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ALLIED HEALTH PERSONNEL AND HEALTH-MANPOWER PROBLEMS* JOSEPH G. BENTON, M.D. Professor and Chairman, Department of Rehabilitation Medicine College of Medicine Dean, College of Health Related Professions State University of New York Downstate Medical Center Brooklyn, N.Y.

I T is entirely appropriate that the New York Academy of Medicine in its annual symposium on medical education address itself to the increasingly important contribution that allied health personnel can make to the delivery of health care. The numbers of physicians, their maldistribution along geographic as well as specialty lines, their productivity, availability, and changing patterns of practice are continuing areas of concern and study. In addition, as a corollary, the economics of the provision of health care already has become critical and will no doubt become even more important in these times of fiscal exigency at both national and local levels. Health care is the second largest component of the Gross National Product, with projections of a still further increase as a result of the anticipated expansion of national health insurance. Costs are now a matter of great concern to administrators of health-care facilities. The largest share of such costs is for personnel. There has been an increased production of physicians in the past two decades by the well established as well as by new medical schools and there are continuing pressures to expand physician output even further. Despite this, significant deficiencies still remain in the health-care-delivery system. This is especially true in inner-city and rural areas. The production of physicians probably will continue to increase, albeit the types of physicians may well differ from the traditional medical specialties that have characterized American medical education in the past. This complex situation will not be discussed further but it does have relevance for allied health

personnel. *Presented in a panel, The Contribution of Other Members of the Health Team to the Solution of Medical Manpower Problems, as part of the Fourth Annual Symposium on Medical Education, Prospective Medical Manpower Requirements-How Are They To Be Met? held by the Committee on Medical Education of the New York Academy of Medicine October 9, 1975.

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As one means to provide the escalating requirements for manpower of our expanding need for health care, the concept of the health-care team has evolved. Effective utilization of such teams has allowed for not only increased physician productivity but also for a more comprehensive approach to varying needs in the total management of patients. The utilization of allied health personnel in such configurations now has been well established in a number of medical specialties. Among others, psychiatry, obstetrics, rehabilitation medicine, pathology, pediatrics, and primary medical care may serve as prototypes. The significant role played by the allied health worker in these medical disciplines has been well demonstrated in a wide variety of health-care settings. Allied health personnel in such appropriately supervised and structured milieus can make an important impact on the ability to fulfill our needs for health-care manpower. Since the other members of this panel will no doubt address themselves to considerations of those who increasingly are being referred to as physician extenders (i.e., assistants to primary-care physicians, physician assistants or associates, nurse-practitioners and nurse-clinicians), I shall confine my comments to other allied health personnel. In addition, I shall not comment on the complex issues which have arisen regarding licensure, registration, certification, medical supervision, and independent practice for allied health personnel. They are important considerations, however, in relation to health manpower and perhaps they can serve as topics for future Academy symposia. In 1975 the Council on Medical Education of the American Medical Association (AMA) accredited 24 varieties of programs of allied medical education in collaboration with 29 other national organizations representing various disciplines. The requirements for accreditation for these programs evolved in a cooperative fashion; the first list of essentials was established in 1935 for the field of occupational therapy. In succeeding years, essentials for the other 23 disciplines were adopted by the AMA House of Delegates. The essentials, through this collaborative mechanism, undergo continuing review. This allows for medical input and for some degree of updating and stability in these programs. Unfortunately, it now appears that there has occurred a too rapid proliferation of other programs of allied health education which are not accredited by the AMA, largely as a result of the shift away from the early hospital schools to the almost explosive expansion of degree programs in community colleges, colleges, and universities. This has resulted in some degree of

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fragmentation, increased emphasis on credentials, as well as poorly conceived programs. This is especially significant now in the changing opportunities for allied health jobs in the health-care field caused by the widespread fiscal crisis and increasing requirements of accountability. Further, certain technological improvements, such as automation, have created a tightening of the job market in some allied health disciplines as a result of changed patterns of staffing for technicians and technologists in health-care facilities. In light of the above, a careful evaluation of existing as well as projected allied health-educational programs is indicated. That this is a matter of some concern is proven by the fact that in 1974 there were 2,650 AMA-accredited allied health programs in the United States (141 in New York State), with a total enrollment of 46,096 students and 26,108 graduates. The large number of other allied health programs which are not accredited by the AMA increase the number of graduates manyfold; there were an additional 1,615 allied health programs in existence in community colleges in 1970. In addition, projections in this latter group were for the establishment of more than 90 new programs by 1975. Increases in student enrollment can be expected to occur, since a Department of Health, Education, and Welfare study in 1974 indicated that the percentage of all entering college freshmen expressing interest in joining the health fields increased from 12% in 1966 to 18.3% in 1972-an increase of more than 50%. It is noteworthy that in this interval increasing numbers of ethnicminority and women students are represented in these figures. As a result of current fiscal retrenchment and decreasing opportunities in the teaching fields, large numbers of college graduates with majors in science are unable to find jobs or enter graduate education. It has been suggested that individuals in this group could be recruited into the allied health field through modified, nondegree educational programs which lead to a certificate of competency. This avenue is worth exploring. The large numbers and widespread varieties of allied health fields have resulted (for reasons of effective administration as well as fiscal economy) in the establishment of colleges or schools of allied medical or health sciences. These have increased rapidly in number, from 13 in 1966 to 130 in 1974. Such facilities have been established where high-quality clinical facilities and other medically oriented educational resources which are necessary are available, notably in universities and health-science centers. Many of these institutions have varying degrees of integration or coopera-

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tive arrangements with medical schools and their teaching and their affiliated hospitals. Recently, there has been a more rapid development of such institutions, so that their output of students, in addition to those of community colleges, outdistance by far the number of physicians graduated from American medical schools. For pedagogic as well as medicolegal reasons, physician-supervised clinical experience with patients are requisite elements in most of these programs for allied health personnel. The active involvement of medical scientists and physicians is essential and is required. As a consequence, the AMA-accredited programs have a built-in requirement of medical direction in the planning, development, administration, and operational phases of allied health-education programming. The number and variety of such programs can be expected to increase and it is hoped that the medical profession will continue to play its now well-established and necessary role in their development and direction.

Vol. 52, No. 9, November 1976

Allied health personnel and health-manpower problems.

1144 ALLIED HEALTH PERSONNEL AND HEALTH-MANPOWER PROBLEMS* JOSEPH G. BENTON, M.D. Professor and Chairman, Department of Rehabilitation Medicine Colle...
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