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The Acceptability of Credentials Earned Online for Obtaining Employment in the Health Care Professions

The United States is facing a serious health care crisis in the coming years due to an aging population, the prevalence of chronic and acute health problems, and a shortage of trained health care professionals. Although health expenditures have increased by more than 5% of the GDP over the past 15 years to $1.7 trillion annually, the rates of heart disease, cancer, obesity, strokes, AIDS, and respiratory disorders have not significantly declined (National Center for Health Statistics, 2005).

In addition, as the proportion of American citizens over the age of 65 increases, the need for medical services is likely to increase. However, states now face a shortage of medical personnel, including nurses, pharmacists, radiology and laboratory technologists, and respiratory and physical therapists.

This shortage has been described as ‘‘one of the most pressing problems we face today’’ (Wertsch, 2003, p. 1). In the past, one solution for addressing shortages of health care professionals has been to hire qualified personnel from afar. Indeed, qualified professionals from other nations have been migrating to better-paid jobs in wealthier nations for some time (Atienza, 2006; Overland, 2005; Parris, 2004). However, many of these nations are currently experiencing severe shortages of health care professionals that will worsen in the years ahead (Nordquist, 2006).

In the United States, expected shortages will help fuel the demand for university programs to train nurses and other health care providers. Of the six professional occupations that are expected to grow the fastest through 2014, three are health-related, with positions for registered nurses accounting for 64% of the demand for new job growth (Hecker, 2005).

One consequence of this situation is that it has opened a significant market for distance education by traditional and for-profit institutions that offer health-related degree programs, certificates, and course work via the Internet. A report issued by the Sloan Consortium indicated that in the fall of 2004, about 32% of public and private universities offered a health profession major online, and 56% of all universities considered online education as part of their long-term enrollment strategy (Allen & Seaman, 2005).

However, the efforts of all of the traditional institutions cannot supply enough health-personnel to fill the need. One reason is because many schools are reporting a shortage of trained personnel to teach in health programs (LaRocco, 2006). Such shortages leave a large opportunity for the for-profit distance institutions to step in and respond to the demand for health personnel and increase their enrollments.

In the coming years, for-profit online institutions are expected to grow at more than twice the rate of higher education as a whole. These institutions are expected to offer an increasing number of programs in health fields, such as nursing (Blumenstyk, 2005), where enrollments should be particularly strong (Wills, 2005).

Indeed, while enrollments are growing in traditional public institutions, by 2008 one in every 10 students taking classes is expected to be enrolled in an online for-profit institution (Golden, 2006). Evaluating Distance Education for Health Practitioners Historically, technology-supported instruction has played an important role in university-based health profession programs.

Many types of technologies have been used in teaching for the purpose of supplementing instructor-led classroom sessions. These include interactive video (Calderone, 1994; Cohen & Dacanay, 1994), computer tutorials (Lieberman, Abramson, Volkan, & McArdle, 2002), interactive television, web casting (DiMaria-Ghalilli, Ostrow, & Rodney, 2005), prerecorded lectures, and technology-supported study guides.

All have been common in health care training. Given the widespread use of technology-supported instruction, plus the demand for qualified health professionals, adopting programs that include earning credits online toward a degree would seem to be a natural progression. However, one important difference between computer-assisted instruction and online education is that, in the past, computer technology has been used to support instructor-led classroom instruction, where a professor presents material to a class of students, all of whom are physically present.

In contrast, online courses are now being used to supplant such face-to-face teaching by sending content to computers of individual students at remote locations. This represents a new direction for health care education that has led to an intense debate as to whether such online instruction can be effective in training health care professionals.

A major issue in this debate is whether online lessons are educationally equivalent to traditional lab and classroom instruction. This issue has been widely studied, but most of the research that has been conducted to evaluate distance education has focused on student outcomes. Frequently studied are various kinds of test scores (Russell, 1999), grades, student attitudes (Ali, Hodson-Carlton, & Ryan, 2004), and overall student satisfaction with their courses (Rodrigues, 2004).


Procedures A questionnaire was used to collect data in a national study of human resource professionals who serve as hiring gatekeepers. The questionnaire was designed to assess how those who hire applicants for advertised health care positions view the scholarly accomplishments of persons who respond to position advertisements that require a college degree when that credential has been earned completely or partially online. To identify the appropriate hiring managers to study, the first step was to locate ‘‘help-wanted’’ position announcements for health care workers in the classified advertisements of newspapers.

To gain this information, newspapers in 38 cities throughout the United States were examined. During a four-week period, job advertisements were culled from those presented in the online versions of more than 50 newspapers published in these cities. A total of 1,200 announcements were identified in this first step. From this list, half of the announcements were randomly selected by using software developed for that purpose. Next, each ad was examined for contact information or a website that would provide this information.

Those that had no such information were eliminated. Generally, then, each position announcement was examined and included in a database if the announcement met three criteria: a college degree was required to apply, a physical address for applicant contact was presented in the ad, and the advertisement specified that the position was in an area of patient care or was clinical in nature. From this complex procedure, 296 employers seeking applicants were identified. A questionnaire was mailed to each of these employers.

After several attempts to encourage them to return the instrument, 159 completed questionnaires were received. This represents a 54% return rate. Given the complexity of the procedures required to identify potential employers of health personnel, the return rate was judged to be sufficient for providing preliminary data concerning the issue of the acceptability of credentials earned online for health care workers.


The questionnaire was divided into four parts. In the first section, hiring decisionmakers selected the most qualified applicant in two hiring situations. The decisionmakers explained the choices they made in the second section. In the third part, hiring officials provided background information, such as whether or not they had ever taken an online course, the age group to which they belonged, and gave their opinions about the benefits and limitations of online courses or degrees.

In the final section, respondents had the opportunity to write additional comments regarding their thoughts about online degrees and courses. Hiring situation scenarios. The major focus of the questionnaire was to assess employers’ responses to hypothetical applicants who held one of two different educational credentials: a fully or partial online degree and a traditional degree.

Three applicants were presented in two different hiring situations. Hiring Situation 1 consisted of Applicant A who held a traditional degree and Applicant B who held a degree that was obtained fully online. Hiring Situation 2 consisted of the same Applicant A who held a traditional degree and Applicant C who held a degree that was obtained partially online and partially within a traditional classroom context.

In all other ways, the applicants’ credentials and background were the same. For example, each of the applicants had the same prior work experience, good letters of recommendation, and positive results from personal interviews. Thus, the applicants’ qualifications were identical except for the academic environment in which their degrees were earned. The educational credentials of the three applicants are described more fully in Table 1. All respondents received both hiring situations and were instructed to simply select the more desirable candidate in each situation.

Author :  Jonathan Adams , Margaret H. Defleur & Gary R. Heald