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Colleges worry about ‘degree creep’ in health care


Students at Jefferson Community and Technical College (Kentucky) use an infant simulator as part of their training in respiratory care.
​If attempts to require nurses and respiratory therapists to have a bachelor’s degree succeed, community college leaders are concerned that “degree creep” will hit other areas in the health professions.
Similar discussions are under way for nuclear medicine technology professionals, radiographers, dental hygienists and dieticians. Degree creepmandating higher degrees than are needed to perform a jobis happening at the upper levels, too. In the past, physical therapists needed a bachelor’s degree to practice; today, they need a doctorate. 
A big concern
Barbara Jones, president of South Arkansas Community College (SouthArk), sees degree creep for respiratory therapists as a "real threat."
“Additional education is good, but should not be required to enter the field,” said Jones, who is the former president of  the National Network of Health Career Programs in Two-Year Colleges (NN2) and a former member of the American Association of Community Colleges (AACC) board of directors.
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Proponents of the baccalaureate for respiratory therapists argue higher degrees mean higher competency and better customer services. But state licensure exam results show respiratory care therapists with associate degrees have the same level of competence as those with bachelor’s degrees, Jones noted.
Degree creep has been an issue in nursing for years, but it gained momentum last fall when an Institute of Medicine (IOM) report called for 80 percent of the nation’s registered nurses to have bachelor's degrees by 2020.
Requiring a bachelor's degree would discourage many prospective nurses from entering the field, especially those who can’t afford a four-year degree, said NN2 President Carolyn O’Daniel.
“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,” said O'Daniel, who is dean of allied health and nursing at Jefferson Community and Technical College in Kentucky. 
A recent AACC policy brief reported that nurses with associate and bachelor's degrees had comparable levels of competency and pass rates on licensing exams. There also doesn’t seem to be major differences in pay between nurses with associate and bachelor degrees, O’Daniel noted.
Jones cited additional problems with degree creep in nursing: a lack of qualified faculty to teach baccalaureate programs, a decline in workforce diversity, deceased access to health care in rural areas, and a decline in job satisfaction and morale if health care workers feel their skills and knowledge are not fully used.
Reasons behind the push
The main push to require bachelor’s degrees for respiratory care therapists comes from the American Association for Respiratory Care (AARC). Similar to IOM, AARC hosted a series of conferences to determine the future education needs of respiratory therapists, and it is expected to recommend a bachelor’s degree as the entry point to the profession.
A white paper by an AARC steering committee argues that the job has become more complex, requiring more critical thinking, research and management skills. It also says the role of respiratory care professionals has expanded to include more areas, such as critical-care medicine, pulmonary rehabilitation, neonatology, sleep disorders and cardiovascular diagnostics.
O'Daniel believes AARC has other motives, including the need for health care facilities to get federal reimbursements under Medicare and “greater professional status and recognition” for respiratory care therapists.

NN2 opposes arbitrary degree creep as a barrier to student access and recruitment. According to O’Daniel, the AARC efforts “lacked transparency, a research base, validity, a lack of analysis of the impact on employers, or any evidence that a bachelor’s degree is needed.” 
Participants at a roundtable discussion on the issue at the NN2’s last annual meeting agreed to form a new organization, NN2RC, to support associate degree programs in respiratory care.
“It was clear that the existing professional organization [AARC] was not an advocate for associate degree education,” said O’Daniel.
NN2RC’s top priority is research to show respiratory therapists with associate degrees have comparable skills to those with bachelor’s degrees, said the group’s president, Tommy Rust, national director of the respiratory care program at Concorde Career College in Kansas.
According to Rust, there are 425 associate degree programs, 47 bachelor degree programs, and two master degree programs in respiratory care, and universities aren’t rushing to start new programs in this area.
“We believe degree creep is counterproductive to patient care,” Rust said. If all associate degree programs were done away with, he said, “there would be a profound shortage of respiratory therapists.”
Hospitals in the Dallas area “don’t see a need to require respiratory therapists to have a bachelor’s degree,” said Sondra Flemming, vice president for health/economic development at El Centro College (ECC).
ECC’s respiratory graduates have no trouble getting good jobs, Flemming said. Requiring them to earn a baccalaureate would be an extra hardship because there are no bachelor degree programs in that region, anyway.
The Commission on Accreditation for Respiratory Care (COARC) issued a statement in June acknowledging that "there are multiple access points into the respiratory care profession which include associate, baccalaureate, and master’s level programs.” But It also encourages respiratory therapists with associate degrees to continue their education.
COARC is the only accrediting body for respiratory therapists. If COARC stops accrediting associate degree programs, Rust said, NN2RC will try to become an accrediting organization for two-year programs.
Career pathways
“Many students come to us because they want to go work,” Jones said, noting that students can continue their nursing education, thanks to SouthArk’s articulation agreement with the University of Arkansas Medical School. “We all support lifelong learning and career paths,” she said.
In Texas, ECC has formed a close relationship with the University of Texas (UT) at Arlington to create dual admission and a seamless transition for nursing students. Starting this fall, students who complete their associate degree and pass their state boards can complete a bachelor’s degree online from UT within 13 months, Flemming said.
Two-year college advocates says such approaches offer students the most flexiblity to continue to learn. Community colleges should “create and strengthen partnerships aimed at building career pathways with multiple entry and exit points,” said NN2's O’Daniel.
These types of arrangements  would allow “students to enter and advance within the pathway as their circumstances permit,” according to an NN2 position paper. “At a time when meeting workforce needs is increasingly challenging, this type of flexibility enhances opportunities for recruitment and retention of diverse students to meet the healthcare needs of an aging population.”
“Not only can ‘degree creep’ unnecessarily raise the cost of education, making it less accessible or even inaccessible for some students, but it can also raise the already spiraling costs of health care,” the brief added.