Report to Congress on the Study of the Role of Allied Health Personnel in Health Care Delivery.

365 Pages·2007·14.38 MB·English

DOCUMENT RESUME
ED 307 395
CE 052 006
TITLE
Report to Congress on the Study of the Role of Allied
Health Personnel in Health Care Delivery.
SPONS AGENCY
Health Resources and Services Administration
(DHHS/PHS), Rockville, MD. Bureau of Health
Professions.
Jun 88
PUB DATE
NOTE
365p.; Subsequently published in further edited form
by the National Academy Press, 2101 Constitution
Ave., NW, Washington, DC 20418, under the title:
"Allied Health Services: Avoiding Crises. Report :.)f a
Study" (ISBN-0-309-03896-0, PB: $29.95; HB:
$39.95).
AVAILABLE FROM
National Technical Information Service (NTIS), 5285
Port Royal Road, Springfield, VA 22161.
PUB TYPE
Reports - kesearch/Technical (143)
EDRS PRICE
MFO1 /PC15 Plus Postage.
DESCRIPTORS
Accreditation (Institutions); *Allied Health
Occupations; *Allied Health Occupations Education;
Demand Occupations; *Employment Projections; Females;
*Futures (of Society); Labor Market; *Labor Needs;
Minority Groups; Nontraditional Students;
Postsecondary Education; *Student Recruitment
ABSTRACT
This report, the result of an 18-month study by the
NAS Institute of Medicine, Committee to Study the Role of Allied
Health Personnel (including two workshops with invited experts),
examines the diverse set of health care occupations that fall under
the umbrella term "allied health." The report is organized in eight
chapters. Chapter 1 introduces the concept of allied health
occupations and traces briefly the evolution of 10 fields. Chapter 2
examines various data sources and discusses ways of forecasting the
demand for and-supply of allied health personnel. Chapter 3 looks at
forces such as demography, disease patterns, the structure of the
health care delivery system, and women's study choices that have an
impact on the demand and supply of allied health personnel. Chapter 4
reviews national projections of the demand for allied health workers
up to the year 2000. In Chapter 5, recommendations are offered to
increase recruitment of students, including minority students, into
allied health education programs and to improve the capacity of
educational institutions to deliver allied health programs.
Presenting the employer's perspective, Chapter 6 reviews options for
correcting and adapting to supply imbalances and outlines a role for
health care administrators in enhancing the size and effectiveness of
the allied health work force. Chapter 7 discusses state licensure and
other types of control of allied health personnel. Chapter 8 examines
long-term care and the needs it poses for allied health personnel.
Each chapter contains references. Appendices include the
Congressional mandate, list of workshop participants, list of
'1.1ied
health job titles and program classifications
data on labor
supply/demand estimates and projections, criteria for approval of
certifying agencies, and a list of historical source material.
(KC)
Report to
the Study of the
ongress on
ole of Allied Health Personnel
in Health Care Delivery
Allied Health Services: Avoiding
Crises
Report of a Study
Division of Health Care Services
Institute of Medicine
National Academy of Sciences
JUNE 1988
EDUCATION
U S DEPARTMENT OF
and improvement
Office of Educational ReSearCh
INFORMATION
EDUCATIONAL RESOURCES
CERERIC/
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heal'h Reslun es and Servicrs Administration
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U S DEPARTMENT OP HEALTH A HUMAN SERVICES
SEST COPY AVAILABLE
2
1
HEALTH RESOURCES
AND SERVICES ADMINISTRATION
"HRSAHelping Build A Healthier Nation"
The Health Resources and Services Administra-
tion has leadership responsibility in the U S Pub-
lic Health Service for health service and resource
issues HRSA pursues its objectives by
Supporting states and communities in deliver-
ing health care to underserved residents, moth-
ers and children and other groups,
Participating in the campaign against AIDS,
Serving as a focal point for federal organ trans-
plant activities,
Providing leadership in improving health profes-
sions training;
Tracking the supply of health professionals and
monitoring their competence through operation
of a nationwide data bank on malpractice claims
and sanctions; and
Monitoring developments affecting health facil-
ities, especially those in rural areas.
3
This report Is available through the !IS. Department of Commerce,
National Technical Information Service (NTIS), 5285 Port Royal
Road, Springfield, VA 22161
4
The Oommittee would like to gratc.!Ully acknowledge the contributions
of many people and organizations who provided assistance
and information
to this study.
thief among the organizations are the allied health
professional associations themselves.
Despite apprehensions from time to
time about what conclusions and recommendations
the Committee might
produce, these organizations generously rose to the challenge
of providing
the information the Committee requested.
The Cammittee solicited input
frames's:hie-ranging set of allied health associations
and wishes to thank
each of them
Special acknowledgements, however,
are in order for those
associations representing the ten fields studied in
depth, as well as the
American Society of Allied Health Professions and the National
Society of
Allied Health Professions.
The Committee was also aided by Dr Gerry
Kaminski, Dean of Cincinnati Technical College, who provided
us with
information from the organization of two-year college allied
health deans
an allied health programs in cumunity colleges.
Several government agencies provided critical assistance in
the use of
federal data systems.
Our deepest thanks go to Ann Kahl and her staff,
Sandy Gantliel, Steven Tise, and William Austin, who spent considerable
time with the staff discussing the Bureau of Labor Statistics
(BLS)
methodology and their work an specific allied health fields.
Alan Eck,
also of the BLS, generously offered his expertise in the
areas of supply
and occupational nobility.
Deborah Jerold of the Department of Education
was extremely helpful in providing the Committee with higher education
projections.
Numerous indariduals in the central office and facilities
of
the Veterans Administration were willing to describe their
experiences in
recruiting, retaining and educating allied health staff.
Above all, we
wish to thank our sponsors, the Bureau of Health
Professions, Health
Resources and Services Administration.
TUllio Albertini, the study
project officer, and other staff members
were eager to meet the
COmmitte4es needs for guidance and information throughout
the study.
We also wish to acknowledge a number of institutions who
welcomed
Committee members and staff, allowing us to tour their facilities
and
speak to allied health personnel in the workplace.
These institutions
include the Sisters of Mercy Health Corporation, Harvard Camiunity
Health
Plan, Rancho Los Amigo Medical Center, Beverly Manor Convalescent
Hospital, On Lok Senior Health Services, Garden Sullivan Hospital,
VA
Medical Center Palo Alto, Ludlam County General Hospital,
Beverly Health
Care Center, Tarboro, N.C., and the Berry Hill Nursing
Home.
Cur thanks also goes to 3. Warren Perry, Alexander McMahon,
and John
DiEliaggio for attending COmmittee workshops and providing
advice to
Committee and staff.
Finally, we wish to thank all those who participated
in our public
hearings and workshops.
These individuals are listed in Appendix II.
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INSITIVIE OF MEDICINE
021/1ITIEE ID STUDY THE ROIE OF ALLIED HEALTH PERSCNNEL
WILLIAM RICHARD6CN, FH.D., Chairman*, Executive Vice President and Provost
Pennsylvania State University, University Park, PA.
JOHN E. AFFEIDT, M.D.*, Medical Advisor, Beverly Enterprises, Pasadena,
CA.
STANLEY BALM, M.D.*, Professor and Chairman, Department of Radiology,
Hospital of the Unviersity of Pennsylvania, Philadelphia, PA.
FLORENCE S. CRCMCIL, M.A.*, Consultant in Program Development, and
Editor, Occupational Therapy in Health Care, Pasadena, CA.
E. HARVEY ESTES, M.D.*, Director, Family Medicine Division, Department of
Community & Family Medicine, Duke University Medical School,
Durham, NC
Association of
GARY L. FILERMAN, Ph.D., President,
University Programs,
Administration, Arlington, VA.
in Health
FOLLY FTIZ, M.A., Professor, School of Allied Health Professions,
University of Connecticut, Storrs, CT.
AIIZANIA
FREEMAN, Ph.D., Dean, School of Public and Allied Health, East
Tennessee State University, Johnson City, Tennessee.
Operations,
SISTER ARLENE ?WC AN, Vice President for
Providence Hospital,
Cincinnati, CH.
ROBERT E. PARMA, Ph.D., President, Montgomery Community College,
Rockville, MD.
EDY'DIE H. SOVENRICH, M.D., Director, Continuing Studies, Johns Hopkins
School of Public Health, Baltimore, MD.
swam,
C. ECVARD
Etscecutive Director and Vice President for Medical
Center Hospital of the University of Pennsylvania, Philadelphia, PA.
FRANK SLOW, Ph.D.*, Chairman, Department of Ecarraics, Director, Health
Policy Center, Vanderbilt Institute for Public Policy Studies,
Vanderbilt University, Nashville, 7N.
*Member, Institute of Medicine
6
Superintendent, Hamilton County
PAUL M. STARNES, Assistant
Department
Member,
of Education;
Tennessee House of Repremtatives,
Chatanooga, TN.
Weber
REVD =INGHAM, D.D.S., Fh.D., Dean, School of Allied Boa lth,
State Oo liege, Ogden, Utah.
7,4YRA =OBER, Ph.D., Professor of Econanics, School of Educaticn,
Stanford University, Stanford, CA.
REBA EE TCRNYAY, R.N., Fh.D.*, Professor, School of Nursing, Di' -34-.:tor,
MU Clinical Nurse Scholars Prograa, University of Washirgton,
Seattle, WA.
Institute
NANCY WATTS, Ph.D., Professor of Physical Therapy, MCI
of Health
General Hscpital, Boston, MA.
Professions, Massachusetts
STUDY STAFF
KARL D. YERDY, Director, Division of Health Care Services
MICHAEL L. MILLMAN,
Study Director
SLINNY G. YODER, Associate Director
JESSICA TOWNSEND, Research Associate
MARYANNE P. KEENAN, Research Associate
CAROL C. M2FZEITA, Research Associate
DEIDR1M H. SUMN, Secretai-y
Institute
Medicine
WALIACE K. VATERFALL,
Editor,
of
0101720:5
EMEND J. MZI1ERNAN
RICHARD NeRRISCN
EUGENIA CARPENIIER
OLIVE M.
IG1413ALL
HAROID GOIESTEIN
Mail WOKEN
RUTH BRCWN
NURIT DEER
BILL SALTON
7
TABLE OF CCffl'ENIS
PREFACE
EXECUTIVE SUMMARY
that is Allied Health?
CHAPTER 1.
Approaches to Demand and Supply
CHAPT ER 2.
Forces and Trends in Demand and Supply
CHAPTER 3.
Demand and Supply for Ten Allied Health Fields
CHAPTER 4.
The Role of Edncation Policy in Influencing Supply
CHAPTER 5.
The Health Care &player's Perspective
CHAPrER 6.
Iicensure and Other Mechanisms for Regulating
CHAPTER 7.
Allied Health Personnel
Allied Health Persona]. and Lang Term Care
CHAPTER 8.
APPENDICES
Congressional Mandate
I.
Meeting and Workshop Participants
II.
A Sample of Allied Health Job Titles and
III.
A Classification of Instructional Programs in Allied Health
Estimates of the Current Supply in Ten Allied Health Fields
IV.
Projections of Demand and Supply in Occupations
V.
Minnesota Sunrise Provisions
VI.
National Commission for Health Certified Agencies' Criteria
VII.
for Approval of Certifying Agencies
VIII. List of Historical. Source Material
PREFACE
of an 18 -month study by a ccawaittee of
This rat:art is the result
the Institute of Medicine to e3cplore policy issues surrounding
the roles
of allied health perscrinel.
Pro:toted by a ocrqressiamol mandate contained in Public
Law 99-129,
the Health Profes&icns Training Pat of 1985 (Appendix I), and implemented
Services Administration
throsgh a contract with the Health Hesocursoes and
study represents
of the Deter at of Health and Men Services, the
the
first major
examination of the diverse set
,sdepero i
of health care
compations that often fall under the
urbrella term "allied health".
Study Background
as dietetics date back to
Although some allied health fields such
the 19th century, it was the federal health professicns legislation of the
gave life to the concept of a collectivity now known as allied
1960s that
perscnnel.
health
direct federal support for allied
Despite the withdrawal of most
education in
health
the early 1980s allied health leaders =winced
Ccmagress that such a large
workforce (ranging in
part of the health care
estimates !ran ace
almost fear million people) should not
to
continue to
about
go urecnitored and unstudied, especially when so much
the health
care system is
pressure
undergoing sweeping ctenge.f \Ibex'e is increasing
!me both public art private sectors to
-a
-
ants; there is
,
introduction of no, scchisticated health
are
logies; there
growing
increasing attention to individuals with
embers of elderly; there is
chromic disabilities; and
are drastic develcpments in
there
disease, such
acquired
syndrome (AIDS) epidemic.
as the
immune deficiency
pressure& Winds in
Hai the health care system adapts to these
large pert on whether workers
are available
with the requisite education
at the right
Thus, careful assessment of future
place and time.
personnel
needs has never been more important than nod.
However, making sound
regulation
other matters
policy decisions about education,
and
that affect
sur.ply and dui and for allied health personnel is difficult.
This is in
shxlied elements of
part becauee they have been mon; the least
the health
care systaos
In, rescasse to this deficiency, in 19F
1
0:tigress mandated
this national study.
9
-2-
Interpretation of the Congressional Charge
Theme inquiries were not
Congress posed five teaks for this study.
raised in the specific context of existing or proposed federal
legislation, but rather a aroader =own that a large body of health care
workers has received insufficient attention relative to their importance
In effect, Congress asked for information about
in future health care.
12121201211814.213.112X_CtaBGE
Assess the role of allied health personnel in health care delivery.
1.
Identify projected needs, availability, and requirements of various
2.
types of health care delivery systems for each type of allied
health personnel.
Investigate curnmtpmctioes under which each type of allied
3.
health personnel obtain lioenses, credentials, and accreditation.
Assess changes in programs and curricula for the education of
4.
allied health personnel and in the delivery of services by such
requirements
perecmnel which al2 necessary to meet the needs and
identified pursuant to paragrapa (2).
Assess the role of the Federal, State and local governments,
5.
educational institutions, aryl health care facilities in meeting the
needs and requirements identified pursuant to paragraph (2).
this major coevxxvmmt of the health workforce in order to determine whether
corrective action is needed, and if ao, where responsibility for such
action rests.
The study ccamittee was directed to assess the role of allied
The committee has
health personnel in the delivery of health care.
better
knot/ledge about the ways
interpreted this charge as a recitYmt for
deployed,
their functions, their
in which allied health practitioners are
other
health care practitioners, and the settings in
relationships with
In addition, the charge has been interpreted as a need
thich they butic.
for
elucidation of the 'various factors aid farces -- education and training,
employer requirements, third party payer policies, the regulatory
apparatus, to name several important onesthat &baps that role.
10