CHAPTER 6 History of Allied Health Professions Patricia Royal, EdD Learning Objectives Aer wading this chapter, students shouldbe abe to: + Define the term ale health professions * Identity some af the Workers classified as allied health professionals * Discuss the importance of the evolution of allied health * Discuss the labor trends for allied health professionals, * Identity the opportunities and challenges in working in allied health careers Definition of Allied Health Professions There are many different definitions to deseribe allied health professions. Some of the most commonly used refer to allied health professions as a cluster of health-care practitioners who ‘work cither directly or indirectly with patients and who are trained or credentialed by certifications, registrations, or li: censure. Allied health professionals practice independently Key Terms + Aled heath professions + osteopathy Porsatry Midlevel + Radiographer technician + Histologic techniean = Cytotechnolagist ‘or work in team environments and collaborate with physi ans to deliver quality patient care. The American Medical Association (AMA) defines allied health professions as indi ‘viduals assisting facilitating, and complementing physicians and other specialists, Rather than defining allied health pro fessions, in 1992 the Pew Advisory Panel for Allied Health de Fined what itis not—it is not medicine, nursing, osteopathy, dentistry, veterinary medicine, optometry, pharmacy, and podiatry. The Pew Advisory Panel agreed that allied health ssSection Ii The Divisions of Health Cave professions were midlevel workers who support, comple ‘ment, or supplement practitioners. Regardless of definition, the field ofallied health professions is diverse and offers many opportunities to work in health cate, There are more than 80 diferent allied health professions, such as occupational and physical therapy, dietetics, dental hygiene, and health admin: 'stration, to mention a few. In 2008, allied health professionals represented 60% of ll health-care providers and the employ. iment outlook indicates high growth over the next several ecades.! This book examines some ofthe allied health-care dis ciplines in depth by providing complete chapters dedicated to specific professions. Other allied health-care disciplines are covered to a lesser degree at the end of the text, With as many as 200 professions qualifying as allied health careers, it is not possible to include an examination ofeach tone of them. Box 6-1 lists some professions not cavered in this text, Origin of Allied Health Professions ‘The lied health professions began before the 19th century 1s the Shattuck Report of 1850 established a structure for defining health workers. Before Shattuck’s investigation and research into the relationship between hygiene and dis- cases in the United States, the focus on prevention, sanitary conditions, and public health was practically nonexistent.’ Shattuck’s framework was developed to provide parameters for organized medical education that included accups tional, preventive, and public health, as well as medical health, The health-care industry was growing and more st dents were being trained; however, the training lacked standard for higher admission and graduation, Abrabam Flexner, noting the lack of standardization, proposed that medical schools adopt a detailed protocol to provide con- sistency in medical education, In 1910, the formal educa- tion was outlined in the Flexner Report and this model became the standard for providing medical education.’ In the 1930s, the AMA, through its Council on Medical A On wi received professional training and cre: dentials in an allied health field, such as clinical laboratory science, radiology. emergency medical services, physical therapy, respiratory therapy, me assisting, athletic training, dental | eiane. or occupational therapy. FIGURE 6-1 Aled heath professionals represent @ diese and \witesproad population in neath eae 56 Anesthesiologist assistant Art therepist Dancejmovament therapist Diagnostic medical sonographer Electronauraciagnastic technologist Genetic counselor Htotechnologist kinesiotherapist Magnetic resonance technolog st Medical dosimetist Medica arian Medical transcripsionst ‘Musle thorapist Nerve conduction studies technologist Nuclaar medicine tochnologist Nutso aide instructor Orthoptist Orthotst and prosthetist, Paraoptemetiian Poetry therapist Poiysomnographic technologist Surgical nouroptysiotogist Veterinary medical technologist Education, began an instrumental role in helping to estab- lish accreditation for programs in occupational therapy, physical therapy, and clinical pathology. Other programs, such as health information administrator and radiographer programs, began the same accreditation pracess through the AMA in the mid 1940s asthe previously mentioned pro- {essions. These professions were referred to as paramedical education by their accrediting organization.‘ The initial call for more paramedical workers was made in 1952 by President Truman, The Commission on the Health Needs of the Nation recognized the need for more paramedical workers who possessed special skills needed for investigation, treatment, and prevention of disease and dis ability. For the next L5 years, there was tremendous growth in the number of new programs and schools far these pro fessions, referred to as ancillary and paramedieat workers. TThe growth was spurred when Cangress enacted the Allied Health Professions Personnel Training Act of 1967, which was established to boost opportunities for training in the fields ‘of medical technology and other allied health professions, as ‘well ast improve the quality of education.* By 1970,a new name had emerged as the AMA House of Delegates defined allied health professionals as health-care workers who were able to apply independent decisions within their scope ofcompetence, but allowing fora medical stato have absolute accountability for patient cares! Over the past century, many things have changed in allied health professions, including definitions, names, and the emergence of new specialties." Tt is expected that many other specialties will surface as patient needs and advances in technology change. Similar to medicine, allied health will face new challenges and opportunities as the needs fof an aging population dictate changes in health-care environments, Educational Requirements Depending on the degree ore, the allied heath educa tional quirements vary greatly. Tn addition tothe edu- especially depending on state requirements Some pro grams allow for on-the job traning, others quite less than 1 year of education, and sill others require graduate degrees. Many technology-elated roles require only 1 year of training, whereas therapy related oles typically require d years or more depending on the specific knowl- edge area and scope of practice, Following are some Lypical educational expectations for roles in allied health fields’: + EEG technician—1 year + Histologic technician 2 years + Radiologist + Cytotechnologist 2 years 3 years + Occupational therapist—postgraduate + Physical the pist—posigraduate Educational Standards and Accreditation Before allied health professionals became a recognized _group, accreditation and educational standards were impor- tant issues for individual flelds. With the help of the AMA, some programs were able ta obtain accreditation that stan- ardized curriculums. Before the establishment ofan allied health accreditation organization, the AMA worked with 50 national committees and 22 review committees in prepa ration for accrediting 3,000 educational programs. In 1994, ‘the Committees on Allied Health Education and Accredita- tion began accrediting allied health programs. The name 1vas later changed to Commission on Accreditation of Allicd Health Education Programs (CAAHEP) and itis currently the largest accreditor of programs in health-care fields with ‘over 2,000 educational programs? The accreditation process consists of six criteria: (1) evaluation and accreditation of Chapter 6: History of lied Health Professions the programs, (2) reviewing existing educational essentials, (3) maintaining active relationships with the collaborating medical specialties and associations, (4) establishing and maintaining liaisons with technical and professional groups allied to medicine, (5) maintaining an association with in stitutions supporting accredited programs, and (6) working with the most directly related medical specialty when new allied health occupations are recognized by the AMA.S Many of the allied health programs are accredited by CAAHEP, but many others have their own discipline specific accreditation. In addition to university oF college national accreditation, professional programs need to be ‘competitive by meeting. standardized, nationally recognized ‘curriculum that meets stringent educational requirements, Some ofthe programs and their date for adoption of educa ‘onal standards include the following’ + Occupational therapist: 1935 + Radiographer (previously called x-ray technician): 1944 + Rehabilitation counselor: 1971 ‘+ Ophthalmic lsboratory technician: 1979 + Pharmacy technician: 1982 + Massage therapist: 1991 + Surgical assistant: 2002 Professional Associations and Relationships Maintaining professional associations and rebationships is important for both programs and students, Professional associations prove networking opportunity, conferences, internship potentials research dat, career options, and Potential for continingedviaton credits Professional s ‘ociatons tha allied beath programs and professionals may beinvoled wth nchse the AMA, National Assocation or Health Profesional, Associaton of Schools of Aled Heath Professions (publisher of owrnatof Aled Health) and Area Health Elcaton Centers as wells tate and loa spt alinis, and timing sites Onan individual program level tach lied health program typically maintains some typeof tclationship with associations pect that dsp. Stu dents ae usaly encouraged to become a member inthe professional asocaton while still in school because the Imembership rates ar lower for students and they transition to practitioner member aller graduation. Employment Trends ‘The employment projections for health professions are well, above average. The health-care and social assistance category 37Section I The Divisions of Health Care has the highest profections of grovsth for 2010 to 2020 com. pared with al categories. The health-care job market is pro: jected to create about 28% of all neve jobs in the United States, and the overall growth is expected to be around 33%, ‘The driving factors for growth in health care are related to longer life expectances, an aging population, and advances in new treatments and technologies.? "The projected growth is not specific to allied health, but because allied health makes up roughly 60% ofall health-care jabs, ean be assumed that the overall growth in allied health jobs will be higher than average, Following are some of the allied health disciplines and their expected percentage of| growth within the next 7 years Nutrition: 20% Physician assistant: 30% Respiratory therapy: 28% + Dental hygiene: 38% «+ Physical therapy: 39% + Audiology: 37% + Speech-language pathology: 25% + Health services manager: 22% + Medical and clinical laboratory: 13% With the average growth outlook for all jobs being 1492 health-care workers will have a significant advan” tage. Individuals training in a health-care role should fee! comfortable with the job outlook and the potential for a long-term career. Fastest Growing Occupations in Health Diseiplines 2012-2022 al < SPP. oe Ff ve Coe ty Me Gee? 7 & Salaries and Job Settings Salaries for allied health workers vary according to the dis ciplne, education, taining, eedentals, and jb sting Common jab settings include the following + Hospitals « Physicians’ offies + Healthcare acties + Schools + Home heath agencies + Nursing homes + Outpatient centers «Diagnostic hboratories Disciplines eqiring terminal degre, such as dentistry, usally have higher salaries individuals working in private prctces or clinis may ern more then those working in & Siateor public health-care fay, Table 1 provides asam- Pingof common alia health jobs with median salaries and tnalefemale demographics Opportunities and Challenges As with most jobs, working in allied health cre has both op- portunities and challenges. Most health-care jobs are exciting and fast paced, with opportunities to be on the cutting edge of technologies and lifesaving treatments. Being immersed in healt care typically requires continuing education and train ing on new equipment, teatment, techniques, a therapies. FIGURE 6-2 Heak-care professions are expetedto gow steady ove the next 7 years. The occupations shown here have the fastest projection rates forall allied heath fils Source: Monthly Labor Review, January 2012, US Bureau of Labor Stats)TABLE6-1 Sampling of Allied Health Folds and Statistics oo i Demist Nurrtnist Madicalelinica! oratory technologist Heat information technology (Oceupational meapy Physical therapy Physician assistant Respiratory therapy Soci work ‘Specehanguage pathology Heath servces msnagernont Note: Slaries vary depending on eredentalsandob stings. sco: Bureau of Labor Statistics, 2012 “The opportunities for new learning are higher in health care than in most other fields. Allied health professions are growing, and with this {growth come opportunities for advancement and other avenues such as specializations. As indicated, allied health fields have been around for more than 100 years; however, ‘more than 40 new careers were born in the past 40 years.) As specialty areas emerge, careers will also materialize, provid ing more opportunities for those interested in health care ‘Working in allied health can be rewarding because of op- portunities foreither director indirect patient care, Some in~ Aividuals desire to have patient contact, whereas others preferto haveless direct care. Allied health professions afford individuals the opportunity for both with ample selection of| disciplines. Some job choices for individuals seeking direct patient care inelude audiologist, physical and occupational therapists, physician assistant, and dental hygienist, Roles for individuals who prefer indirect care include nutritionist, social worker, and counselor, For individuals who prefer to ‘work alone or with few coworkers there are some choices that satisfy that criterion. Jobs such as clinical laboratory scientist, blood bank specialist, cytotechnologist, and health formation technician provide opportunities for those who prefer more solitude in their dally work activities. Allied health-care fields can also be very rewarding. Whether you choose direet or indirect patient care, you can be assured of helping people. This internal gratification re ceived from an allied health career often neutralizes the chal lenges that may come with the job. As mentioned, health-care jobs may be fast paced and demanding, There is often little down time because patients or family members are waiting for diagnosis, treatments, results, or advice in making tough decisions. Like most obs in health care allied health workers Chapter 6: History of lied Health Professions oo Percent Male 49310 1s 55.240, 87 47820 m2 34,160 107 74400 50 79.60 702 sn.g20 28 5570 26 44200 194 ea70 a4 47370 a5 ns should have total concentration and good communication skills to interact with patients and family members, Even one ‘misunderstanding can be potentially disastrous, and health «are professionals need to be alert and focused at al ime. Job burnout can occur in any profession; however, in health cate itis more Bkely to occur because of job-related stress, Long hours, lack of resources, sustained concentra tion, and responsibilty for patients’ care may all contribute to work-rekited stress, which in turn may lead to job burnout, Understanding the potential rik for job burnout may increase the awareness of the problem and prevent it from occurring. Generally, many health-care professtonals Feel thatthe risk of job burnout and other challenges of work~ ing in health care are offset by the rewards and opportunities provided. SUMMARY ‘The field of allied health ig vast and still growing. Finding a suitable career as an allied health professional has never been easior because of the various opportunities available, In addition to the wide varity of choices, the employment ‘outlook is positive with potential growth rates approaching 40% in the next 10 years. As in any job, challenges are ‘often intense, but the opportunities often outweigh the negatives, Review Questions 1. Before the term allied health was used, the term supplement workers was used to describe non- physician individuals working under the supervisor of a physician. A. True 8. FalseSection I 2 ‘The Divisions of Health Care Allied health workers ar level workers supporting, complementing, or supplementing the ‘work of physicians. A. Upper B. Middle ©. Lower D. None of the above Allied health careers comprise roughly _% of all health-care jobs. 30 8.35 c.50 D.60 Over the past 40 years, the number of new allied health fields created is roughly A.22 B40 c.45 D.60 Individuals who prefer indirect patient care should select a role such as: A. Physician assistant B. Physical therapist . Nutrition D. Dental hygienist One of the driving factors for increases in the allied health professions is: A. Aging population B. Higher salaries . Management roles D. All of the above Job burnout is not commen in the allied health roles. A.Tue B. Falee Programs in purpose of A. Creating more challenges B. Standardizing the curriculum . Meeting the demand of the population D. Providing safer rales for professionals The initial call for an increase in. paramedical ‘workers occurred during what presidency? A. Johnson B. Nixon lied health are accredited for the ©. Eisenhower D. Truman 10. The educational requirement for allied health professions varies but generally requires at least: A. 3months of training B, 6 months of training . 1 year of college D. 2 years of collage Glossary of Key Terms A plines that complement and support the work of physicians and other health-care specialists sd health professions—a cluster of health-care disci- Osteopathy—alternative health care that stresses the tlationship between the structure and function of the body Podiatry—medical -movement, with the focus being on the foot science area devoted to human ‘Midlevel—health-care professionals who are not medical doctors but have advanced education, training, and cent cation in their scope of practice some (e.g physictan assis {antsand family nurse practitioners) may diagnose, treat, and prescribe medicine (depending on the discipline) while under the supervision ofa licensed physician Radiographer~a person with knowledge and training in the field of x-rays (previously x-ray technician) EG technician—an electroencephalogram (EEG) techni- cian is a skilled professional trained in the operation of the EEG machine, which monitors the nervous system by analyzing brain wave activity Histologic technician—allied health professional who performs various tise-related procedures in the laboratory Cytotechnologist—allied health professional trained in the microscopic interpretation of cells for detection of abnormalities BoavisPlus Additional Resources are Available online at wow davisplus.com Additional Resources Association of Schools of Allied Health Professions (ASAHP)—www.asahp.org Chartered in Washington, DC, in September 1967 as a not {for-profit national professional association for administrators, educators, and others concerned with crtieal issues affecting allied health education, The arganization was established by the deans of 13 university-based schools of allied health professions in response to an urgent need for an interdiseiplinary and interagency association to relate to improving the quality and quantity of needed workforce inthe health professions, The term allied health was popularized daring the deliberations that led to the passage ofthe Allied Health Professions Personnel Training Act in 1967. The passage of this legislation brought about a new and radical concept of unifying all the various disciplines that make up allied health into academic units with a single administration, CareerOneStop—www.carecronestop.org, ‘Tools to help jab seekers, students, businesses, and career professionals. Sponsored by the U'S. Department of Labor. Ameri un Medical Association (AMA)—www.amarassn. org/ama Overview of selected allied health careers, including an overview of sclected allied health career salaries. ‘Commission on Accreditation of Allied Health Education Programs (CAAHEP)—www.caahep.org Provides information about accredited allied health programs. Health Professions Network (HPN)—wwwhealthpronetorg, HPN fs a collaborative group representing the allied health professions; organizational members include professional associations, educators, accreditors, and credentialing and licensing agencies Healthcare Career Connect -eww.healthecareers.com Provides information about jobs in health care. References Explore Health Careers: Allied Health Profession. hups/www.explorehealthcareers.org Accotsd November 7, 2013, 2. Health Professions Network 1995-2002. Ten years of accomplishments, hutps/seww.healthpronetorglahp_monthfindex htm _Accened November 3, 2013, Chapter 6: History of lied Health Professions 3. Hendrix D, and Science. Presentation, 2006 aries R. Drew University of Medicine hutp:/collab.nlm.nih.gov/webeastsandvideos! drew/healthsciencecareers061.pal. -Accesed November 3, 2013, Donini-Lenhoff FG. Coming together, moving apart: Ahistory ofthe term allied health in education, accreditation, and practice. Allied Health. 2008; S7(045-52. 5. Monograph # 1, Allied Health—The Past and the Future, Weber State University Website itp /radpacs wehersdu/lmages/R_Walker/RADT 6204942/RADT%2049425420Supplemental. PDF. ‘Accesed November 3, 2013. 5, The Allied Health Professions Personnel Training Act ‘0f 1966, 8 Amended. Report to the President and the Congress. National Institutes of Health (DHEW). 033211, ‘Accesed November 7.2013. tpyeric.ed gov! 7. Allied health education, Medical education. Depart ment of Allied Health Evaluation. J Am Med Assor: 1978;240(26):2856-2863. 8. Commission on Accreditation of Allied Health Education Programs (CAAHEP) hutpstiwww.cashep.org Assessed November 3, 2013, 9, Bureau of Labor Statistics, U'S. Department of Labor, Occupational Outlook Handbook, 2012-2013, Edition hutp:tiwwwbls govlooh. Accessed January 14,2014 6