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Improving professional accreditation: Current trends

WILLIAM K. SELDEN Princeton, New Jersey

It is my desire to discuss some of the issues related to the various national health professional organizations. My comments will be in three parts. First, I shall describe a projected study that will affect many of the health professions. Second, I shall enumerate some of the forces which have exerted and are exerting an influence on all health-related organizations. Several of these have had a direct influence in creating the need for this study. Finally, I shall conclude with a few personal observations. I. Projected study The idea for the study to which I have just referred was presented in September 1969 by the Advisory Committee on Education for the Allied Health Professions and Services to its parent body, the Council on Medical Education of the American Medical Association. Without recounting the various steps pursued in developing the proposal, I shall merely report that it has received endorsement by the panel of consultants to the advisory committee. The panel comprises representatives of a number of allied health professions involved in accreditation of their educational programs. Subsequently and recently the proposal has been approved by the three bodies which will be its joint sponsors. These are the Council on Medi-

cal Education of the A.M.A., the Association of Schools of Allied Health Professions, and the National Commission on Accrediting. Funds to finance the study are now being sought from several foundations, the U.S. Public Health Service, and the U.S. Office of Education. Assuming that financing is provided, the study will be launched as soon as personnel are appointed; these include a broadly composed steering committee, a director, and a staff. It is projected that from 16 to 18 months will be needed for completion of the study. The focus of the study will be on accreditation as conducted for the educational programs of the various health professions, with emphasis on selected fields. Subject to analysis and review will be the basic issue of accountability or responsibility for accreditation, the structure of the organizations conducting accreditation, financing, research, and the relations of accreditation and licensure and of accreditation and registration, or certification. As stated in its proposal:
The results of this proposed study are vitally important to all of the health professions. In addition, they are important to the other fields of study in which accreditation is currently being conducted and to those contemplating doing so, as well as to the many colleges, universities, and specialized institutions which are subject to accrediting reviews. Furthermore, government is directly dependent upon the many nongovernmental organizations involved in accreditation. The success of this study has implications of considerable import for our national policy. The manner in which the health professions collectively resolve issues and undertake shared responsibilities is bound to exert profound influences on our society.

Remarks at the annual meeting of the National Health Council. Feb. 23. 1970.

II. Forces responsible for proposal So much for part one. Let me now enumerate a few of the forces which have led to the proposal for this study and which are exerting an influence on all the health-related professional organizations.


A. Historical influences The first points which I wish to make are historical. Their connection may initially appear to be remote, but they do have a bearing on the subject of this discussion. 1. The American and French revolutions, with their emphasis on equality, encouraged a new attitude toward privilege and special positions for individuals. The Jacksonian period of the 1830s and 1840s gave further emphasis to this trend, to such an extent that education for the professions and licensure to practice were directly affected. The philosophies of laissezfaire and caveat emptor epitomize this period in the United States, and remnants of this thinking can still be identified in statements, for example, of some businessmen, educators, and professional persons. 2. Changes in economic, political, and social concepts began to develop, however, during and after the Civil War. In the 1870s and 1880s the United States Civil Service Commission was inaugurated, and the Interstate Commerce Commission, the first of the nation's national independent regulatory bodies, was created. Their creation foretold the movement toward increased social control and later to recognition of the need to consider the welfare of the individual within the context of the benefit for all of society. 3. During the middle of the past century there began a movement toward the formation of organizations to represent the common interests of men in the various professions. For example, the American Medical Association was organized in 1847, although it was many years before there was sufficient agreement among its members for the association to give concerted attention to improvement in the education expected of its future members. 4. Although they were not historically descendants of the medieval guilds, these pro-

fessional associations did incorporate certain features that were similar to those of the European closed organizations which preceded them. As the need for regulation of admission to professional practice increased, society did accord to professional societies, either directly or indirectly, responsibility for deciding the qualifications for membership in the professions and who, in turn, should be permitted to practice.
B. Current pressures

So much for historical references. I shall now mention several of the current pressures on the health professional organizations. 1. The first and most pervasive is population. The rapid increase in the number of persons is affecting the supply of and demand for professionally qualified personnel. It is affecting the costs of health care and the education of the needed professional workers. It is stimulating the needs of individuals in all walks of life to become identified with groups for personal satisfaction and for economic, professional, and social protection. 2. Scientific and technologic developments and the increase in the extent of identifiable knowledge are encouraging specialization in all areas of activity, and especially in the area of health care. Specialization encourages individuals, in turn, to join with each other for the purpose of exchanging information of a specialized nature among themselves, and educational benefits are expected to accrue to thes who join such professional organizations. 3. Society is identifying health care as a right and no longer a privilege limited primarily to those who can afford to pay for it themselves. To finance the desired increase in the provision of health care, to provide coordination in its administration, and to encourage the education of increased numbers of health pro-

.Tournal AOA/vol. 69. August 1970


Professional accreditation

fessional workers, government has had to assume an increased share of responsibility. 4. As government assumes an increased share of responsibility in the area of health care and as individuals for a variety of reasons find it increasingly difficult to make independent judgments as to the qualifications of individual health practitioners, the need grows for such judgments to be made by bodies capable of making them. III. Personal observations These eight points have been presented merely to serve as a sketchy background for four personal observations. A. The health professionals are on a collision course between the political and social traditions of the past and the trends and movements of the present. In the past, as already stated, society has assigned to professional bodies the social responsibility of screening and policing their members. This practice was possible because of wide respect for professional and learned men and because society was not vitally dependent on their performance. B. Changes have been and are taking place. First of all, reasonably smooth functioning of all health professional persons is now necessary for the operation of the health care system, or systems. Workers in the health professions do not function in isolation from each other, and health care is no longer primarily dependent merely on the physician. Secondly, not only minority groups but the public at large no longer hold the professional and learned man in such high regard as they once did. C. Professional organizations, although con-

tinuing to give emphasis to their educational and professional contributions, are displaying much greater concern than they once did for the economic and social welfare of their members. As a consequence of various social developments, some of which have been implied in my earlier points, this movement on the part of the health professional organizations toward an approach more like that of a labor union is regrettably consistent with the trends of the time. D. These trends and movements which I have been outlining are not compatible with each other. Unless strong and enlightened leadership appears collectively among the health professional organizations, there are bound to be growing conflicts with the public and these will extend into the debates in Congress. The rumblings of criticisms of federal regulatory commissions should provide sufficient warnings to alert the health professional organizations. Conclusion In conclusion, let me return to the proposed study of accreditation of the educational programs for various allied health professions. This study was initiated as an attempt to resolve some of the growing conflicts to which these remarks have been directed, before they become so intense that they are uncontrollable or the groups become unreconcilable. I trust that what I have presented will encourage you to continue the dialogue.
Mr. Selden was formerly the executive director of the National Commission on Accrediting. He now serves as a member of the Committee on Education for the Allied Health Professions and Services of the American Medical Association. Mr. Selden, 37 Olden Lane, Princeton, N.J. 08540.