The Professional Counselor | Volume 10, Issue 4 443 Discussion The results indicate a large and significant difference (p < .05, η2 = .38) in the number of CACREPaccredited doctoral programs by region when controlling for the confounding variable of population size. The number of CACREP-accredited master’s programs per state is also a large and significant predictor (standardized β = .85, p < .05) for the number of CACREP-accredited doctoral programs in a state. Other variables, such as state population size, state population density, number of colleges and universities per state, and number of APA-accredited counseling psychology programs, did not predict the number of CACREP-accredited doctoral programs in a state. The Western region had by far the fewest number of CACREP-accredited doctoral programs, the smallest percentage of states with CACREP-accredited doctoral programs, the largest ratio of CACREPaccredited master’s-to-doctoral programs, and the largest ratio of population size to both master’s and doctoral CACREP-accredited programs. With only two CACREP-accredited doctoral programs in seven states, the Western region may experience a significant pipeline problem. It is worth noting that the number of CACREP-accredited master’s programs has doubled in the Western region since 2009, from 16 to 35 programs (CACREP, n.d.). During the same time period, the Western region has not gained any new CACREP-accredited doctoral programs. From an analysis of in-process programs, it seems that the Western region stands to gain further CACREP-accredited master’s programs but no CACREPaccredited doctoral programs in the near future, exacerbating any existing pipeline problem. In addition, the North Atlantic region has a relative lack of doctoral programs as compared to master’s programs. In the ensuing section, potential reasons for the lack of CACREP-accredited doctoral programs in the Western and North Atlantic regions, along with the potential impact of this problem, are discussed. CES Doctoral Programs in the Western Region The Western state of California was initially an early developer and adopter of counselor education accreditation standards, yet today it has relatively few CACREP-accredited master’s programs relative to population size and has never had a CACREP-accredited doctoral program. The California story is worth exploring in greater depth because it illustrates a further barrier to establishing doctoral CACREP programs in the Western region. California is a major outlier in this study in that only 24% (n = 23) of 96 master’s degree programs in counseling (i.e., clinical mental health counseling; marriage, couple, and family counseling; school counseling) were CACREP accredited. One explanation for this low number is that it was not until 2010 that California granted licenses to professional counselors (T. A. Field, 2017). As mentioned earlier, licensure requirements (especially those that require CACREP accreditation) can increase the number of CACREP-accredited programs in a state, with Ohio being a notable example. It is also interesting to note that despite California’s long history of granting licenses to marriage and family therapists, COAMFTE (n.d.) was not a strong accreditation competitor to CACREP. As of 2019, only 10% (8) of 82 MFT licensable programs were COAMFTE accredited. CES Doctoral Programs in the North Atlantic Region The North Atlantic region had only eight CACREP-accredited doctoral programs, which were concentrated in three states (i.e., New Jersey, New York, District of Columbia). No CACREP-accredited doctoral programs were in the New England region (i.e., Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont). The North Atlantic region has several densely populated states, with New York and Pennsylvania being the fourth and fifth most populated states in the United States. The North Atlantic region also had a fairly large number of master’s CACREP-accredited programs