University Senate Proposed: December 13, 2002
MINUTES OF NOVEMBER 22, 2002
President Lee Bollinger called the meeting to order shortly after 1:15 pm in the Davis Auditorium of the Schapiro Engineering building. Fifty-seven of 97 senators were present during the meeting.
Minutes and agenda: The agenda was adopted as proposed. The minutes of November 1, 2002 were adopted with a minor revision requested by Sen. Suzanne Bakken (Ten., Nursing).
President’s report: As he had at the previous meeting, the president spoke briefly about the budget. He said universities around the country are experiencing a different financial world from the one they knew in the last decade. They are suffering in various degrees from current conditions, and Columbia will not be exempt. But the picture is not bleak. The university will have to more efficient and hold down costs, focusing on its core activities and looking critically at experiments.
Late changes in committee assignments: The Senate approved a list of changes in assignments presented by Executive Committee chairman Paul Duby.
Executive Committee chairman’s report: Sen. Duby said the Executive Committee devoted most of its last meeting, on November 15, to discussion of the two clinical doctoral degrees that were now on the agenda. There were a number of unresolved questions, and a need to present more information to the full Senate, and to make sure there is enough time to discuss it. The committee was unanimous in deciding to forward the two resolutions to the Senate for discussion only, and to defer voting for one more meeting.
Sen. Duby reminded senators that reviewing academic programs and presenting them to the Trustees is an important Senate responsibility. Doctorates, the university’s highest degrees, are particularly important, he said.
Sen. Duby mentioned the Senate column in the University Record, as he had at the last two meetings. Last time he had attributed the cutting of two paragraphs from an account of the first meeting to “an unfortunate misunderstanding.” But the column about the November 1 meeting had also been cut. This was still unfortunate, he said, but perhaps less of a misunderstanding. The Executive Committee had discussed this matter at some length, without coming to a conclusion. Sen. Duby has asked two committee members, Sens. Sharyn O’Halloran (Ten., A&S/SS) and Roosevelt Montas (Stu., GSAS/Hum), to meet with Provost Jonathan Cole in search of a solution to be discussed at the next committee meeting on December 9. Sen. Duby said he would then report again to the full Senate. He said he would prefer not to discuss this issue further now, in view of the importance of other agenda items.
—Resolution to Establish a Doctor of Nursing Practice Degree (Education, for discussion only): President Bollinger began the discussion by repeating Sen. Duby’s statement that decisions about degree programs are among the most important things faculty do. He called for a full, open, and fair discussion about the nursing proposal.
Sen. Letty Moss-Salentijn (Ten., SDOS), chair of the Education Committee, called attention to relevant documents that had been produced since the last Senate meeting, including a new synopsis of the DrNP prepared by Sen. Bakken of Nursing and a set of tables presenting the curricula of the medical and dental doctoral programs, alongside both proposed programs now before the Senate, the DrNP and the Doctor of Physical Therapy (DPT).
Sen. Moss-Salentijn reminded senators that the DrNP is an unprededented degree, and a number of nursing schools are watching Columbia closely. She said it is essential for Columbia to do this job right. She said the committee has chosen not to focus on important broader issues like the implications of advanced nursing practice for health care in the U.S.
To assess the DrNP, she said, the Education Committee has compared it with Columbia’s established clinical doctorates. The MD, first offered by King’s College in the late 1760s, was the first doctorate in the college and the first MD in this country. This program is still the gold standard for clinical doctorates, she said. Columbia’s dental doctorate (DDS), launched in 1960, was modeled on the MD, and remains closely aligned with it.
Noting that her committee had voted to forward the DrNP to the Senate, Sen. Moss-Salentijn repeated some remaining questions and doubts about the program:
—Does the program meet the requirements for a clinical doctorate? The DrNP is an add-on of two years to the existing two-year master’s program, not a comprehensive doctoral program starting from the bachelor’s degree.
—Of the two years added on, the second is a residency. In the medical and dental professions, by contrast, residencies come after the four years of clinical and academic training leading to the degree.
—Does the program content adequately prepare graduates for the role of providing primary medical care? Sen. Moss-Salentijn said a senior administrator in Health Sciences has described the DrNP as a second educational path to the practice of medicine. This raises the bar, she said; under these conditions, the content of the DrNP program should be more closely aligned to that of the MD.
Sen. Ralph Holloway (Ten., A&S/SS) recounted a recent 8-hour visit to a nearby emergency room, and wondered how a DrNP could have made this experience better. He said that, despite the Education Committee’s preference for setting aside broader health care issues, he remained troubled that the proposed degree would worsen an already critical shortage of Registered Nurses, who have bachelor’s training. Noting that Gerald Fischbach, Executive Vice President for the Health Sciences, had described the DrNP at the previous Senate meeting as an experiment worth trying, Sen. Holloway suggested the experiment of paying health care providers more.
Sen. Suzanne Bakken (Ten.., Nursing), who said proudly that she has been an RN for almost 28 years, stressed that the DrNP is not an attempt to solve a nursing problem, but a health care problem—the delivery and quality of primary care in this country. A number of prominent health care experts who have reviewed the DrNP have enthusiastically affirmed the need to train a new kind of primary care provider who is not a junior doctor. The DrNP is built on a nursing base, with a different perspective, but with added skills in diagnosis and management of medical problems.
Sen. Bakken asked senators to consider several key facts:
—The DrNp is conferred after four years of training beyond a B.S. in nursing, five years if the bachelor’s degree is not in nursing.
—The DrNP curriculum is based on 10 years of academic practice (involving 10,000 patients) that has been externally evaluated in a controlled study.
—An extensive external review of the DrNP has taken place, by experts inside and outside the nursing profession; a number of nursing schools are prepared to follow Columbia’s lead in establishing this program.
—Referring to the synopsis of the program that she had recently prepared, Sen. Bakken noted the total DrNP requirements for students who had completed the equivalent of a bachelor’s degree in nursing: 825 hours of didactic training, 135 hours of seminars, and 29 hours of clinical practice. Responding to Sen. Salentijn’s point that the DrNP residency takes place before the degree, not afterwards, Sen. Bakken said the DrNP’s innovative residency program offers opportunities for full-scope, cross-site training that nurses cannot get anywhere else. Responding to Sen. Holloway’s question about the role of advanced nurse practitioners in the emergency room, she said a DrNP, alerted about his trip to the ER, would have met Sen. Holloway there and managed the experience for him. A DrNP would also keep him better informed about his condition, and share the decision making with him.
Sen. Michael Shelanski (Ten., HS) noted an underlying concern in the discussion about degree inflation, observing that Columbia was also a pioneer in this trend: its 18th-century medical doctorate was not the first medical degree in this country; that was the University of Pennsylvania’s Bachelor of Medicine, a respected British degree still given today. A similar trend is apparent in other fields. In law, the Juris Doctor suddenly emerged and quickly spread.
Sen. Shelanski said the situation with nursing, an evolving field, was different. There is a shortage of RNs, and they are irreplaceable. The problem is that the field offers few upward career paths besides management, and it is difficult to keep the best nurses involved with patients, with greater responsibility and the education to go with it. The Nursing School’s advanced practice program has addressed this problem. Sen. Shelanski said a limited randomized study of primary care that he had co-directed seemed to disappoint the nursing faculty, who expected to learn that nurses performed better than primary care physicians. The results were about the same. The Presbyterian Hospital medical board, during his presidency, had extended admitting privileges to advanced practitioners on the nursing faculty. This experience has also been positive, he said; nurses have not overreached.
Sen. Shelanski concluded that the DrNP is an experiment worth doing. He said it would be a pity if the end result were an alternate track to a medical degree. There are already two tracks: the MD and the Doctor of Osteopathy, which lead to exactly the same license to practice medicine. He favored the provision in the proposal for a five-year review, to see if the needs will be met. His one reservation was that master’s-level nurses, already in demand for their skills, may not want two more costly years of DrNP training. Sen. Shelanski guessed that only the most devoted nurses would continue to the doctorate. Still, this is an opportunity to keep the best nurses from leaving for other fields.
Sen. Sangeeta Das (Stu., SEAS) objected to the idea of using the need to maintain the supply of RNs as a justification for denying nurses the chance to pursue their educational aspirations.
Sen. Raimondo Betti (Ten., SEAS) expressed concern about degree inflation. He acknowledged the need for more training for nurses, but didn’t see the need for a doctoral degree. In his field, he said, there are two almost indistinguishable doctoral degrees, the Doctor of Engineering Science and the Ph.D., which involve research. Another credential, the Professional Engineering Degree, is awarded to engineers who go beyond the master’s but not all the way to the doctorate. He suggested that a credential like this would help to address health care shortages, and might also be better suited to the proposed curriculum for nurses.
Sen. Eugene Galanter (Ten., A&S/NS) noted an underlying preoccupation among his colleagues about the use of the title doctor, which he considered, in principle, irrelevant.
Sen. Herbert Gans (Ten., A&S/SS) asked what a DrNP would actually do. Is this doctor a manager, an advanced practitioner, both?
Edwidge Thomas, a nonsenator and an assistant professor of clinical nursing, said the DrNP is a primary care provider, responsible for managing a patient’s health in different settings, including the office and the hospital. She said that a primary care provider of this kind, available to patients 24 hours a day 7 days a week, would have shortened the hospital experience Sen. Holloway had mentioned earlier.
Prof. Thomas said she has been an advanced practitioner for 10 years, and her master’s degree did not prepare her for the kinds of primary care she is now providing. She and her colleagues had to supplement her education as they could. The DrNP will provide nurses like herself with the cross-site training they need. It will also assure patients that advanced-practice nurses are up to the job.
President Bollinger requested and received unanimous consent for all members of the nursing faculty to speak, including Prof. Thomas.
Sen. Avery Katz (Ten., Law) distinguished two main questions that had driven the discussion so far:
—Should Columbia have such a degree at all? Derived from this are questions about whether Columbia University should be the first to offer it, and about its possible impact on health care.
—Does this particular proposal fulfill the requirements of such a degree program? Related questions concern the adequacy of the curriculum, the faculty teaching it, etc.
Sen. Katz said the discussion so far had focused on the former set of questions somewhat at the expense of the latter, perhaps partly because it is easier to speak to general policy issues. He asked senators to try to rectify this imbalance by concentrating in the discussion remaining on the latter set of issues.
Nursing School Dean Mary Mundinger said the intent of the DrNP proposal is not to initiate a new level of practice—that has already happened—but to standardize the education for the most advanced nurses. Right now their authority far exceeds their formal training.
Why a doctorate? Dean Mundinger said every kind of health professional at the highest level is called doctor; nursing is the only health discipline without a clinical doctorate. There are three million nurses in this country, and 100,000 advanced-practice nurses; no one has the title suited to the most advanced level of current nursing practice. The issue is quality, she said. Patients have the right to know which nurses have the training for the most advanced patient care, and the doctoral title tells them.
She said nursing has well-defined and accepted levels of practice training at the bachelor’s and master’s levels, which provide a benchmark for measuring the DrNP. The DrNP goes beyond the master’s, both in practice scope and in science.
Why Columbia? Dean Mundinger said Columbia is the gold standard in nursing as well as medicine, with the oldest advanced-practice master’s program in the country, started in 1965; the first advanced-practice program in primary care; the first randomized trials to measure nurses’ performance in primary care, in 1993; the first group faculty practice, which has now had 10 year of unblemished success; and the first group practice to receive individual reimbursement from Medicare. Why shouldn’t Columbia be the first to offer this doctoral practice degree? She said that, as she spoke, faculty from seven other schools were at the Nursing School working on a consensus document that they will use when they adopt a DrNP. These schools accept Columbia’s leadership, she said. She appealed for Senate support for the DrNP, which she said is based on science.
Sen. Noah Raizman (Stu., P&S) acknowledged a debt that he said all medical students owe to nurse practitioners, who he said are better practitioners of medicine in many ways than many doctors. He said it is an insult to the nursing profession that a DrNP doesn’t exist already.
Sen. Roosevelt Montas (Stu., GSAS/Hum) called attention to a distinction made in Executive Committee discussions between the question of support for establishing a degree of this kind and the question of support for this proposal to grant that degree. He said he had no reservations about the first question, but was uncomfortable about the second. As a student, he felt ill-equipped to judge the adequacy of the program, and to think about standards to apply to a practice doctorate, whether in nursing or physical therapy or another field.
Sen. Montas asked why the DrNP curriculum seemed to be completely separate from the medical school curriculum. He understood the differences in the philosophy of care of doctors and nurses, but said that if both groups are practicing primary care medicine, there should be significant overlap in the scientific basis of their training. Sen. Montas noted the analogy Vice President Fischbach had drawn at the last meeting to osteopathy, a discipline that gained legitimacy by adopting the same curriculum and standards as the MD, with the same licensing requirements. Sen. Montas suggested that a closer integration of the DrNP curriculum with that of the MD might be the solution.
Sen. Montas recalled Sen. Mullen’s point at the last meeting that there are no clear standards for practice degrees. He suggested that the next step should be to appoint a task force that would work for a month or two to set some standards, which could be used to judge the present proposal.
Sen. John Nicholson (Ten., HS) pursued the analogy with osteopathy. He praised the goal of the DrNP and said the philosophy of primary care underlying it is not that different from what is taught in medical school (though it may differ from the actual practice of primary care physicians). But to become a doctor, he said, a nurse should take the same exam Doctors of Osteopathy and MDs take. Now, in New York State, the DO gets the same license to practice medicine as the MD. He said he was sure many nurse practitioners, given four years of preparation, could pass the U.S. Medical Licensure Examination. He said the DrNP curriculum should be corrected to enable nurses to pass that exam. The Nursing School doesn’t have to copy the P&S program, he said, but a P&S student who doesn’t pass the exam doesn’t get the degree.
Sen. Mary Byrne (Nonten., Nursing), a pediatric nurse practitioner with a Ph.D. in nursing, noted that there are sometimes translation problems when people talk across disciplines. She stressed differences between nursing and other health disciplines: Nursing is an independent school, with knowledge developed partly as a separate science, based in health promotion and disease prevention as well as the disease management and treatment emphasized in medical school. The School has developed this body of knowledge sufficiently to deserve the doctorate for the highest level of nursing practice. Nurses are already practicing at this level, she said, but their training for it beyond the master’s has been mainly informal, and must now be formalized.
Sen. Byrne put the question, What should be the standards, across disciplines, for a doctoral degree? It should be of the highest quality, but how to determine that, if the disciplines speak somewhat different languages? Clearly it is neither the Ph.D nor the similar Doctor of Nursing Science, which Columbia has offered for several years. This is a professional doctorate, analogous not only to the MD.and the DDS, but also to the JD, the Pharm. D., and others. What is the highest level for nursing? Sen. Byrne said Sen. Bakken’s synopsis answers that question in detail, including the preparatory training at the bachelor’s and master’s levels, and the significant training beyond the master’s that must be the hallmark of any doctoral program.
Sen. Shelanski questioned the example of osteopathy as a model for nursing. Osteopathy arose on the American prairie in the second half of the 19th century, he said. During the 20th century osteopathic schools moved to a curriculum nearly identical to that of regular medical schools. Their graduates called themselves osteopathic physicians, with a different theory of disease, which they abandoned over time, though some of their therapies proved useful. There remained two separate licensing exams in many states only because the medical establishment, the allopathic physicians, blocked the access of osteopathic physicians to their exam. The AMA dealt osteopathic medicine a blow by claiming to recognize their degree, but not offering residencies to osteopathic physicians. In fact, osteopathic medicine has become indistinguishable from the rest of the medical profession.
Sen. Shelanski said the situation is different with nursing, which accepts the medical profession’s theory of disease, though perhaps not its philosophy of patient care. Sen. Shelanski said the nursing profession should have boards and licensing examinations, but to require the same ones used for physicians would be a mistake.
Sen. John Brust (Ten., HS), a neurologist at Harlem Hospital, said the term “residency” used to describe the last year of the DrNP curriculum seemed misleading. As he understood it, the term refers to resident physicians—he was one for five years—who spend the night in the hospital taking care of patients under close supervision at the start, then progressively more autonomously.
Sen. Brust said he is a specialist, but believes the most subtle and difficult work in medical practice is done by the doctor who sees the patient first, a doctor for whom he has the highest respect. Sen. Brust said he did not care that there is already a cadre of nurses providing primary care. He wanted to be convinced that people in primary care—whatever their title—have had as much training as someone who has completed a medical residency in that field.
Sen. Brust also agreed with Sen. Nicholson’s view about requirements for practicing medicine, saying that anyone who calls himself or herself a doctor should pass the same boards as Doctors of Osteopathy and Doctors of Medicine.
Dean Mundinger pointed out that the master’s-level nurses already have passed national boards certifying them as primary care providers in a site-specific practice. The two years of the DrNP curriculum include a very intense first year of didactic work in science and in practice. In the second, residency year, students take responsibility for a panel of patients, and follow them wherever they need care—into long-term care settings if they have chronic illnesses, or into the hospital if they have acute episodes. In addition, there are 10 credits of course work. So a nurse who completes the DrNP will have had a total of four years of training beyond the B.S in Nursing.
Sen. Brust said he didn’t hear anything in Dean Mundinger’s account resembling a residency as he had described it. He said the experiences she described sounded like a third-year clinical clerkship in medical school, or perhaps a fourth-year ambulatory care elective.
Dean Mundinger said the nursing residency is different because the student stays with one patient population the whole year, giving them care wherever they need it. She mentioned an editorial in the New York Times calling for a new kind of primary care that is the core of the experience the DrNP program would provide.
Sen. Brust suggested calling the second year of the DrNP program something other than a residency, or providing a real year of residency. He said he would like to know that any doctor he visits has done a residency to become competent to take care of him.
Dean Mundinger said DrNP graduates have taken on significant practice responsibilities, but they are different people, with a different training. They do have significant overlap in science courses, which they use to provide primary care of a quality indistinguishable from that of physicians. Instead of a distinct residency experience of the kind Sen. Brust described, similar experiences are spread across the entire span of a DrNP’s training, from the general bachelor’s education in nursing through the four graduate years, including the distinct residency experience of the final year.
Sen. Carol Lin (Nonten., A&S/NS) said that her tentative conclusion, after comparing the curricula for the practice doctorates presented in the set of tables distributed for the present meeting, is that the DrNP is one year shorter than the DDS and the MD.
Judith Honig, Associate Dean for Student Services at the Nursing School and a nonsenator, said that to complete the DrNP, a student must have completed a B.S. in Nursing, with a license as an RN, and then completed two years of master’s training, with certification by a national organization, and two more years of advanced training.
As for the final year of the DrNP program, Dean Honig said “residency” might be the wrong term. It was consistent with Nursing School usage for other experiences in the course of the training of an advanced-practice nurse. But before a larger audience this meaning may be unclear. She said the Nursing School would consider another terminology.
Dean Honig explained that the Nursing School does not have the luxury of having an institution that pays its students to learn, as the medical school has with Presbyterian medical center. As a result, Nursing makes its own arrangements for clinical experiences for its students at every level. These efforts have been supported by nursing colleagues who feel a professional obligation to help the next group of nurse practitioners, and by physician colleagues as well. The school’s residencies are built upon the clinical experiences it has always offered—a clinical preceptor who agrees to mentor a student one on one, along with a faculty member behind the scenes who coordinates the clinical placements for seven students, and brings them back to the school once a week for clinical seminars, to review their clinical decisions. This is the basis of the residency in the final year of the DrNP.
Sen. Eugene Litwak (Ten., A&S/SS) said there is no question that nurses are providing much the same kind of primary care as physicians. But do they get equivalent training? The answer seems to depend on how you keep score, he said. After the bachelor’s degree, the training for the nursing doctorate seems to be one year short of the MD and the DDS. The undergraduate training for the B.S. in Nursing might make up some of that deficit; on the other hand, physicians usually have extensive pre-med undergraduate training, which restores the deficit.
But if master’s-level nurse practitioners are providing primary care as effectively as physicians, Sen. Litwak said, the implication might be that requirements for the MD should be reduced. The other possible implication is that nurses should have equivalent training to doctors if they are going to provide the same kind of care.
Sen. Litwak found it astonishing to hear nurses say they are providing a kind of primary care that doctors have abandoned, with almost no protest from the medical school. If this is true, the key question may not be the training, but how it is implemented. He called this situation a sad commentary on the level of primary care that physicians are now providing. But he said it still does not justify the level of training provided by the DrNP.
Sen. Litwak concluded that the real issue with the DrNP is whether its four years of graduate training including a residency is equivalent to the medical degree, with four years of training plus a residency.
Sen. Marni Hall (Stu., GSAS/NS) asked how the patient portfolio in the final year of the DrNP is defined and developed. Dean Honig said the portfolio is a record of all of the student’s significant encounters with patients, with minimum requirements for the kinds of care that must be included, with a number of case studies.
Paul Thompson, a nonsenator, alumni member of the Education Committee, and member of the subcommittee that reviewed the proposal, said he started out dead set against the DrNP program, but changed his mind only after studying it at length. Despite a Ph.D. in health economics and many years of experience in health services, he said he found it difficult to grasp the complex issues involved.
Mr. Thompson repeated a point he had made at the last Senate meeting: on the question of whether to go into primary care, young physicians have voted with their feet. Over the last 30 years the number of doctors opting for a family practice of for the general subspecialty of internal medicine falls far short of what’s needed for primary care. Medical school faculty also generally encourage their better students to become specialists like themselves, and generally discourage them from going into primary care. Medical schools seem to be teaching much more than what is needed to practice primary care medicine. Under these conditions, Mr. Thompson said, an expansion of the well-established track of nurse practitioners seems like a natural solution.
Sen. Edward Mullen (Ten., SW), another member of the subcommittee that reviewed the DrNP proposal, said he was convinced that nurses are entitled to a nursing doctorate, just as physicians and dentists are. The issue for him is the quality and integrity of the proposed program. At the Columbia Nursing School, there are some 13 different specializations in nursing practice in the existing master’s program. What’s being proposed is an add-on to the master’s program of one year of academic work and one year of residency. Would it have been better to propose an integrated doctoral program of three or four years that would begin with the first year of graduate school? Sen. Mullen noted that this possibility is mentioned on the Nursing School web site.
Gerald Fischbach, Executive Vice President for Health Sciences, praised the Senate for an extraordinary debate and the Education Committee for its work. On the question of the standing of primary care in medical schools, Dr. Fischbach noted that two years ago the College of Physicians and Surgeons could not be accredited without a minimum of 15 percent of the class going into primary care; today less than 5 percent go into primary care. And the primary care these physicians practice is different from the kind under discussion at the present meeting. He said he didn’t believe there is a different nursing science, but nurses have a different approach to primary care. He said there seemed to be agreement on the need for a new degree program. He urged people to vote their own conscience, and said he had no recommendation either way on whether this program fits the bill. But he said that question should be the focus of the debate.
President Bollinger concluded the discussion with a final question: What are the basic criteria for awarding doctoral degrees at Columbia? He outlined three possible answers suggested by the discussion so far: each field is discrete, and has the right to set its own standards, provided that its programs are rigorous (though that’s a general criterion); a few fields can serve as models for similar fields; or, there is an underlying set of criteria that Columbia insists upon for all doctoral degrees. The president said the decision on the proposed program depends on the answer to this question, which will also come up if the proposal is forwarded to the Trustees.
The president suggested that the Executive Committee would need to take up the DrNP proposal again at its next meeting, taking into account the present discussion, and decide whether to bring it back for more discussion or for a vote.
Sen. Duby agreed. He suggested that it might make sense for the Education Committee to do some more work, in the light of the present discussion, and offer a new statement.
—Resolution to Establish the Doctor of Physical Therapy Degree (DPT): Sen. Moss-Salentijn explained that Education had approved this proposal, which, like the DrNP, is a clinical doctorate. But she highlighted some significant differences:
—This is not a new degree. It has been established in a number of states. The increase in recent years in the academic and professional content of the educational programs for physical therapists has led to a decision by the national accrediting group to replace the master’s degree with a doctorate as an entry-level degree. In a few years, the master’s degree will disappear.
—The physical therapy faculty has rethought its program from the ground up, with significant increases in scientific and professional course content. It is a three-year program, but the number of hours compares favorably with other clinical doctorates at Health Sciences.
—There is some urgency in getting this program adopted by next year, because the applicant pool for the Columbia physical therapy program will otherwise dry up.
Sen. Holloway asked if graduates of the DPT proposed program would be prepared to take state board exams. He also asked how many hours of instruction in total would be required of degree candidates.
Risa Granick, director of the program in physical therapy, said physical therapists have to pass a state exam to be licensed to practice.
As for the academic content, Dr. Granick said the DPT program would run 84 weeks and 8 semesters, including two in the summer. The curriculum is 3500 hours. Some 410 hours are devoted to basic science courses; 1,098 hours to clinical sciences; 236 hours to critical exploration, or preparation for a capstone project; 90 hours to coursework outside the professional discipline, on management issues; 100 hours of electives in advanced courses; and 1,566 hours for three full-time educational clinical experiences, in which students must meet the clinical standards of the American Physical Therapy Association.
Sen. Betti asked the question he had asked about the DrNP: Why is a doctoral degree needed for the most advanced physical therapy students? Would a lesser credential beyond the master’s be acceptable?
Dr. Granick said the decision to adopt the DPT was made not by the Columbia faculty but by the Commission on Accreditation in Physical Therapy Education. She offered some background on the profession. During World War I, an 18-week certificate program was adopted, a crash course to get physical therapists to the battlefield quickly. After the war, there was a greater need for physical therapists and a desire for legitimacy, so the certificate was expanded to a four-year bachelor’s degree. As the practice evolved, the degree was upgraded to a master’s and now, with the recent institution of autonomous practice for advanced physical therapists in 35 states, to a clinical doctorate. The number of hours in the doctoral program is comparable to that for the Doctor of Optometry, the DDS, or the Pharm. D.
Sen. Richard Bulliet noted that the Columbia program had significantly upgraded its requirements in developing a doctoral degree, but he expressed some unease about Columbia doctoral programs being approved outside Columbia. He wondered if some other schools might rename the master’s program a doctoral program. Will there be a standard amount of upgrading or is Columbia just better than other schools?
Dr. Granick said Columbia is better, and there will be some variations in standards within the accrediting guidelines. Today there are 58 accredited DPT programs across the country, averaging 1948 total contact hours; the curriculum of the most ambitious of these requires 2880 hours. Columbia’s program will require 3500 hours. The average number of academic weeks in DPT programs is 81.3, with 96 the highest number; Columbia comes in at 84 weeks. The number of clinical weeks in DPT programs ranges from 24 to 53, and averages 36.75. Columbia will offer 38. Columbia will be at the high end of the DPT standards.
Sen. Bulliet wondered if a rigorous Columbia doctoral program, given the unevenness of the standards nationwide, might further depress enrollments.
Dr. Granick said Columbia graduates have a good reputation in the clinical community. This has helped Columbia attract the best and the brightest nationwide over the years. But now students are drawn away from schools that offer only the master’s. If Columbia does not move to the DPT, its graduates may also suffer in a marketplace where employers want to hire only people with doctorates.
There being no further discussion, the president adjourned the meeting at around 3:15 pm.
Tom Mathewson, Senate staff