Impact of Student Debt on Decisions of Terminal Clinical Education Experiences in Physical Therapist Education

Purpose: Student debt is of growing concern in physical therapy and other health professions in the United States. This study explored the extent to which finances and other factors influenced student decision making when applying to and selecting terminal clinical education experiences. Methods: An online survey was developed and distributed to 250 recent graduates of a Doctor of Physical Therapy Program (2016-19). A logistic regression model was used to determine the relationship between respondents’ reported student debt and other factors when choosing a nontraditional model (the yearlong internship model (YLI)/residency model) or the traditional 4-month model. A 5-point Likert scale was used to rate the level of importance for each factor. Results: Seventy-six participants, across four cohorts completed the survey, representing a 30.4% response rate. The logistic regression model found that student debt did not significantly predict whether a student was likely to choose the nontraditional model over the traditional shorter terminal clinical experience; however, age and relationship status were found to be significant predictors of preference for length of experience. Based on aggregate mean data, the most important decision-making criterion in deciding the terminal clinical experience was patient population, followed by the culture of the clinic, then geographic location, and type of clinical setting. The criterion with the lowest aggregate mean was peer (within cohort) competition followed by student debt. A comparison of means found two decision-making criteria significantly reduced from the point of application to the commitment decision: saving money and interprofessional opportunities. Both decision-making criteria became less important for students when deciding on their terminal clinical experience as compared to when they were applying for the terminal clinical experience approximately 3 months earlier. Conclusions / Recommendations: Student debt was not an important factor in selecting the terminal clinical education experience and did not predict whether a student would apply to or select the YLI model rather than the shorter, traditional option. Instead, students considered multiple factors when selecting their terminal experience. Healthcare education programs may want to consider these factors in recruitment of clinical sites, student advising, and/or student placements related to the terminal clinical education experience.