consistent with the standards established by this organization.)

The Cost of Degree Creep:

With more fields requiring professional doctorates, critics argue that we are moving in the direction where, soon, everyone who sees a patient will be called “doctor.” As a result, patients may get confused since it may be unclear to them whether the person they are dealing with is in fact a medical doctor. Additionally, there are other significant issues that should be considered before changing degree requirements. First, doctoral programs require more resources than do master’s programs: faculty members at a higher education level, more extensive libraries, and better laboratories. Because of this, doctoral programs are more expensive to run. Second, eliminating master’s or bachelor’s programs may aggravate the shortage of health-care professionals. When health disciplines transition to an advanced entry-level degree (such as a professional doctorate), vulnerable populations are often affected the most and are at greater risk of losing adequate service (e.g., rural populations). Furthermore, increasing degree levels to qualify for entry to practice will reduce the pool of faculty members qualified to instruct at the higher level, thus further reducing the training capacity of our schools. Third, any increase in degree requirements will hit students hard because they will have to take on additional courses and costs before being able to enter into the profession. The professional doctorate in pharmacy, known as the Pharm.D., for example, typically takes six years from the start of the freshman year of college. It has replaced a five-year bachelor of science, which used to be the diploma required to work as a pharmacist and was finally phased out in 2000. The six-and-a-half-year doctorate of physical therapy, or DPT, is rapidly replacing a six-year master’s degree. And at a minimum of five and a half years, the doctor of occupational therapy, or OTD, can be the same length as the master’s program.


In a time of such great need and acute shortage of health care personnel, lawmakers need to look closely at proposals to change the degree requirements for any profession. These proposals should be subject to a rigorous academic review to determine whether the change in the level of training is justified. While elevating the educational requirements for an entry-level credential could result from a legitimate performance-based need, it might also simply be the “degree creep” phenomenon.


For more information on this report or other Business, Professions & Economic Development issues , contact Amber Alexander, Senate Republican Office of Policy at 916/651-1501.