In this issue of the Journal of Physical Therapy Education, Gresham, Thompson, Luedtke-Hoffman, and Tietze further explore institutional and program factors that contribute to success as measured by graduation rates and National Physical Therapy Examination (NPTE) pass rates. As indicated in their wellwritten article, those outcome metrics are well-established and important measures of success to academic institutions as well as to the physical therapy profession. The authors are to be commended for embarking on an analysis that included 96% of all accredited physical therapist assistant (PTA) programs.
The authors investigate and address timely and important topics related to physical therapy educational settings. The work contributes 2 additional and unexplored factors for consideration in predictive models of success: the impact of a for-profit institutional status and of productivity measures on program outcomes. As noted by the authors, college enrollment at private for-profit institutions has grown considerably, as has the number of PTA programs within these proprietary institutions. Enrolled students in for-profit institutions are less likely to graduate, more likely to to compile greater student loan debt, and typically receive a lower quality of education than their counterparts at public institutions or nonprofit private institutions.1 It is important to determine whether those adverse outcomes also apply to PTA programs located within proprietary institutions. Additionally, as the cost of higher education continues to escalate in all institutional settings, it is important to understand whether the input of resources justify the output in terms of graduation and entry into practice as a licensed PTA.
The Annual Accreditation Report
The data collected for purposes of the Annual Accreditation Report (AAR)2 is comprehensive and includes a broad range of information for all accredited physical therapy programs in the United States. The purpose of the AAR, however, is to provide the Commission on Accreditation in Physical Therapy Education (CAPTE) with information related to the ongoing compliance of programs with established standards. Therefore, if is often difficult to extrapolate the data for other purposes, including research. The lack of reliability and validity of data collected for purposes of the AAR, as pointed out by the authors, negatively impacts our capacity to draw meaningful conclusions based on the analyses. This limitation was identified by the authors and is experienced by all, including myself, who seek to answer questions related to program quality based on the available data set.
Given the deidentified data provided for analyses, the authors were unable to confirm and perhaps correct some of the values provided for several of the factors considered. Further examination of the numeric ranges of the reported study variables leads to several questions related to the reliability of the values provided. For example, the lower range of weeks for complete program length is reported to be just 26 weeks. It is difficult, if not impossible, to see how the competencies related to preparing the PTA for entry-level practice could be covered in 6 months. Additionally, it is likely that value is either erroneously entered or represents the culmination of other education and experiences prior to formal PTA program entry, but not accounted for in the total weeks. Erroneous or incomplete information may have a significant negative impact on the results of any analyses.
The available data in the AAR also presents difficulties in operationalizing appropriate indicators for inclusion in predictor models. The impact of clinical education on outcomes is an excellent example of this difficulty. The authors chose percent of full-time clinical education as a factor to be considered. Although its positive association with graduation was reported, the theoretical rationale for this indicator is not entirely clear. Are part-time clinical hours perceived less important to program outcomes? And, as total weeks of the program varies, 2 programs with an equal number of weeks of full-time clinical internship but a different week total of complete program length would be assigned different values in the model. The rationale for the different values is not elucidated. This does not represent a critique but rather an indication of how much work we still need to do to understand what type of data we need to collect to make decisions about quality.
A key finding of the authors was the negative association between programs located in for-profit institutions and pass rates on the NPTE. This is an important finding given the ongoing trends nationwide as well as in the profession. Some evidence has noted that enrollment trends in for-profit institutions had been declining but subsequently stabilized and is now likely increasing at a rate faster than public institutions.3 Total enrollment in for-profit institutions remains strong, although not uniformly across institutions. The authors identified the real trend in PTA program growth in the for-profit environment and noted that programs admitting multiple cohorts per year, an additional significant predictor of lower NPTE pass rates, were also more likely to be located in a for-profit institution.
The higher cost and adverse outcomes generally associated with for-profit institutions should be concerning for all stakeholder groups. Many proprietary institutions derive significant revenue from taxpayer-funded financial aid but graduate a lower percentage of their enrolled students.4,5 In addition, the cost of attendance is high when compared to public and other nonprofit options.4.5 However, if the authors’ finding related to lower NPTE pass rates for programs located in proprietary institutions is to be useful in informing CAPTE, faculty, and prospective students, more work will need to be done to investigate the reasons for the lower scores. CAPTE makes determinations of quality based on program compliance with established standards.6 Further exploration is necessary to determine if programs located in for-profit institutions routinely fail to meet or minimally meet those standards.
Proprietary schools frequently enroll disadvantaged students who do not gain entry into public schools given the economic challenges and decreased state and local support currently experienced by public higher education.7,8 Data exists that support the notion that for-profit institutions recruit and admit underqualified students.5,7,8 It may be relatively straightforward to determine whether the same holds true for PTA programs located in for-profit institutions. Does the profit motive negatively impact the quality of the teaching and learning environment? The findings of the authors did not substantiate a decrease in revenue spent per student in the proprietary schools. However, the authors also indicated the finding was likely confounded by the number of new programs in this category and the subsequent increase in operational costs associated with the start up.
We have much to learn and will need to continue our efforts to determine what data could and should be collected to inform decisions related to best academic practices and program quality. Perhaps aggregate data provided by the AAR and subsequently published on CAPTE's website can be separated with an additional subcategory provided for data collected from programs located in proprietary institutions. Currently, the aggregate report describes AAR data for public and private institutions. Including for-profit institutions as a separate category probably requires the numbers to be sufficiently robust to be meaningful and to protect the identity of individual programs. However, observed trends may prompt focused follow-up research questions and investigations.
The authors are to be commended for the work they accomplished that will provide an impetus to future research questions and investigations. They asked important questions that require ongoing study so that all stakeholders are adequately informed about program quality as well as the value of the program that takes into account the cost and the potential outcomes of the education provided.
1. Department of the Treasury and the Department of Education. Economics of Higher Education.
3. National Student Clearinghouse. Postsecondary student enrollments continue decline. http://nscnews.org/postsecondarystudent-enrollments-continue-decline/
. Published December 11, 2014. Accessed July 15, 2015.
4. Cellini SR. Financial aid and for-profit colleges: does aid encourage entry? JPAM
5. Cellini SR. For-profit higher education: an assessment of costs and benefits. NTJ.
6. CAPTE Accreditation Handbook: Standards and Required Elements for Accreditation of Physical Therapist Assistant Education Programs. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTAStandardsEvidence.pdf
. Accessed July 24, 2015.
7. Cellini SR. Crowded colleges and college crowd-out: the impact of public subsidies on the two-year college market. AEJ: Economic Policy
8. Deming DJ, Goldin C, Katz LF. 2013. Forprofit colleges. The Future of Children.
2013; 23(1):137-163. http://scholar.harvard.edu/files/lkatz/files/foc_dgk_spring_2013.pdf
. Accessed Jun 14, 2015.