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It’s an unavoidable question. Why is school so expensive?! It isn’t a question of if it should be or what education and academia ought to be — let’s just talk about what is.

Well, I’m not in the thick of academics. Therefore, it only made sense to get the thoughts of someone who is. To this, I had the pleasure of interviewing a developing DPT program’s chair and department director for their perspective on the functional economics behind higher education.

The following are summary points from an interview conducted at CSM 2018 with Dr. Stacie Fruth, Founding Chair at the Western Michigan University Doctor of Physical Therapy program.

Why Does Grad School Cost So Much?

A Thought Primer

First off, it’s important to express that “No one is targeting DPT or PTA students.” It’s not a financial game or some type of scam… this is all about the almighty “Credit Hour.” So, what’s a credit hour? The credit hour is the unit by which academic programs attribute the necessary hours a week for a course to be successfully ran — at least, that’s what I got out of it from a plebeian viewpoint.

A 3 credit hour course needs to have 3 hours of lecture a week. However, depending on the structure of the program and the institution’s policies, these hours may be more or less depending on many factors. One constant remains: At least for this chair I interviewed, their goal is to contain as many credit hours as possible for their DPT program — for many courses, 3 credit hours may actually be charged to students for tuition; HOWEVER, class may be meeting 9 hours a week. This saves student’s money, but is tremendously taxing on the faculty.

As communicated during this interview, CAPTE requires 90 credit hours in the form of “seat hours.” Classroom hours are different, of course. And, in this complex machinery that is formal academia, both the university and CAPTE have their own requirements… all of which can create a perfect storm making graduate level education more expensive than it has historically been.

Demands On Faculty

Now, before we get into how expensive everything is and the fact that is accepted by most… that education is indeed a business (as is healthcare). Again, we’re talking about what *is,* now what should be… … we need to first explore what is required and impressed upon the faculty — What can they control? What can they not?

Nearly all faculty members have pressures of grants and students… all the time. Beyond this, clinical education is determined by an internal university budgeting process. An increase in tuition dollars come from a pack of reasons. While educators desperately want to give 1 on 1 time, with even simple considerations such as retakes and remediations… “More. More! MORE!” is being demanded of everyone.

Just as no clinician wants more patients and more procedures, no educator truly wants more students.

In fact, the shear time required of faculty to do their jobs can be elusive to the unaware eye. Many see an educator’s life as a cushy gig — 9 to 12 hours of teaching a week? Piece of cake, right?! In reality, educators spend more like 70 hours a week to do their job in tasks that are virtually impossible to streamline. Their responsibilities may include:

  • Spending time with students
  • Grading entire class working of 50 students at a time
  • Online classroom management; setup and materials
  • Committee services
  • Pursuing the “Service. Scholarship. Teaching.” core responsibilities
  • Research projects; coordinating experiments and subjects
  • Writing and publishing; revisions

… Just to name a few. Naturally, none of the above can be predictably or systematically blocked out for efficiency of time. Educators want to press for affordability and relevant topics; however, regulations require divergent efforts.

People Want To Teach

Typically, after a career launch, everyone in clinical care looks to teaching with interest. However, there is way more involved than just showing up to speak in front of a classroom. Typically there is 15 hours of preparation time to 1 hour of delivered lecture time.

As someone who had a teaching residency and speaking frequently across the nation — I can very much attest to this.

Many faculty members have made a habit of making their work “look easy” only because of their own mastery to this craft. It can be promised that there is far more effort than is being shared. On top of this, tenure-ship and scholarship — all done in 6 years within a career pivot, which isn’t a long time, detracts from the teaching element of being an educator. There is also the task of writing scientifically versus writing for research versus writing for scholarship purposes.

Then, there’s this question of: CAN YOU TEACH?! Some of the best researchers are the worst teachers. There’s classroom management, student guidance, and understanding cohorts — identifying when they don’t get it, when they do, when to move on, when to motivate, when to give tough love… it’s a lot to juggle. And, there are institutional leanings that may sway for departmental makeups.

Of course, should anything go wrong, faculty members are put on a process improvement plan… perhaps for the smallest miss which wasn’t even under their control.

To Become An Educator

If you hear yourself thinking “I want to teach,” try out the environment. You can teach through media, through clinical instructorship, through continuing education — there are a lot of ways to be part of the next generation’s growth.

Most people who are educators and thrive in this environment have something in common: To be a part of it, they BELIEVE in it.

50% of people in education have a PhD, EdD, or an advanced doctorate like a PsyD. Some may have their DPT had be board certified. However, a clinical doctorate such as a DPT, OD, DDS… these do not qualify individuals for TEACHING. These qualify professionals to be TREATING. The skill set in managing courses, contributing to the university as a faculty members — all this requires validated “contemporary expertise.” Perhaps the quickest way to this in Physical Therapy is board certification.

“Academia is Fun!”

Thoughts & Takeaways

Have all the questions been answered? No.
Do we have more information from which we can glean potential solutions? Yes!

This CSM interview was quite enlightening. Having the fortune and privilege to have experienced a teaching residency as well as every major setting in healthcare, I hold a different perspective to the flow of economics — and, now, a better understanding with the financial model that is in institutional education.

Now, it was even mentioned in the Private Practice Section exclusive conference called Graham Sessions, that the student debt being accrued is unsustainable and “threatens the health of our profession.I’m inclined to agree.

So, what’s the solution? We are getting a better picture of even supplying grad school level education; but, what about the demand? How do we make this more affordable, or better yet, a better return on investment?

Here are some off the top thoughts:

  1. We need to make business management, legislative advocacy, public relations & marketing, as well as entrepreneurship — as both an interwoven theme and a forefront focus within our professional education, training, and cultural priority as a profession. After all, it is through these above that industries truly grow — providing a quality product is a mere entry level prerequisite; to go above, you must reach beyond what consumers expect.
  2. We need to leverage technology and content platforms to engage in learning experience that are more effective and congruent with the Millennial economy. Like it or not, here are two facts about our contemporary age: Technology tends to make things more affordable -and- This coming generation of learners are soon to become the next generation of colleagues — not to mention, healthcare providers. It would behoove EVERYONE to work in the channels that most meaningfully connects learners from entry-level to experts. In Other Words: We need more virtual classrooms, learning apps, new models of clinical education and instructorship; we need to re-think what is truly prerequisite upon entry level graduate programs — after all, on international playing fields, there are physicians trained at what is equivalent to undergraduate college prerequisite levels, providing truly skilled clinical care. Let us adopt what is effective, lean out what may be superfluous, and adapt to the coming demands of healthcare’s economic landscape.
  3. We, as a profession and an industry, need to STOP IT with the scarcity mindset. It’s so very quick and easy to turn on each other as competitors; we need to start seeing each other as collaborators. After all, we can only boast 7-9% of marketshare to the musculoskeletal market. EVEN THEN, this means the outpatient Physical Therapy setting is conservatively a $30 BILLION dollar industry — meaning our total value could actually be $300 BILLION if we chose to expand our reach past our current marketing, outreach, and legislative efforts… into the greater consumer populace. RIGHT NOW: If you’re practice primarily runs on word of mouth and medical office referrals… I’m CHALLENGING you to look beyond this singular lead source pool; where else can you find new patient discoveries? where else can you engage your immediate COMMUNITY? HINT: Social Media.

The best answers come from daring ideas. Let us dare to conversate and innovate!