NBCOT/AOTA/State Boards: Are We Getting Our Money's Worth?

OK, I think we have finally hit a good point to discuss: the 'value' of a two year degree in today's economy and the negative impact of minimum wage increases on salary structures.

Please don't interpret anything that I say as 'demeaning' about a two year degree.  I am writing from a perspective of fact only.

Minimum wage, which is (unfortunately, in my opinion) increasingly interpreted as a living wage, is episodically increased by mandate.  These increases place "pressure" on the wages of those workers who are above minimum wage but on the lower end of the salary scale.  Traditionally, this includes people who have technical positions, associate degrees, etc.

Collective bargaining units see increases in the minimum wage and lobby for wage increases for their workers.  This is why you see inflated labor costs for so-called low-skilled workers who are represented by unions (like the truck drivers or waste management workers that you referenced).  Labor costs also become inflated for government and civil-service positions because there is an easy way to fund these increases (just raise taxes).

In private non-union industry (like health care) the situation is different.  COTAs are not typically unionized, but the nurses or aides might be.  An aide's salary, which is mandated to increase via collective barganing, might start to approach the salary of COTAs (or lab workers, or phlebotomists, etc.).  The company then has "wage compression" where the lower skilled workers have mandated wages and benefits that begin to approach the skilled workers.  Since private industry can't just raise taxes to pay for these costs, budget cutting occurs elsewhere.  Insurance companies feel the same pressures as the health care facilities, so they aren't exactly eager to increase reimbursement rates.  In the end, you have wage compression and a dispirited professional workforce that sees so-called low-skilled labor with benefits and salaries that creep steadily toward the skilled labor costs.

To be sure, there is waste and untoward/undeserved management bonuses in the insurance industry and other forms of inefficiency - but that is not the only problem and it does not fix the underlying cause of the issue.

In order for COTAs to earn $35 per hour the reimbursement would need to be increased dramatically, or there would need to be some external way to fund salaries.  I expect that a government-run single payor source would begin to address this issue, but I personally believe that it will contribute to inflation in ways that we can not even imagine.  Please reference the part-time Head Start program of the 1950s and its original purpose with the behemoth that it is today if you believe that the government has the ability to run a cost-effective, streamlined, or efficient program.  (And this is not a Head Start slam - which I see as an important program - but rather an example of how our government doesn't know how to run things cheaply or to their original purpose).

I don't offer solutions here; rather I just present some issues that impact the salary problem.  Wage compression, minimum wage benefits, mandated increases from unionized labor, and inflation are all tough issues.  We can all think about this as we move forward into elections, I guess.

Christopher J. Alterio, Dr.OT, OTR

Christopher J. Alterio, Dr.OT, OTR-

Thanks again for your comments.

As far as the dollar amount spent by AOTA during this litigation, yes, I am speculating. However, two years of lawyers, court fees, time paid to representatives and staff HAS to add up to a hefty figure. And since AOTA instigated this, I assume that insurance did not cover any of the monies spent. Even if insurance did pay a portion, where did the monies come from to pay the premiums? Membership dues. As far as a reserve fund, where would that money come from? Again, membership dues. This is the only income AOTA has to my knowledge.

I do remember receiving a postcard from AOTA during this time requesting membership response regarding the continuation of the trial. However, AOTA never published the results.

As far as graduating with my "C", no, I actually did not receive it until I passed the boards, but again, in the past I could use it freely and without an additional fee. Today if I don't register with NBCOT, I can only be an OTA. So essentially I feel I earned my "C" by passing the boards, not by paying a fee.

As far as pay structure, I feel that many companies are currently underpaying COTA's. I note a demeaning tone from you regarding the fact that we only hold a two year degree. Regardless of the degree, what we are able to generate in revenue is the same as an OTR or even a Dr of OT. Medicare pays the same for a unit of ther ex no matter who actually performs the therapy. If you've had the opportunity to read some of my other posts here, you'll see that I've had managers (not even therapy degreed individuals) that were given a yearly bonus larger than my entire yearly salary. Where is this fair? I am also aware of the dollar amounts generated by a therapist. In these days when a car mechanic makes $30+ per hour, the UPS driver makes $28 per hour, and a waste management worker makes $25 per hour plus state benefits, I believe that paying a COTA $18 per hour is a crime. Along with the insecurity of jobs, no guarantee of working 40 hours per week, and productivity requirements, being a COTA today has to be for the love of the profession only. I am not trying to take any pot-shots at anyone here, but want to see fairness promoted throughout the profession, in salaries, in productivity, and respect. After all, we are all here for one reason, our patients.

Thanks for the discussion, Tim.

I do not know the dollar figure (in AOTA resources) that was spent on the litigation.  Perhaps that has been published; I just don't know.  I also don't know that it was a substantial percentage of everyone's dues.  These kinds of fees are often paid for by insurance policies and reserve funds.  If you are aware of actual dollar amounts spent I would be very interested in knowing what you know.  Otherwise, this just seems to be speculation.  I also have no knowledge that AOTA lobbying decreased because of the litigation.  How do you know this?

Also, AOTA is a membership organization and as such the membership has some responsibility for the conduct of the organization.  I don't recall hearing a large outcry from the membership about the resources spent on the litigation.  As the litigation did stretch over several years it is a fact that the membership had various ways to 'stop' the litigation if it was concensus opinion that the litigation was not worth the dollars spent.  To be sure, some spoke out about the costs - but the membership as a whole tacitly agreed to the litigation, evidenced by the fact that the litigation continued!

Any amount that was spent is unfortunate, but I hope we are in a better place and with stronger credentials as a result.  That is my hope, anyway.

To your second point, I don't believe that anyone 'graduates' with the title "COTA."  Rather, that designation is earned following successful performance on the NBCOT examination.  Again, if you graduated from some school that told you that you had license to use the title "COTA" on graduation I would be interested in knowing where you graduated.

Lastly, regarding pay structures, I do not know how much the executive director of AOTA makes - but I do know that there are "industry standards" for managers of large organizations.  I trust that the AOTA Board of Directors takes these standards into consideration when setting compensation packages for its staff.  If you are concerned about this, get involved in these organizations and find out!  

Also, I don't know if it is fair of you to attempt to characterize my personal situation as taking advantage of others.  You really have no basis in fact for making these kinds of statements and they don't promote professional dialogue.  

The issues of COTA compensation are complex and are highly related to external industry factors (such as the so-called 'Medicare boom' of the 1990s).  COTA compensation is also complexly related to the educational phenomenon of 'degree inflation' and the decreasing value of a two year college degree.  COTA compensation is also complexly related to federal and state increases in the minimum wage and the pressure that these increases have on people who have two year degrees.  Finally, COTA compensation is also complexly related to local market factors, including relative supply and demand of the local workforce.  

I understand how it is easy to take pot-shots at people who are making more money in the economy (whether it is your own supervisor or the Executive Director of AOTA or whoever) but you do a disservice by failing to look at the problem from a broader perspective.

There are some very real issues to discuss here; let's use the platform responsibly.

Professionally,

Christopher J. Alterio, Dr.OT, OTR

Dr Chris Alterio-

You can't deny that AOTA was using plenty of their resources (our dues money) to maintain a court battle for two years, and the fact that AOTA representation in Congress those two years was way less than in the past. I did not intone that the ONLY reason PPS came about was this court battle, but it sure factored in the outcome.

As far as earning my "C" in school, I graduated with the title COTA, but now I must pay a fee to NBCOT to use it? Yes, it does involve agreeing to abide by the rules and regulations, proving con't ed, etc., but I had to do that in the past too. The only thing that has changed is now it costs me to do it.

And you also can not deny that even though there are volunteers involved in state organizations, AOTA and NBCOT, that there are also plenty of paid staff in all of these organizations. I'm sure the president of AOTA makes $150K + per year. Many COTA's earn somewhere between $18-25 per hour today, which is still less than the pay rate back in 1997. As an owner of a therapy company, I'm sure you are one of the problems too. You probably make a hefty salary, and pay your staff the minimum you can get by with to increase your profits.

Is this fair? Not in my book.

I'm sorry, but this is my opinion. I do not believe that I misinformed anyone here. Since '97 I have seen my salary decrease, and at the same time all related fees, dues, con't ed costs, and regulations have increased.

Dear Tim,

Although I appreciate your intentions of generating discussion, it is important to get all of the facts correct.  Your summary of the history of the creation of AOTCB/NBCOT is imprecise.  Additionally, I don't agree with your assertion that the AOTA and NBCOT dispute was linked to the passage of the PPS legislation.  PPS had nothing to do with this internal OT dispute.  The fact that PPS impacted other health care professions should be proof enough of that.

It is also incorrect to believe that you 'earned' your certification credentials in school.  Certification is granted following completion of all the requirements, which includes your education, fieldwork experiences, agreement with the NBCOT Code of Conduct, and successful completion of the certification examination.

You also don't get certification renewal simply by paying a fee.  You have to agree to abide by the Code of Conduct, you have to answer questions about your professional conduct and background, and you have to complete professional development units.

AOTA is a membership organization.  NBCOT is a certification organization.  Their missions are completely different and they do not overlap in function or purpose.

To the degree that organizations need to be run in the most efficient manner possible, within the scope of achieving their stated missions - I completely agree.  You may be surprised to find that most State Regulatory Boards are "staffed" by OTs who volunteer their time.  As for NBCOT, there is a central office staff that handles the operations of the organization.  However, there is a very large cadre of volunteers who donate their efforts to the cause of certification and certification renewal.

Opinions are fine, Tim; misinformation is not.  Let's make sure that we publish information that educates people accurately and moves the discussion forward.

Professionally,

Christopher J. Alterio, Dr.OT, OTR

Thanks for your comment Sheila-

Kind of like taxes, always going up but nothing more is given for it. I still believe I "earned" my "C" by going to school, not by paying a fee.

Tim:  Good point! Thanks for your point of view.  I am glad that someone also notices.  I hated it when AOTA was chopped into 2 ways.  It really became a milking money way to get from all therapists.  We have to pay more just to retain our title.

Thanks.  I hope the AOTA/ NBCOT will hear our cries.

Sheila