The Debt Burden of Entry-Level Physical Therapists

Abstract

Background

The growing student debt of physical therapists entering the workforce, coupled with the growth in projected need, raises concerns about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden.

Objective

The purpose of this study was to identify the debt profile of entry-level physical therapists and explore relationships between student debt and clinical practice setting choices.

Methods

This study utilized a cross-sectional survey design to identify debt profiles and explore relationships between student debt and the clinical practice choices of entry-level physical therapists.

Results

The mean debt-to-income ratio based on the total reported educational debt was 197% (93%). The most frequently reported debt range for doctor of physical therapy (DPT) debt and total educational debt was $100,000 to $124,999. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision.

Limitations

This study is limited by its small sample size, originating from 1 state, and being taken by convenience from a special interest group. Data were collected via an anonymous survey, which increases the risk of selection bias. In addition, there are further personal, family, and institutional characteristics that were not collected in this study, which may influence the interaction between student debt and clinical practice choices.

Conclusion

The results of this study suggest that practice setting choice may be affected by physical therapist student debt, and student debt may be a barrier overall to practice and career choices in physical therapy.

Student Debt, Academic Physical Therapy, Health Care Education, Higher Education Finance

As the amount of student debt in America moves well beyond 1 trillion dollars and begins to surpass automobile, mortgage, and credit card debt, the concerns around the potential effects on society continue to grow.^1,2 Changes in policy at both the federal and state levels have shifted the growing cost of higher education to the student and their families.^2,3 In graduate and professional education, including physical therapist education, educational debt affects students from their undergraduate preparation through the completion of graduate or professional programs. Up to 40% of undergraduate students cite debt burden as a primary reason for not continuing on to doctoral or professional education.⁴ Additionally, the borrowing for students that do continue with graduate and professional education is at record levels and increasing rapidly.⁵

Physical Therapist Income and Debt

Physical therapists are identified nationally as a profession in high demand with growing workforce shortages.^6,7 Additionally, the job growth for physical therapists is projected as “much faster than average” by the Bureau of Labor Statistics.⁸ Despite the increased education, growing practice responsibilities, and high demand for physical therapists, recent graduates have seen steadily rising education costs with disproportionate changes in income once they enter the workforce.^9,10 The growing debt levels of physical therapists entering the workforce, coupled with the growth in projected need and potentially flat or declining compensation, raises concern about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden.

The average median income for a physical therapist in the United States is $86,850, with a range from $59,080 at the tenth percentile to $122,650 at the ninetieth percentile.⁸ The average, national median income for a physical therapist with a doctor of physical therapy (DPT) degree is $72,000, and the average for those physical therapists with a bachelor’s or master’s degree is $96,000 to $95,000, respectively.⁹ Physical therapists who are considered entry level (0–3 years of practice) with a DPT degree average $67,000 annually.⁹ Additionally, with the rise in total program costs from $25,642 for public institutions and $64,313 for private institutions in 2005 to $59,210 and $105,857 for public and private institutions respectively in 2017, even at the highest end of the salary spectrum the estimated debt-to-income ratios remain high and above the ratios expected for qualified home loans and other areas of qualification for credit.^10,11

Student Debt and Clinical Practice Choices

There are few studies with published data profiling the debt of physical therapists and how this debt may be affecting professional choices. More recent studies have used proxy measures but also note the limitation of data in physical therapy education to ask questions about student debt.^12,13 Although little is known in physical therapy about the amount and effect of student debt and complete institutional and workforce data are lacking, there are parallel discussions in medicine that inform the potential problems with the growing debt ranges for all health care professionals. The academic medical community has studied the potential effects of medical student debt and specialty choice for some time. In the early and mid-1990s, results were mixed and confounded by different training periods, changes in lending programs, and differences in the prediction models used across studies.¹⁴ Colquitt, Zeh, Killian, Cultice¹⁵; Rosenthal, Marquette, Diamond¹⁶; and Woodworth, Chang, and Helmer¹⁷ all found that medical professionals with larger student debt were less likely to choose primary care specialties or those specialties with longer training periods. During a similar time period, Kassebaum, Szenas, and Schuchert¹⁸ and Spar, Pryor, and Simon¹⁹ found no statistically significant differences between student debt and specialty choice. More recent analyses of debt-to-income ratios in medicine highlight a growing concern for the primary care specialties (internal medicine, pediatrics, and family practice).²⁰

Recent changes in health care have only heightened the concern of student debt and clinical practice choices in medicine. In the United States, only about 30% of physicians practice in primary care compared with 50% to 60% in other countries with similar economies.²¹ The passage of the Affordable Care Act and a growing focus on prevention has only increased the demand for primary care providers.²² At the same time this has happened, recent medical graduates are reporting a decrease in the choice to enter primary care secondary to their educational debt burden.^22,23 One response to this gap in patient access for primary care has been to expand the primary care team.²⁴ In physical therapy, efforts have begun to define the role of the physical therapist on the primary care team.^25,26 Unfortunately, as the physical therapy profession prepares to fill these gaps in care, it is beginning to consider similar problems with student debt and clinical practice choices.^13,27,28 In 2011, Thompson et al²⁷ analyzed debt ranges of physical therapist graduates and found that the debt amounts did impact job choices. Pabian et al¹³ found, in 2018, that entry-level DPT graduates had debt hardships similar to entry-level physicians entering general practice or internal medicine. These studies have been important in bringing these issues to light. However, these studies are either from a single institution or use estimates for the physical therapy profession due to lack of available data to answer these questions more directly or through broader sampling.

Lack of available data and trends in the cost of physical therapist education and the potential for these trends to begin to effect practice choices, as they have in other professions, highlight the growing need for research in this area.^10,20 Student debt has the potential to affect both the practitioner and the citizens they serve. Concerns of professional satisfaction, burnout, and increased ethical dilemmas may arise when practitioners are more motivated by financial means than by their desired practice setting.²⁹ Workforce needs may also be affected, as they have been in medicine, where select practice settings or regions of the country experience shortages in the necessary number of practitioners needed due to greater differences between debt and income.³⁰ The purpose of this study was to identify the debt profile, including the debt-to-income ratio, of entry-level physical therapists and explore the relationships between the student debt and the clinical practice setting choices of entry-level physical therapists across graduates from multiple institutions.

Methods

Study Design

The study was a cross-sectional survey of entry-level physical therapists practicing in Florida conducted in 2016.

Participants and Survey Instrument

The sample for this study was a convenience sample taken anonymously from the Florida Physical Therapy Association’s (FPTA) Early Professional Special Interest Group. This group consisted of entry-level professionals (0–5 years following graduation) licensed and practicing as physical therapists or physical therapist assistants in the state of Florida. These individuals were educated at various programs across the country before becoming licensed to practice in Florida. For the purposes of this study, physical therapist assistants were removed from the sample. The size of the group was approximately 350 physical therapist members at the time of data collection.³¹ Additional demographic data about this group were unknown at the time of data collection. The survey was developed using the Association of American Medical Colleges Graduate Questionnaire as a guide and is included as Supplementary Appendix (available at https://academic.oup.com/ptj). This survey by the Association of American Medical Colleges has been used in the literature to inform the student debt and clinical practice choice questions in medicine.²³ The survey in this study similarly covered questions related to educational and noneducational debt, clinical practice choices, as well as personal and institutional characteristics. Content validity was assessed using methods described by Johnson.³² Evidence of validity based on content was gathered using 2 rounds of feedback from doctoral students in education. Between the feedback sessions the questions were also piloted with 12 recent DPT graduates. This allowed for consideration of the degree to which the questions represented the domain of interest (physical therapist student debt) while also allowing for feedback on formatting, wording, and administration by the assessment of the responses from individuals studying educational research.

Data Collection and Analysis

Prior to any data collection, this study was approved by the University of South Florida’s Institutional Review Board. Data were then collected using a cross-sectional anonymous survey. There were no exclusion criteria applied among this sample because all of the information related to clinical practice choices and student debt were considered relevant for informing the topic at this stage of exploration. The survey was developed and disseminated electronically using Qualtrics (Provo, Utah, USA). To maintain the anonymity of the respondents, a representative from the FPTA sent the survey, and at no time did the investigators have access to the email accounts of the participants.

Data were then analyzed using the Statistical Analysis Software (SAS 9.4, Cary, NC, USA). Means, ranges, and percent differences were used to calculate the debt-to-income ratios and to inform the questions related to student debt and clinical practice choices. Median income ranges were calculated to allow for comparison with other published data. Pre-DPT educational debt, DPT educational debt, and non-educational debt (excluding home mortgages) were collected. Debt-to-income categories were calculated using total educational debt (pre-DPT plus DPT educational debt). The debt-to-income ratio was calculated using the median of a given total educational debt category as the numerator and the participant’s income as the denominator. The debt-to-income ratio mean was determined by using the average of the debt-to-income ratios across all participants.

When determining “agree” or “disagree” to questions relating student debt and clinical practice choices, answers were converted from Likert scores to “yes” and “no” answers. For these answers, 4 or 5 was coded as “yes” and answers of 3, 2, or 1 were coded as “no.” The rationale for the coding of the Likert scale in this study was based on the traditional Likert scale from 1 to 5 where 3 is undecided or unknown.³³ The 3 on the scale was always grouped with the choices of no effect on practice choices to allow for more conservative estimates. Similar methods have been used in the study of medical student debt.³⁴

Initially, 119 individuals accessed the survey for an initial response rate of 34%. Thirty-three participant records were invalidated for a final response rate of 25%. Records were invalidated if participants did not agree to consent or did not complete the survey by submitting it. Records were also eliminated if they were missing both the income and debt information requested. Missing data were low in frequency (<10%), and it was determined that imputation methods were not necessary or helpful in the analysis of the data for the research questions posed in this study.^35,36

Table 1

Demographic Characteristics of Participants

Characteristics	All Respondents(n = 86)    No. (%)
Age, y
18–24	6 (7)
25–34	63 (73)
35–44	13 (15)
45–54	4 (5)
Sex
Male	27 (31)
Female	59 (69)
Home state
Florida	47 (54)
Other	40 (46)
Undergraduate state
Florida	51 (59)
Other	35 (41)
Physical therapy school state
Florida	64 (74)
Other	23 (26)
Physical therapy school public/private
Public	49 (58)
Private, non-profit	17 (20)
Private, for-profit	19 (22)
Graduation year
2011	6 (7)
2012	12 (14)
2013	11 (13)
2014	16 (19)
2015	16 (19)
2016	25 (29)

Results

Debt Profile

The final sample consisted of 86 participants. Demographic characteristics are summarized in Table 1. Debt and income profiles by practice setting are summarized in Table 2. The sample included individuals from all major practice settings. The mean annual salary of the participants was $69,328 ($12,860) and the median annual salary was $67,900 ($12,000). Median annual salary by practice setting ranged from $55,000 in a school setting (may be 9- or 10-month salary) to $82,659 in the home health setting (Tab. 2). Four participants were enrolled in a residency program at the time of the study. The mean annual salary for participants enrolled in a residency program was $50,375. The mean debt-to-income ratio based on the total reported educational debt was 197% (93%) (Tab. 3). The most frequently reported debt range for DPT debt and total educational debt was $100,000 to $124,999. In addition, the majority of participants reported relatively small amounts of pre-DPT (75% reporting <$25,000) or non-educational (90% reporting <$25,000) debt, suggesting the majority of debt reported in this study is attributed to the participant’s physical therapy education costs. Finally, the average percent of monthly income dedicated to loan repayment was reported at 10% (19%) (Tab. 3). However, a number of responses were reported as 0%. Many participants reporting 0% stated that this was secondary to income-based repayment plans and loan repayment not yet starting. When the 0% responses were removed, the average percent of monthly income dedicated to student loan debt rose to 22% for those assumed to be in traditional repayment plans.

Table 2

Income and Practice Settings for Entry-level Physical Therapists^a

Setting	All Respondents    (n = 86) No. (%)	Yearly Income Mean (SD)	Yearly Income Median (IQR)	Debt-to-Income Ratio Mean (SD)
All settings		69,328 (12,860)	67,900 (12,000)	1.97 (0.93)
Academic institution   (post-secondary)	3 (3)	63,667 (21,221)	70,000 (20,500)	3.32 (0.74)
Acute care	16 (18)	69,432 (7982)	70,000 (11,000)	2.15 (0.94)
Home health	4 (5)	82,579 (22,399)	82,659 (30,762)	1.82 (0.62)
Hospital-based outpatient	14 (16)	64,691 (15,068)	64,200 (11,000)	2.10 (1.01)
In-patient rehabilitation	9 (10)	69,398 (14,958)	64,084 (10,000)	2.02 (0.99)
Pediatrics	7 (8)	59,729 (14,522)	60,100 (3500)	2.09 (0.62)
Private out-patient or   group practice	25 (29)	71,570 (8713)	69,000 (7000)	1.53 (0.49)
School systemb   (preschool/primary/  secondary)	1 (1)	55,000	55,000	4.55
Skilled nursing	5 (6)	78,208 (2493)	79,040 (2000)	1.74 (0.65)
Other primaryc	2 (2)	71,000 (5656)	71,000 (4000)	1.22 (0.28)

^aIQR = interquartile range.

^bMay be 9- or 10-month salary.

^cOther primary included 1 subject in a travel position and 1 subject in a non-academic research setting.

Practice Choices and Debt Burden

Responses to the factors influencing therapist’s practice setting choices are summarized in Table 4. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision. When the participants’ responses to the question of whether debt had affected their practice setting choice were compared by debt level, there was a noticeable trend of increasing debt and increasing percentages of debt effecting practice choice setting (Tab. 5).

Table 3

Debt to Income Ratio by Total Educational Debt Levels

Total Education Debt	All Respondents No. (%)	Debt-to-Income Ratio Ranges    No. (SD)
No debt	0
$1 to $24,999	1 (1)	0–0.36
$25,000 to $49,999	2 (2)	0.36–0.72
$50,000 to $74,999	9 (11)	0.72–1.08
$75,000 to $99,999	13 (15)	1.08–1.44
$100,000 to $124,999	21 (25)	1.44–1.80
$125,000 to $149,999	11 (13)	1.80–2.17
$150,000 to $174,999	7 (8)	2.17–2.53
$175,000 to $199,999	10 (12)	2.53–2.89
$200,000 to $300,000	10 (12)	2.89–4.33
Debt-to-income ratio mean		1.97a (0.93)
Debt-to-income, mo		0.10b (0.19)

^aThe mean debt-to-income ratio was determined by using the median of each reported total educational debt category.

^bThe debt-to-income percentage per month increases to 0.22 after removing income based plans or loans payments not yet starting.

Table 4

Student Debt and Practice Setting Choices

Variable	5-High	4	3	2	1-Low
Degree that debt prevents desired practice setting	11%	17%	22%	25%	24%
Factors affecting practice setting decision
Financial (eg, debt, salary, sign-on bonus)	29%	29%	29%	10%	3%
Setting (eg, types of patients)	51%	32%	15%	1%	1%
Education (eg, mentoring, continuing education, residency)	32%	26%	23%	11%	7%
Location (eg, geographic location)	22%	33%	24%	15%	6%
Degree that debt affected overall job choice	30%	27%	26%	7%	10%

Table 5

Participants Answering “Yes” or “No” to Practice Setting Choice by Debt Category

Total Education Debt	Debt Influenced Setting (n = 24)	Debt Did Not Influence Setting (n = 59)
No debt	0%	0%
$1 to $24,999	0%	2%
$25,000 to $49,999	0%	3%
$50,000 to $74,999	0%	15%
$75,000 to $99,999	8%	17%
$100,000 to $124,999	33%	22%
$125,000 to $149,999	17%	12%
$150,000 to $174,999	4%	10%
$175,000 to $199,999	25%	7%
$200,000 to $300,000	13%	12%

Discussion

This study is the first to our knowledge to present debt profiles of entry-level physical therapists beyond data from a single institution or proxy estimate. In addition, this study considers the possible effects of student debt on clinical practice choices in physical therapy. The data provide useful information to all stakeholders in academic physical therapy and the profession while informing the need for more robust data sets and additional research in this area.

Debt Profile of Entry-level Physical Therapists

This study consisted of entry-level physical therapists practicing in Florida. Entry-level was defined as 0 to 5 years in practice. The available, indirect comparisons for the demographic data collected in this study are based on 3 published reports in physical therapy: the Physical Therapist Centralized Application Service data report, the Physical Therapist Member Demographic Profile, and the aggregate program data report from the Commission on Accreditation in Physical Therapy Education.^37–39 It should be noted that the majority of members in this second report are over the age of 40 years and have been in the profession for more than 16 years. Although these reports do not provide direct comparisons of the demographic data in this study, the participants were similar to the national data in these reports across personal, institutional, and practice setting characteristics. Secondary to these similarities, there is little to no reason to question debt or income comparisons secondary to any differences among the demographic information collected on these participants.

The median annual income for entry-level physical therapists (0–5 years in practice) in this study was $67,900 ($12,000) (Tab. 2). This is similar to the published national annual median income categories from the APTA of $67,000 (0–3 years) and $74,000 (4–6 years).⁹ The national data described previously from the Bureau of Labor Statistics provides limited comparability secondary to a lack of categorization that identifies entry-level therapists.

The published income data by practice setting do not parse by years of practice and consequently provide little availability for comparison with the data in this study. However, one can compare the range and percent difference from lowest to highest of income across settings. National median income ranges from $72,000 to $95,000 and has a percent difference of 27%.⁹ The data from this study demonstrate a median range across practice settings of $55,000 to $82,659 with a percent difference of 40% (Tab. 2). The difference in range and percent difference may reflect greater differences in starting salary in different clinical practice settings; however, without comparison with other studies or other regions, one cannot be conclusive about why entry-level professionals appear to have a greater range of income across practice settings.

At the time of this study, there was not a known publication for the ranges or means of student debt-to-income ratios in physical therapy. One study of graduates from 1 institution reported the total loan amounts of graduates.²⁷ In the 2011 study by Thompson et al,²⁷ most loan totals were between $40,000 and $80,000. In this current study, the most frequent debt amount was reported at $100,000 to $124,999. Even considering that these are not direct comparisons, it would appear that academic physical therapy has not escaped the rapid rise in total educational debt accumulation that has occurred across higher education. The aggregate, median total program costs (tuition, fees, and other costs) for academic physical therapy programs is $58,074 for public institutions (in-state) and $105,817 for private institutions.³⁷ Although these costs do not provide a direct, complete comparison with the total student debt accumulated by physical therapists, it does allow for some comparison as well as a preliminary look at what debt students accumulate beyond the published program costs. The mean debt-to-income ratio considering total educational debt in this study was 197% (93%) (Tab. 3). This is higher than the debt-to-income ratios reported in the medical literature that has prompted concern for specialty choice secondary to debt and income. Asch et al²⁰ reported an approximate debt-to-income ratio between 80% and 90% for family medicine physicians. In the same article, Asch et al²⁰ identified veterinary medicine graduates’ debt-to-income ratios between 160% and 180%. Reports from the veterinary literature show mean debt amounts of $143,394.⁴⁰ These debt-to-income ratios from other professions are like those reported in this study for entry-level physical therapists. A recent study by Shields and Dudley-Javoroski¹² used economic modeling to consider a more long-term relationship between debt and income by estimating the net-present value (NPV) of physical therapy compared with other health professions. Using estimates of $150,000 debt, physical therapy NPV falls below all health professions studied except veterinary medicine and chiropractic. Debt estimates at $200,000 or above put graduates at risk of not achieving recommended payment benchmarks or no longer exceeding the NPV of a bachelor’s degree (>$260,000).¹² Although the majority of participants in this current study reported debt levels below these estimates, 12% reported between $200,000 and $300,000 (Tab. 3).

Another way to assess the debt burden on graduates is to consider the percent of monthly income directed towards loan repayment.¹ Policy recommendations for the percent of monthly income devoted to repayment fluctuate between 8% and 10%.⁴¹ In this study, after removing those not yet in repayment or those on income-based plans, the percent monthly income directed toward loan repayment averaged 22%. This is consistent with recent estimations from Pabian et al¹³ who estimated that graduates with greater than $120,000 in educational debt would fall into a hardship category of greater than 20% monthly income-debt ratio. Monthly income percentages this high have not only been shown to increase default rates, but they have also been found to delay marriage and other personnel decisions among young professionals.⁴²

Student Debt and Choice of Clinical Practice Setting for Entry-level Physical Therapists

Over one-half (57%) of the entry-level physical therapists in this study reported student debt having an effect on their overall job choice. There was a noticeable trend of increasing debt and increasing percentages of debt effecting practice choice setting (Tab. 5). Direct comparisons in academic physical therapy are not available in the literature for this data; however, similar findings have been shown in medicine. Rosenblatt and Andrilla²³ demonstrated similar trends with an increase in the reported influence of debt on career choice as total debt increased. It was also demonstrated in this study that as medical student debt increased, the intention to choose a career in primary care decreased, showing an effect of student debt specifically on the practice setting.²³

It is possible that these results even underestimated whether a physical therapist would change their practice setting choice for financial reasons. Current literature in physical therapy shows only a 27% difference in median annual salary range by specialty ($72,000–$95,000), with school system at the lower end of the range and skilled nursing care at the high end.⁹ In this study the difference was 40%, with the lowest income being in school settings and the highest income being in the home health setting. In contrast, the medical literature demonstrates an approximate 74% difference in the annual salary range ($204,000–$443,000), with family medicine and other primary care specialties at the lower end and cardiology and orthopedics at the high end of the range.⁴³ Given these differences, it is possible that educational debt in physical therapy does not influence setting choice for some practitioners simply because the range of income across specialties in physical therapy is not large enough to alter the debt-to-income ratio significantly for these individuals. This finding may have important implications as the physical therapy profession considers alternative payment methods that could alter the income potential for physical therapists based on the types of problems that their patients may present with.

Limitations

There are a number of limitations to this study that should be considered. First, this study has a small sample size and involved only entry-level physical therapists with a DPT degree who practice in the state of Florida. Second, this study only involved physical therapists who are members of the FPTA. Although there are many similarities between the data in this study and national comparisons, generalization of these findings on a national scale should be interpreted with caution.

Because the method of data collection is an anonymous survey, the results of this study are subject to selection bias. It is possible that those with the highest levels of debt were more inclined to participate in a survey about debt burden. Additionally, because the survey was sent through the FPTA’s early professional special interest group (SIG), it is possible that there are differences between individuals in this group compared with other entry-level physical therapists who are not members of the FPTA/APTA or part of the SIG. Because this SIG included a possible 5-year difference between graduation years, it is also possible that individuals’ debt may differ by graduation year. However, 67% of participants were within 2 years of graduation, and debt categories of $25,000 increments are larger than the 5-year change in total program costs.¹⁰ Although the total program costs do not account for all that might be included in a graduate’s debt, it is unlikely that the 5-year window of the SIG would produce a change in debt category unless there were large differences in repayment patterns. Repayment patterns beyond percent of monthly income were not collected in this study. Furthermore, because not everyone who received the email to take the survey responded, there is no way of assessing additional potential differences in responders and non-responders and the effect this may have on the results. To attempt to account for this bias, a question was included for why someone may decline to participate in the study. Unfortunately, there were no responses to this question to allow for analysis of selection bias.

Additionally, there are additional personal, family, and institutional characteristics that were not included in this study that may modify and add to the understanding of any relationships between student debt and clinical practice choices of entry-level physical therapists. A study on a larger scale is necessary to allow for consideration of both the personal and structural factors that potentially influence an individual’s perception of student debt and its effect on life choices.

Conclusions

Student debt is becoming a limiting factor for all who go to college, especially those who seek advanced degrees. This increase in debt has already started to affect practice choices of physicians. Physical therapists have similar or higher debt-to-income ratios compared with physicians, yet there is little available literature regarding the potential impact of this debt on physical therapist practice choices. The results of this study suggest that practice setting choice may be affected by physical therapist student debt and that student debt may be a barrier overall to practice and career choices in physical therapy. Regardless of the multitude of factors related to the debt burden of physical therapists, the high levels are cause for concern for the profession and for society. Additional research and support for innovations that reduce the debt burden in academic physical therapy should be considered and supported.

Ethics Approval

This study was approved by the University of South Florida’s Institutional Review Board.

Funding

There was no funding to report for this study.

Disclosure and Presentations

The author completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.

This manuscript was completed in partial fulfillment of the PhD requirements in higher education at the University of South Florida, under the direction of William H. Young III, EdD.