"Degree Creep" and the Cost of Health Care Education

For two years, I've interviewed health care professionals about their careers for Q&A feature stories. The questions range from why they chose their career to what their biggest concerns are for the profession. Increasingly, more workers in allied health have expressed their worries about higher ed.

"Does everyone in healthcare need a doctorate?" asked Susan, a physician assistant and PA educator in Pennsylvania. She recently posed this question to the medical trade journal I work for in a questionnaire submitted to our website. When asked for her thoughts on the greatest concern to the PA profession today, Susan responded, "Degree creep."

The term refers to requiring higher degrees than are needed to perform a job. PharmD and DPT credentials are the new norms for practicing pharmacists and physical therapists, and speech-language pathologists, audiologists and occupational therapists are a sampling of other health fields that require schooling beyond the baccalaureate level. Beginning in 2015, a traditional physical therapy student, for instance, will be in school a total of six or seven years before being eligible to practice.

So, does everyone in health care need some form of advanced education? The knee-jerk response might be, yes; of course we want our health care professionals educated to the highest degree possible! But education for many professions extends beyond the classroom to real-life on-the-job training. More class time also means more college costs and the real possibility of a large, six-figure debt load, all before starting out professionally.

Community colleges are feeling squeezed, too, as national dialogue turns to upgrading professional requirements. Often thought of as an accessible and affordable means to enter associate degree-level health care careers, some educators worry the degree creep trend does more harm than good.

In an article in Community College Times last August, Barbara Jones, president of South Arkansas Community College, worried about requiring respiratory therapists to have a bachelor's degree. "Additional education is good, but should not be required to enter the field," she said.

Similar pushes for the BSN to become the entryway to nursing could discourage prospective RNs, as well. Carolyn O'Daniel, dean of allied health and nursing at Jefferson Community and Technical College in Kentucky, stated, "For some students, the only way to get into a health career is to take it a chunk at a time. Requiring a bachelor's degree would make health careers inaccessible to many people."

With the shaky economy, degree creep can also emerge as a scare tactic. Last October I traveled to Minneapolis on business and came across Occupy Minnesota in its second week. I stopped by the first aid station and spoke with a young nurse who almost lost her job at a community hospital the year before. She described how she and other less tenured nurses basically begged to keep their positions. As a result, she was working reduced hours and back in school on her own dime to become a nurse practitioner in the hopes of remaining marketable.

The high cost/slow yield for some health care educations might also make great, would-be practitioners reconsider entering certain fields altogether. Take for instance salaries of $66,660 (median pay per year) for audiologists at the doctoral level versus $86,410 (median pay per year) for physician assistants at the master's degree level. As my editor mentioned, salaries often rise along with tuition rates, but contribute to overall increasing healthcare costs.

Tuition is expensive for students across the board; however, there is a specific challenge for careers, such as some in health care, which require higher learning just to begin practicing in the field. I'm interested to know: Are you a new professional in a career that requires advanced education? Has it paid off professionally and financially?