A few weeks ago I had the honor of addressing the Association
of Schools of Allied Health Professions at its annual meeting.
Both the Pew Commission and the Center for the Health Professions
have been actively involved with the allied health community
and the over two hundred different professions and occupations
that they represent. Over the years I have come to recognize
the ways in which these professionals (i) are invisible to many
policymakers.
However, much like the crisis brewing within the nursing community
(ii), there are pressing issues in our allied health workforce;
perhaps even greater, and better hidden.
Approximately sixty percent or of all health care workers fall
into the "allied health" category. In other words
they constitute a workforce of about six million professionals
(compared to the largest professional segment of two and a half
million nurses.) And because of the extreme segmentation of
their education, regulation and practice, there is little, if
any, crossover in work duties. If you are short two lab techs,
for example, it is difficult to simply find two more to cover
a shift.
Many of the issues facing allied health do not differ from
those that confront nursing: the growing demand for care anticipated
by the aging U.S. population, the collateral aging of the health
professional population, more competition for employment of
the smaller entry-age cohorts of potential workers, extreme
pressure within health care for higher quality and cost containment
at a time when levels of acuity are growing, a proliferation
of new demands brought on by
technological change and innovation, tighter budgets leading
to lower salaries, and a growing opportunity for women outside
of health care.
In thinking about the unique challenges facing allied health,
several distinctive opportunities for solutions come to mind.
In particular, for allied health educators, these opportunities
could lead to an important repositioning of their profile on
campus and within health care practice.
First, the education community should revisit the multi-skilling
proposals of the early nineties. These seem to have lost their
way. The flexibility that such programs and practice models
projected will be desperately needed by the system of care as
it responds to the challenges ahead. These should be built into
incremental career ladders that allow students to continuously
reenter the educational and training programs from the workplace.
Second, schools should take the lead in creating entirely
new arrays of education. Most important among these is the further
development of education/work partnerships. As care systems
realize just how threatening the lack of appropriate workers
will be, they will be increasingly ready to engage in new types
of relationships with schools. A second great opportunity will
be those programs that build stronger ties to labor and provide
education for members of the service unions. Ideally, partnerships
should be three way combinations among management, labor and
education. Such integration offers great rewards as we look
to high school students as a primary source of new health care
workers.
Related to these partnerships is the research and management
consulting opportunity to become the expert on how to build
and sustaining management/labor partnerships. These partnerships
seem inevitable as a way of rationalizing the system of care,
but they will need academic support to make them successful.
This is a green field for the allied health schools to move
into.
Fourth, as the population ages it will need more health care
workers as well as creative new ways to organize and deliver
health care services. Allied health represents the workforce
that will carry most of this service responsibility.
Schools and professions should strengthen their ties to the
aging population, and to the large organizations that are their
advocates, without delay.
Part of this infrastructure rebuilding to serve the aging
population will need to be built outside of the health care
citadels of today and find itself realigned with local communities.
Allied health should examine how it currently relates to the
greater, non-care delivery community, and push to improve its
understanding and relationship with its members. This activity
should range from informing curricula in the local high schools
to monitoring building codes of government planning agencies.
Allied health has made significant strides in adding a health
services agenda to its research focus - this should continue.
Knowing how and when allied health care workers add value to
a care service process will be vital information, and the workers
who make up the profession must be aware of the importance of
their roles as they move forward.
Accreditation still hangs around the neck of allied health
schools and keeps them from addressing these and other challenges.
The accreditation process should be radically reformed in order
to serve these institutional purposes, or it should be abandoned.
Finally, to carry out all of these recommendations, the allied
health schools must be willing to invest in leadership. Leadership
in education, practice and policymaking can make a difference,
but it requires attention and resources.
The Center for the Health Professions looks forward to continuing
its work with the allied health community and the vital interests
it serves.
Edward O'Neil, M.P.A., Ph.D.
Director, The
Center for the Health Professions
University of California, San Francisco
3333 California Street, Suite 410
San Francisco, CA 94118
(415) 476-8181
(415) 476-4113 (fax)
eoneil@itsa.ucsf.edu
(i) Ruzek, J, et. al., The Hidden Health Care
Workforce, Center for the Health
Professions, San Francisco, 1998.
(ii) Kimball B, O'Neil E. Healthcare's human crisis: the American
nursing shortage.
Princeton, NJ: Robert Wood Johnson Foundation; April 2002
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