According to the American Physical Therapy Association's vision for the profession, by 2020, physical therapy will be provided by PTs who are doctors of physical therapy.

And while few dispute the rationale for awarding the DPT-the considerable breadth and depth in educational preparation not easily acquired within the time constraints of the typical MPT program, and the realization of the profession's goals in the coming decades, including direct access, "physician status" for reimbursement purposes, and clinical competence consistent with the preferred outcomes of evidence-based practice-the educational costs of attaining the degree can be prohibitive.

Many existing professional (entry-level) master's of physical therapy programs already meet the requirements for the clinical doctorate, which means the graduate of an MPT program is denied the degree most appropriate to the program of study.

However, the DPT program is longer than the typical MPT program and therefore is more costly to the student. Physical therapists often begin their careers with significant levels of student loan debt.

Yet in the end, if students can work out the financial issues, the DPT degree will ultimately be beneficial for both physical therapists and their patients, said Mark R. Guthrie, PhD, PT, associate professor and head of the Division of Physical Therapy at the University of Washington in Seattle.

"Whether it's good or not, I don't know, it just is that a doctorate of any kind seems to get people's attention and most of the time it's in a positive way. And, again, I don't know if that's good or bad. It just is. It's an interesting phenomenon," he said. "The other issue is, sort of philosophically and in practice, it is proving to be a good thing for physical therapy and it's my impression that our students even have higher expectations of themselves and of us when they come into the program. I believe that graduating with the DPT somehow seems to instill a higher expectation in people as well."

Tuition and Program Expenses

As an example of program costs, at the University of Washington, tuition for DPT students during the academic year 2007 to 2008 is set at $3,672 for residents and $7,200 per quarter for non-residents (and can be expected to increase 7 to 8 percent per year), according to the university's Website, (depts.washington.edu/rehab/pt/dpt_finance.html). For 11 consecutive quarters over 33 months, that's a total of about $44,000 for a Washington resident.

Textbooks run approximately $2,000 total, and there is a one-time mandatory immunization/insurance charge of $275. Off-campus housing typically runs $700 a month for a one-bedroom apartment; $600 a month will provide food and entertainment; the $45-plus per quarter student U-Pass may cover all local transportation needs.

Students who are assigned to out-of-town clinical internships should be prepared to meet additional travel and housing expenses, which run about $3,000.

"At our school, you're required to do one of your internships in a rural setting, somewhere outside of metropolitan Puget Sound," Dr. Guthrie said.

Plus, there's the time commitment.

"At a minimum you're doing four years of college and then the typical DPT program is three years, some more, some slightly less," Dr. Guthrie said. "And so by the time you finish with college you've been going to college for a minimum of seven years, and it's usually more than that because it takes people longer to get prerequisites and other things."

Granted, the University of Washington is located in a metropolitan area with a higher cost of living and is only one example of the many programs accredited by the Commission on Accreditation for Physical Therapy Education.

At the University of Michigan-Flint, the physical therapy curriculum encompasses 117 credit hours, 30 weeks of clinical education and occurs over a three-year span. Education is provided in a cohort fashion with classes starting in the fall of each year.

Many local internships are available, but they may be at a distance, said program director Donna Fry, PhD.

"We allow students to ask for a specific internship so they have housing in a certain area," she said. "They may be able to go to that area for their internship. There is a selection process where they get to put in their choices in order to help reduce costs."

Outside employment during an internship is generally not possible, though the majority of students do work outside during the classroom or didactic portion of the curriculum, Dr. Fry said. "Studying for physical therapy requires a significant amount of time," she said.

"When students study full-time, they cannot work full-time. They can barely work part-time. Most of our students who return are working for 10 hours a week or something like that. Most of the funding for the program has to come from other sources."

A majority of students at the University of Michigan-Flint completed their bachelor's degree and went directly into the doctoral program, Dr. Fry said. Many choose to live at home to help defray costs.

"They may have lived away from home for their undergraduate degree and moved back home to live with their parents just to save on living costs while they go to school," she said. "The parents and family help in different ways and sometimes it's not directly with money, but just being able to live at home. It really helps to have another source of support."

Financial Aid and Scholarships

In February, the U.S. House of Representatives approved legislation that makes physical therapists who choose to work with children, adolescents or veterans eligible to apply for student loan forgiveness.

The amendment to the College Opportunity and Affordability Act of 2007 authorizes the U.S. Secretary of Education to forgive a portion of qualifying student loan debt to PTs practicing in areas of national need.

"According to the American Hospital Association, physical therapists represent the occupation for which the greatest percentage of vacancies exists in our hospitals across our nation, at 11.4 percent," said Rep. Joe Sestak, D-PA, who sponsored the legislation. "This is at a time when the demand for physical therapists' employment is projected to grow 27 percent within eight years, even as 58 percent of our hospitals were reporting in 2006 that therapist recruitment is more difficult than the year before."

The amendment authorizes the education secretary to forgive up to $2,000 in Federal Family Education Loan and William D. Ford Direct Loan debt per year of full-time employment in an area of national need, with a maximum of $10,000 over five years of service. Members of the House and Senate will meet in conference to finalize the legislation.

Doctoral scholarships also are available, like the six awarded recently by the Foundation for Physical Therapy Board of Trustees in 2007. The $5,000 Florence P. Kendall Doctoral Scholarships are awarded to outstanding physical therapists embarking upon their first year of graduate studies toward a doctorate degree, and are funded by the Henry O. and Florence P. Kendall Endowment Fund.

Salaries and Employability

When it comes to the workplace and employability, the DPT degree comes with no guarantees. In the current health care environment, and depending on the employer, the DPT graduate will not necessarily be favored over the MPT or BSPT graduate, according to APTA. Since licensure to practice does not distinguish among degrees, the BSPT, MPT and DPT are all permissible.

Just as the transition to postbaccalaureate professional education gave rise to the unfounded fear that a practitioner with a professional master's degree would be paid more than one with a baccalaureate degree, there are no data to support a correlation between the DPT and higher levels of compensation.

Although there may be instances where a DPT graduate is paid more than a BSPT or MPT graduate, data collected in the future may or may not demonstrate such a correlation. No one can predict what will happen when the majority of practitioners possess the DPT, Dr. Guthrie said. "Everybody who graduates is going to have a DPT so it won't be like there's any difference," he said. "Right now, there are people practicing physical therapy who graduated from programs years ago with bachelor's degrees in physical therapy and many people practicing with master's degrees and now most of the people graduating have the DPT. And so do those people have an advantage? The answer officially from most employers is no, it shouldn't and doesn't make any difference. We pay people at entry level, for example, what we pay them.

"But we've actually heard anecdotally that sometimes people with DPTs do get bumped up a little bit," he continued. "I suspect before too long when there are lots of DPTs around, that's not going to be the case. But right now, we have heard that sometimes people who have DPTs do get paid a little bit more."

In the end, however, people don't enter the physical therapy profession to become millionaires, Dr. Guthrie said.

"You make a pretty good salary and you're pretty comfortable and there are lots and lots of jobs, but people aren't doing physical therapy because they want to go out and get rich," he said. "It's a big sacrifice that people make, and the rewards aren't necessarily financial."

Sarah Long is a frequent contributor to ADVANCE.