What is allied health? |

Boundaries within Medicine

Allied health refers to a field of health care in which workers participate with physicians and/or nurses in a team effort to promote health and prevent disease in the patient. Allied health occupations may be either professional or technical, depending on the extent and caliber of didactic learning and clinical study as well as on the duties associated with the occupation.

Throughout the evolution of the American health-care system, the role of the physician has remained relatively stable and of primary importance. The American Medical Association
(AMA) successfully developed specialty categories to solidify the role of the physician and to protect the doctorate in medicine.

The designation “allied health” appears to be a creation of the AMA to describe those paramedical occupations that developed within the evolving health care system in response to the advancing technology and expanding health care facilities, such as hospitals, clinics, medical centers, and laboratories. The AMA, through its various societies and committees, guided the formation of a variety of occupations to perform tasks that would not or could not be performed by the medical doctor or nurse. These occupations were carefully husbanded by strict job descriptions, educational guidelines, and evaluation criteria. For the most part, allied health professions are those fields that the Committee on Allied Health Education and Accreditation (CAHEA) of the AMA has scrutinized according to essential criteria that have been adopted by the particular profession. These criteria are primarily the standards that are established by a profession as a means to establish education programs that instruct new professionals, to perform a self-study by each program, and to be evaluated by an outside visiting team. A profession is also characterized by the establishment of a society or association by those practitioners of the occupation for the purpose of supporting the research, teaching, and learning of its members. The society sets standards of job performance and evaluation and also establishes a code of ethics to which its members adhere.

Those professions not accredited by the CAHEA are dentistry, optometry, podiatry, chiropractic, veterinary medicine, physical therapy, and nursing. Whether a profession finds the designation “allied health” complimentary or acceptable appears to depend on the status of the profession with respect to its age, the amount of education and responsibility required, and whether autonomy from the AMA is desired. The more autonomous a profession, the more impressive the identity and social status of its practitioners with respect to salary, power, and influence. For example, although a physical therapist can have a private practice rather than be employed in a hospital or another setting that guarantees a certain number of patients, a therapist is not legally allowed to treat a patient without an order from a physician. According to the Bureau of Labor Statistics, In 2012, the median salary for a physical therapist (PT) was $79,860; those in private practice earned slightly more. To have a private practice, a physical therapist must cultivate a list of local physicians for referrals.

The nursing profession is a good example of a health profession that, to a greater or lesser extent, is not under the allied health umbrella. It is not listed by either the CAHEA or the Association of Schools of Allied Health Professions (ASAHP). Although the US government provided scholarships for nurses in the Allied Health Personnel Training Act of 1966, nursing is excluded from the definition in the Health Professions Education Amendment of 1991. Nursing has been continuously able to maintain its integrity as a profession for a number of reasons: It has always had solidarity provided by the National League of Nursing (NLN), it has continued to develop its education requirements and responsibilities, it requires government licensure, and it has a very visible role in health-care delivery—to some extent more than that of the physician.

The nursing profession continues to develop and is reaching into areas that were traditionally considered to be the domain of the physician. Nurse practitioners are able to take medical histories, read x-rays, order and read tests, and diagnose conditions. They are able to prescribe medications in eighteen states and can be reimbursed for some services by Medicare and Medicaid. Nurse anesthetists can work independently of a doctor in a variety of health-care delivery settings.

According to the 1991 Health Professions Education Amendment, the term “allied health profession” excludes both the nurse and the physician assistant. It includes all those who have had educational training in a science program relating to health services, earning anything from a certificate to a doctorate. It further defines allied health care personnel as individuals who share in the responsibility of the delivery of health-care services or those related to health care. Such services include the identification, evaluation, and prevention of disease and disorders, as well as those related to diet and nutrition, health promotion, rehabilitation, and health systems management.

Those professionals who are excluded from the label of allied health care personnel by the government are doctors of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, pharmacy, chiropractic, and clinical psychology. Also excluded are pharmacists with bachelor’s degrees, social workers, and those with graduate degrees in public health and health administration. It is confusing, however, to have physician assistants excluded from allied health by the government and the CAHEA but included in the designation by the ASAHP. Physical therapy is included by the government and the ASAHP but excluded by the CAHEA. The reason for such apparent confusion rests with the various points of view. The government is interested in the service provided by the particular occupation. The ASAHP is interested in promoting allied health education, professional growth, and collaboration between the professions and in influencing public policy as it relates to these factors. The CAHEA has the responsibility of overseeing the allied health education programs that are under the AMA umbrella.

According to the ASAHP, allied health professionals serve in a variety of autonomous and service positions. Therapists and counselors function in private practice and are directly involved with their patients. The medical technologist practices in a laboratory profession at least once removed from patient contact. Allied health care professionals work in every aspect of the health delivery system in a variety of disciplines with a variety of educational experiences. They work throughout the country in a number of physical settings, including hospitals, physicians’ office laboratories, clinics, hospices, community programs, schools, and extended-care facilities.

Because of the dynamic state of health care, many allied health care occupations eventually become professions. The expansion of knowledge and evolving technology require increased learning and understanding. The aspiring practitioner of a particular occupation is confronted with a body of information that must be mastered. Those involved with the occupation must organize the information, find new applications, and teach what they know to students interested in the occupation. Essentials or standards are adopted, and a new allied health profession is born. The evolution of the medical technologist or clinical laboratory scientist from the help hired by the pathologist provides a good example of how a profession begins and then sustains itself. The first allied health professions to establish essential criteria and have their education programs evaluated by the AMA were occupational therapy, medical technology, and physical therapy.

Science and Profession

Allied health is a designation that can be understood only in the context of direct health care providers and patients. Direct health care providers are those who are licensed to interact directly with the patient in diagnosis and/or treatment. Examples are medical doctors of various specialties, nurses, dentists, optometrists, chiropractors, and podiatrists. Ancillary activities that support direct care would be described as allied health. Those careers that are involved with these activities are allied health careers or professions.

The ancillary activities to primary care have come about for many reasons. Among them are the advances in technology that have resulted in more sophisticated diagnostic testing. Only the direct caregiver such as a medical doctor (and in some cases, a nurse practitioner) can make a diagnosis. This activity may require data, however, that are provided by the medical technologist, audiologist, diagnostic medical sonographer, or radiologic technologist; some data are provided only after time-consuming and specialized laboratory activity provided by the cytotechnologist or the blood bank technology specialist. Health care often involves specialized equipment and someone specifically trained in running it, such as the perfusionist, the radiation therapy technologist, and the cardiovascular technologist; the more mundane but very important task of medical record keeping is performed by an administrator and technicians; highly specialized areas of therapy have resulted in careers that require a very narrow area of medical understanding or a specialized area that complements the medical activity of the doctor, such as art therapist, music therapist, occupational therapist, physical therapist, and respiratory therapist.

Allied health has become an important aspect of the American health-care system. Sophisticated technology and equipment, new therapeutic techniques, routine record keeping, complex laboratory tests, and specialized therapies have resulted in careers that complement the duties of the direct caregiver. Clinical care can only be as good as the primary-care professionals supported by allied health care professionals. An adequate allied health system depends on the support of allied health educational institutions, professional organizations, and clinical settings that support service delivery, research, and education.

If the designation “allied health” is to be related to those professions whose essential criteria for their education programs are adopted by the CAHEA, then three things must be considered when describing each of the allied health professions: first, the educational background in terms of degree requirements and of didactic and clinical experience; second, the occupational duties to be performed; and third, the association or organization that takes on the responsibility of sponsoring the profession with regard to organizing, developing, teaching, and evaluating.

For a number of allied health occupations, either a bachelor’s degree is not required or this requirement varies among programs. Examples of such occupations often use the designation “technician,” as in emergency medical technician, histologic technician, medical laboratory technician, medical record technician, and respiratory therapist technician. Others receive very specialized training, such as the diagnostic medical sonographer and the perfusionist. Examples of those allied health professionals in fields whose essential criteria are evaluated and accredited by the CAHEA and that have maintained the bachelor’s degree are anesthesiology assistants, athletic trainers, specialists in blood-bank technology, cytotechnologists, medical illustrators, medical records administrators, nuclear medicine technologists, occupational therapists, radiation therapy technologists, radiographers, and respiratory therapists.

Even under the aegis of the AMA, however, CAHEA evaluation and accreditation are not enough to be used to define allied health personnel. The ASAHP lists approximately sixty-five careers that fall under the definition of allied health professions as outlined by the federal government. Among those careers are art therapist, audiologist, dance therapist, dental assistant, dietitian, educational therapist, genetic counselor, health-care administrator, histotechnologist, kinesiotherapist, music therapist, nutritionist, ophthalmic medical technologist, optician, optometric technician, physical therapist, psychiatric technician, recreational therapist, speech/language pathologist, veterinary technician, and vocational rehabilitation counselor. The ASAHP listing of allied health careers demonstrates an allied health view that extends beyond the medical profession into autonomous professional areas such as dentistry, optometry, dietetics, nutrition, physical therapy, and veterinary medicine.

Credentials such as certification, registry, or licensure of an occupation/profession are the final aspect that has an impact on the allied health professions. Certification implies that an individual has met certain ethical criteria and has achieved the minimal standards required to practice a particular occupation. Certification is usually provided by a nongovernment agency. Registry, which is usually provided by a government agency, involves being placed on a government listing. It is usually used with occupations that involve a minimal threat to public safety.

Licensure is an important part of the health care system because it attempts to protect both the public (which must rely on competent care) and the health-care personnel (who must protect the profession to which they belong). Public safety is achieved when a government agency is given the responsibility of overseeing the credentials of a person who attempts to practice a particular occupation or use a particular title. The health-care worker is protected because licensure prevents unqualified practitioners from entering the occupation or profession. It also appears to increase salary benefits and prestige, as well as to provide the profession with greater visibility with respect to legislative government and the public in general.

Probably one of the most important aspects of licensure is that it legally defines the extent of the activities that may be performed in the profession or occupation. For example, medical technologists and respiratory therapists can monitor arterial blood gases and electrolytes. If licensure to perform the tests were given to only one of the occupations, however, it would be illegal for individuals in the unlicensed profession to perform the tests. Licensure is particularly significant to the allied health professions because duties may overlap, especially in the variety of health-care settings that are being developed.

The negative aspects to licensure should also be considered for their impact on allied health and most health-care professions. There is a decrease in mobility when each state has its own licensing commission or agency. Some studies indicate that many rural areas do not have adequate care, and it is believed the licensure of professions not already licensed in some states, such as medical technology, could add to this problem by discouraging the movement of health care workers to these areas.

Finally, licensure affects not only individuals but also the facilities in which health care is practiced. Laboratories and direct-care facilities such as hospitals are usually regulated by government licensure. The movement of health-care treatment from hospitals to the many alternative facilities that now exist may also require that standards be established and evaluated.

Because of the uniformity of the health-care system, there is ease of mobility horizontally (from location to location) for those in allied health occupations. There is consistency of facilities, equipment, job opportunity, job description, operating procedures, and regulations. Yet the very reason for the creation of most allied health occupations or professions—the requirement for specialized knowledge, procedures, or technology—makes them narrow in focus. Consequently, many people agree that there is less vertical mobility within some allied health positions.

Nevertheless, the educational requirements for some allied health occupations, particularly a bachelor’s degree in liberal arts, provide greater opportunity for advancement. Job advancement opportunities can also increase with advanced degrees. For example, a bachelor’s degree in medical technology or a master’s degree in business administration provides an individual with professional opportunities in many of the ancillary industries that support the American health-care system.

Perspective and Prospects

The health-care system in the United States is the product of three major forces: private enterprise, government, and charity. Although each of these forces may have had different objectives, their united goal has been the improved health of the American population. The primary location for the delivery of health care has been the hospital. The health-care professions that evolved within this system and that have, in large part, given direction to its evolution are the medical profession and the nursing profession.

With the establishment of hospitals as the site of health-care delivery, the nursing profession made itself fundamental to the continued evolution of health care. The hospital became the keystone of the entire health care system, as well as the focal point where each of the three forces would exert its influence.

As a result of health care moving from the private home to the public setting of the hospital, the health care of the patient improved, but at the same time it became more technology-oriented and more costly. Since the 1950s, technological advances have had a direct effect on patient care and therefore on the ever-evolving professions of medicine and nursing. During this same time of technological growth and specialized care, new areas of health care have begun to develop that are outside the accepted areas of medicine and nursing but allied to them because their common goal is the health of the patient.

As many as sixty-seven professions can be described as allied health. They complement the activities of not only the physician and nurse but also a variety of direct caregivers such as dentists, optometrists, and clinical psychologists. Allied health activities take place in hospitals, physicians’ office laboratories, private laboratories, clinics, schools, extended care facilities, and the variety of other facilities utilized by direct care providers.

Advanced technology, the professions that constitute the health-care team, and the administrative bureaucracy form the nearly $2 trillion health-care industry in the United States. For 2012, the World Bank estimated that health care spending was 17.9 percent of the gross domestic product of the United States. The health-care system also provides one of the most rapidly expanding areas for job opportunities in the American economy.

Allied health occupations and professions are an integral part of the American health care system. Their role is indispensable to those professions responsible for patient diagnosis and treatment. Allied health provides a vast market for scientific products and instrumentation. It is composed of and supported by an array of professional organizations and educational institutions that will provide the impetus for its continued growth and evolution.

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