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Anne Federwisch,
OTR Few people ever identify themselves as allied health professionals. Instead they’re OTs, PTs, respiratory care professionals, speech-language pathologists, or members of any one of hundreds of other disciplines. Yet for the past four decades or so, they have been thrown together under a collective heading. As the individual professions struggle to maintain their identity in the mercurial healthcare system, the question becomes: Is the alliance worth it? The answer isn’t easy or definitive. "There are trade-offs when you join any group larger than your own," said Sam Giordano, MBA, RRT, executive director of the American Association for Respiratory Care. He is also chair of the implementation task force of the National Commission on Allied Health,which is devising strategies and incentives for using the full potential of allied health professionals in the U.S. healthcare system. "The upside is, you can put more resources behind issues of common concern," Giordano said. "What you trade off is you just cannot pursue your discipline-specific agenda to the exclusion of the other groups involved." More political power The strength in numbers is particularly significant when addressing legislative issues, according to Jack Front, MBA, PT, associate director in the department of practice at the American Physical Therapy Association. "When dealing with regulatory concerns such as federal regulations [like those from] HCFA, there’s more clout than with just a single organization," he said. That’s because the individual disciplines have far fewer members than nursing or medicine. For example, in 1997 there were approximately 51,000 OTs in the United States, compared with 2.6 million nurses, about 140,000 in the state of Texas alone. "But collectively, the group known as allied health has been said to encompass 4 to 6 million workers" nationally, said Diane Roberts, DrPH, president of the Association of Schools of Allied Health Professions. "That’s a significant number when you start talking about the political process." One of the crowd But collective clout comes at a cost, said Louise Zingeser, PhD, CCC-SLP, director of healthcare services for the American Speech-Language-Hearing Association. Sometimes those outside the professions view allied health practitioners as interchangeable parts rather than as distinct disciplines, she said. "From a consumer perspective, it can be confusing. From an administrative or payer perspective, it may be misleading as well." And there’s another downside to the label, according to Zingeser. "There’s been some implication about the allied health title that it implies a subservient role," she said. The terminology is also somewhat ambiguous. "The classification may not be the most accurate," Giordano said. Allied connotes a relationship that may not be present among all members of the diverse group. Dental hygienists don’t interact with respiratory therapists, for instance, but both are allied health professionals. "In our system, we have a tendency to want to pigeonhole everybody," he said. In the case of allied health professionals, the pigeonhole may be too big. History of the alliance Although many allied health practitioners work collaboratively in patient care, the professions never really chose to ally under one heading, Roberts said. They got affiliated more by happenstance. "The hospitals were giving up their training programs [in the early to mid ’60s] to community colleges, academic health science centers, and four-year colleges and universities because of the feeling both by the professions as well as the hospitals that with the growth of knowledge in the areas that there needed to be a broader education rather than simply a training," Roberts said. In that exodus from hospital training grounds to academic settings, disciplines were grouped as allied health more for convenience than anything else, she said. The federal funding of allied health academic programs that began in the ’70s solidified the categorization, said Kalya Cotkin, MS, OTR, occupational therapy program director at Texas Tech Health Sciences Center in Lubbock. Reimbursement policies further underscored the classification and shaped each discipline’s traditional areas of practice as well. "Where has the funding flowed? It’s flowed into physical medicine and rehab," Cotkin said. "So what’s happened to psych practice? It’s really shriveled up, almost disappeared, even though many of us will continue to say that’s the basis of OT practice." All in one? With the continual efforts to cut healthcare costs, some fear that entire disciplines under the allied health umbrella may disappear as well. Many policymakers are pushing for multiskilled and crosstrained clinicians who could be more flexible in the roles they play in patient care, theoretically cutting costs. Yet, each of the allied health professions arose to fill a specific need, Giordano stressed. Although the professions may have common ground, each developed to fill a unique gap in terms of knowledge and expertise, he said. Combining them at the professional level wouldn’t make sense, because it would cost too much in terms of time, education, and competency evaluation. "We can teach motor skills to people [quickly], but more than motor skills are necessary. If whatever discipline required only motor skills, then there wouldn’t have been the formation of a profession," he said. But the danger to individual disciplines still exists. "I think that any professions that can be grouped together by someone who doesn’t understand the distinct value of each profession may be at risk," Zingeser said. "It’s a tough climate that we’re all working in." Like many other health professionals, though, she thinks that her discipline will ultimately survive by documenting its value through outcomes research. Cotkin, too, thinks that OT will continue no matter what happens. "I think there may come to be someone called a rehab therapist," she said, "but that doesn’t mean OT will not exist. If OT doesn’t exist, somebody will reinvent it. It’s an incredible, multifaceted type of profession." Roberts is also cautiously optimistic about the future. "It’s awfully hard to kill something that already has an identity," she said. She does not think it likely that professions that require at least a baccalaureate degree will die, though some certificate or training programs may be at risk. "There’s a strong will to survive [among the disciplines], and I suspect they will." |
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What does allied health mean? It depends on whom you ask. "I’d be telling a fib if I told you there was any consensus as to how you define allied health," said Diane Roberts, DrPH, president of the Association of Schools of Allied Health Professions. Even the National Commission on Allied Health debated a dozen definitions before issuing its 1995 report, according to Sam Giordano, MBA, RRT, executive director of the American Association for Respiratory Care and chair of the commission’s implementation task force. The commission settled on a frequently used definition of allied health professional, from Section 701 of the Public Health Service Act of 1992. It’s a fairly narrow definition, but certainly not a brief one. According to that definition, an allied health professional is "a health professional (other than a registered nurse or physician assistant) who has received a certificate, an associate degree, a bachelor’s degree, a master’s degree, a doctoral degree, or postbaccalaureate training in a science related to health care; who shares in the responsibility for the delivery of healthcare services or related services, including services relating to the identification, evaluation, and prevention of disease and disorders, dietary and nutrition services, health promotion services, rehabilitation services, or health systems management services." The explanation goes on to list certain degrees that are not held by an allied health professional, including degrees in pharmacy or social work. |
