A CONTEXTUAL AND LOGICAL ANALYSIS OF THE CLINICAL DOCTORATE FOR HEALTH PRACTIONERS: DILEMMA, DELUSION, OR DEFACT?
Royeen C, Lavin MA. J. Allied Health. 2007; 36:101-106.
Abstracted by Tanya Smith PT, ScD, COMT, IAOM-US Fellowship Candidate
“The purpose of this commentary is to address some of the common misunderstandings of the clinical doctorate, place the doctorate in context of larger educational change and innovation, and share summary judgments about the nature and course of the newer doctoral degrees.”
The terms ‘clinical’ and ‘professional’ doctoral degrees are used synonymously in this commentary. Examples of clinical doctorates include: doctor of medicine (MD), doctor of veterinary medicine (DVM), doctor of dental surgery (DDS), doctor of jurisprudence (JD); these practice oriented doctorates are typically entry level degrees. Terminology issues are relevant, and the title Doctor is not the domain of any one group of health professionals. However, it is important that professionals maintain their specialist titles after completing doctoral education. For example: nurse practitioners should continue to be called nurse practitioners, and so on…. This does not mean that those with a clinical doctorate may not be called “doctor” when holding a professional degree; however, it is important that the nature of the degree be clearly communicated to the public. For instance, physicians, nurse practitioners, and physical therapists should introduce themselves as such rather than identifying themselves as “doctor” since the term “doctor” is not synonymous with one professional group.
The move toward a clinical doctoral degree initiated with medical doctors during a transition in the late 1700’s from a bachelor of medicine (MB) to a doctorate in medicine (MD). It took about 17 years for the transition from MB to MD. More recently there has been a surge of clinical doctorates in various allied health fields, including doctor of clinical nutrition (DCN), occupational therapy (OTD), nursing (DNP) and physical therapy (DPT). The clinical doctoral degree is based on knowledge and skill needed to deliver advanced care within the scope of the specific practice. Clinical doctorates ought not to be confused with post-professional doctorates as they are not intended to emphasize research or teaching. Post-professional doctorates include doctor of philosophy (PhD), doctor of education (EdD) and doctor of science (ScD). The PhD, EdD and ScD degrees are commonly awarded to indicate mastery of an academic subject. The United States Department of Education and the National Science Foundation consider the academic research degrees of PhD and ScD to be equivalent as well as the most prestigious academic degrees, due to their emphasis on development and application of new and advanced knowledge.
Dilemmas in regard to a clinical doctorate can include: confusion of the difference of clinical doctorate from research doctorate or master’s degree and expectation of effectiveness of care delivered. One misconception of the entry-level clinical doctorate is that it not only prepares one for clinical practice but also for academics and research. The entry-level clinical doctorate is not designed to prepare the professional for academic teaching or research. The entry-level clinical doctorate is here to stay; the American Physical Therapy Association is pursuing autonomous and professional development through the advancement to the level of DPT.
With the push for a profession to have only entry-level doctoral degrees, the classic conundrum of economic supply and demand must be addressed. The impetus for all institutions to offer only clinical doctoral programs may have less than optimal consequences; if the school is not a top tier school that provides post-professional doctoral education and research in many other disciplines, this could lead to subpar program development during the transition from masters to doctoral degree. Granted, there is a societal need for a higher level of education for health care professionals given the change in population demographics to an older aged group with multiple health conditions that are often considered chronic. The author predicts that in less than one generation the majority of health care providers in allied health will be educated at the clinical doctoral level at a minimum.
There is no doubt that population demographics are changing and expanding in regards to the patients who are in need of physical therapy services. The movement toward higher education and professionalism is certainly warranted with complex pain and musculoskeletal disorders. Proponents of the DPT contend that the professional doctorate will speed up development and acceptance of autonomous practice. Autonomous practice is one place physical therapy falls short in the definition of a profession. Although many states allow direct access to physical therapy care, some insurance payers do not routinely reimburse for physical therapy care without a physician referral. Some even suggest the DPT is a mechanism to buy the respect of the public, insurance payers and health care colleagues. The profession of physical therapy continues to develop and expand breadth of knowledge, irrespective of critics. The emphasis on DPT education is to improve critical thinking skills, as well as conceptual, integrative competence. The problem lies in the fact that critical thinking skills are a higher order learning process. Do we expect an entry-level professional to employ higher order thinking skills? I think the answer is no; after all, it is an entry-level degree that gives a good foundation for professional career development. The DPT with its frequent employment of the term ‘doctor’ has led to confusion of the public. As stated in the above commentary, it would be advantageous for us to present ourselves clearly by our professional distinction rather than our academic degree. We are all physical therapists whether we hold a PT BA, PT BS, MPT, MSPT, DPT, PT ScD, or PT PhD. There should be no confusion among the public we serve or the team of professional colleagues with which we coordinate the care of our clients. All colleagues with doctoral degrees have the distinction and right to be called “doctor” but who does this serve?
The Latin term for doctor literally means teacher, Doeco translates to “I teach”. The doctorate appeared first in medieval Europe as a license to teach. The history of the terminal academic degree is mastery of subject in order to teach. Whereas the professional/entry-level doctorate was developed to improve the training of professionals by raising the requirements for entry and completion of the degree in order to enter the profession, the trend of professional doctorates is driven by professional associations and leads to criticisms that the programs lack rigor in the new doctoral programs.
The impetus to write about this topic came after a colleague in orthopedic surgical medicine voiced his concerns to me following multiple incidents with DPT’s contradicting post-surgical advice that was given by the surgeon. The therapists in question commonly referred to themselves as doctor in the clinical setting, which potentially led to confusion for the patients. The patients stated to the surgeon, “I do not know which doctor to listen to”. Subsequently, this surgeon stopped referring to those physical therapists.
It is the humble opinion of this author that such events do harm to the profession of physical therapy and although this instance may be an isolated incident, I am aware of similar circumstances in multiple practices across the country. I think it is time that the physical therapy professional programs educate students about the history, evolution and diversity of doctoral education and most importantly include lessons in humility.
- Plack M. The Evolution of the Doctorate of Physical Therapy: Moving beyond the controversy. J Phys Ther.
- Rothstein JM. Education at the crossroads: Which paths for the DPT? (editorial). Phys Ther. 1998; 78:454-457.