Colleges eye 'degree creep'
Allied health fields consider raising minimum degree for entry-level jobs
By MATTHEW DEMBICKI, Published October 23, 2008

BALTIMORE — As the health care industry seeks to deal with an increasing shortage of qualified workers, community colleges warn that efforts in certain health care fields to raise the educational requirements for entry-level jobs will only exacerbate the shortages.

Associate-degree programs in allied health and especially nursing have for several years tried to stave off proposals to elevate required degrees for entry-level positions, an effort called “degree expansion” and “degree creep” by opponents. But the movement appears to have gained traction in several fields.

The National Network of Health Career Programs in Two-Year Colleges (NN2) devoted a significant portion of its annual conference this month to discuss the topic and to encourage community colleges to become more involved with the professional organizations that often make these decisions. The focus should be on providing two-year college students with a career path, starting with an associate degree or other credentials and providing access to a bachelor’s degree or higher degree, participants said.

Community colleges argue that by inflating degree requirements, students have to take on additional courses and costs. With community college students in particular, a more expensive program could prompt them to drop out of the program and not enter the field, according to two-year college educators.

An elevated degree requirement can also impede the career path because it could make it more difficult for two-year and four-year institutions to craft articulation agreements, noted Judith Blum, associate professor and coordinator of the occupational therapy assistant program at the Community College of Baltimore County (Maryland).

The move could also have local economic impacts, as most students with associate degrees tend to stay in a college’s service area. The health profession is the largest industry sector in the U.S., providing more than 13.5 million jobs, according to the U.S. Bureau of Labor Statistics (BLS). It is also one of the fastest growing, expected to increase nearly 20 percent between 2004 and 2014, according to BLS. Some 44 percent of all accredited health education programs are located at community colleges. About 64 percent of workers in allied health graduated from a two-year college.

Despite the increases in job opportunities, many of the health care fields are experiencing a shortage of qualified workers. Respiratory therapy, occupational therapy and physical therapy each have a gap of about 15 percent, according to studies. Yet, these are some of the fields that have increased the entry-level degree. Occupational therapy and physical therapy now require a master’s degree. A physician assistant requires a bachelor’s degree.

Respiratory therapy, dental hygiene and dietetics are now being targeted for higher degrees, said Barbara Jones, dean of instruction at Louisiana Delta Community College.

“If we elevate the credentials, it will increase shortages and present other problems,” she said.

New data indicate that many nurses with associate degrees continue their education, which may also be happening in other fields in allied health, said Roxanne Fulcher, director of health professions policy at the American Association of Community Colleges (AACC). Such data could help boost the argument that many students use the associate degree as an entry-point to the field and plan to move up the career ladder, she said.  

In most cases, professional organizations are driving the move toward higher entry-level degrees. Advocates argue that higher degrees for entry-level jobs boost knowledge and skills, increase access for patients, raise the image of the profession and increase salaries. But two-year college educators noted that there’s little evidence to show that a higher degree for entry-level jobs increases professionalism or salaries. Jones added that any increase in income among entry-level positions is likely a result of shortages of qualified workers, which drives up salaries.

The move for advanced degrees may also affect faculty, who themselves may not have the required degree to teach in the field, Jones said. That could lead to a teacher shortage in certain allied health fields and a strain on programs offering advanced degrees.

The move to boost entry-level credentials and degrees, coupled with shortages of instructors, could also prompt some two-year colleges to offer bachelor’s degrees and possibly even become four-year institutions, said AACC President George Boggs.

“That could be one of the greatest drivers for community colleges to switch to four-year institutions,” he said.

Community college educators are wary of the movement because recent efforts to increase the entry-level degree for physician assistants flew under the radar until it was too late.

“We were unsuccessful in turning that around,” said Fulcher. But it did light a fire under the field to be alert for similar efforts and to ensure community colleges have a place at the table when such issues are discussed, she said.

“If you’re not at the table with a national organization, then we’re in a no-win situation,” Fulcher said.

Carolyn O’Daniel, dean of allied health and nursing at Jefferson Community and Technical College (Kentucky), said that’s why she’s a member of a committee of professionals and educators exploring the needs of respiratory care for the next seven years. Some of the comments during the first of three meetings made her and other community college representatives there uncomfortable. O’Daniel said several of the committee members acknowledged that their opinions were often based on speculation and assumptions, and that there’s little data available to make informed decisions on increasing credential requirements.

Jolene Miller, health sciences chair at Ivy Tech Community College-Lafayette (Indiana), who also represented NN2 on the committee, said she found it “disturbing” when a panel member commented the field should focus on clinical research and not on the “mundane” work.

“Who is then going to do that mundane work?” Miller said at the NN2 meeting.

The respiratory therapist committee will meet again early next year.

For more information, visit www.nn2.org.