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Executive Summary
THIS REPORT IS THE RESULT of the first large, national study of the
enterprise known as allied health. It identifies the major functions of
allied health practitioners, a group that has been relatively unrecognized
by health policymakers. A major consequence of this low profile has been
that policymakers are often unaware of the impact of their decisions on
allied health services.
Allied health personnel constitute a majority of the health care work
force. They work in all types of care primary, acute, tertiary, and chronic-
and in all health care settings physicians' and dentists' offices, health
maintenance organizations, laboratories, freestanding facilities offering special
services, ambulances, home care, and hospitals. The levels of training of
allied health personnel are as varied as the care they provide and the settings
in which they work. These personnel include both highly educated persons
and others with only on-thejob training. They work with widely varying
degrees of autonomy, dependence on technology, and regulation.
Yet there is a paucity of information about them. There is not even a
consensus on what the term allied health means. Compared with nurses,
physicians, and dentists, the allied health work force as a whole has been
little studied. Prompted by a congressional mandate and funded by the
Health Resources and Services Administration of the U.S. Department of
Health and Human Services, this study by the Institute of Medicine was
intended to answer the following questions: First, what roles do allied health
workers perform and how will these roles fit into a changing health care
delivery system over the next 15 years? Second, what will be the future
demand for allied health personnel and how can public and private poli-
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2
ALLIED HEALTH SERVICES
cymakers ensure that that demand is met? Third, should these occupations
be regulated and, if so, how? Fourth, what sorts of actions should educators
take to prepare allied health practitioners for the workplace of the future?
The committee's recommendations are based on what existing evidence
tells about vital characteristics of the allied health labor market:
· the composition of the labor force—namely, the predominance of
technically competent women with a service orientation;
· highly regulated professions and work environments;
· education programs that are unable to compete effectively with other
academic programs for limited resources and sufficient numbers of stu-
dents; and
· employers whose organizations are undergoing sweeping changes in
their financial incentives and who must make hiring, compensation, and
work force allocation decisions in the absence of good information.
.
Throughout the study a major challenge for the committee has been to
capture the diversity of allied health occupations and at the same time
devise specific yet encompassing recommendations for those who must
make policy decisions that affect allied health personnel. Toward this end
the committee chose to focus on 10 allied health fields. It used the following
criteria in their selection: (1) each of the 10 must be large and well known;
(2) collectively, they must span the spectrum of autonomy; and (3) collectively,
their practitioners must work in a wide variety of health care settings.
The occupations that were selected include clinical laboratory technol-
ogists and technicians, dental hygienists, dietitians, emergency medical per-
sonnel, medical record administrators and technicians, occupational therapists,
physical therapists, radiologic technologists and technicians, respiratory
therapists, and speech-language pathologists and audiologists.
It is the committee's hope that this report is only the beginning of a
process that will clarify the place of all allied health occupations in the
health care delivery system.
ALLIED HEALTH PERSONNEL: WHO ARE THEY AND
WHAT DO THEY DO?
There have been many attempts to define allied health and to categorize
the occupations that should be covered by this umbrella definition. Lacking
a satisfactory definition of allied health, however, efforts to classify occu-
pations have focused on specific aspects of work and education (e.g., pa-
tient-oriented groups versus laboratory-oriented groups) or on the level of
education needed. The results of these attempts have not been enthusi-
astically embraced by allied health practitioners. The committee chose not
to join in the search for a definition. The benefits of making the term more
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EXECUTIVE SUMMARY
3
precise are less clear than the benefits of continued evolution. The changing
nature of health care makes some practices and practitioners obsolete at
the same time it opens up opportunities for the formation of new groups.
It is more important that pragmatism continue to prevail and that old and
new groups draw what benefits they can from belonging to "allied health"
than that a description of common characteristics defines the group.
Rather than define allied health, the committee thus chose to examine
policy-related characteristics of occupations that help explain how the fields
are variously affected by changes in the health care environment. These
characteristics include the amount of autonomy in the workplace, the oc-
cupation's dependence on technology, the substitution of one level and
type of personnel for another, flexibility in the location of employment,
degree of regulation, and inclusion in accreditation standards for facilities.
1 1
ESTIMATING SUPPLY AND DEMAND
To respond to the congressional charge "to identify projected needs,
availability, and requirements of various types of health care delivery sys-
tems for each type of allied health personnel," the committee had to resolve
issues of scope and approach. Given its limited funds and time the com-
mittee concluded that its greatest contribution would be to try to clarify
the future outlook for allied health personnel- which is crucial to strategic
planning and policy rather than to systematically assess the current sit-
uat~on.
Data Limitations
The committee's ability to fulfill its charge was severely hampered by a
lack of data, the result of a relatively low interest and small investments of
public resources in learning about the allied health work force. The com-
mittee had to rely on data sources that included some information about
allied health, however incomplete and unreliable those sources might be.
It assessed the existing data and conducted hearings, site visits, and work-
shops to round out its own expertise and enhance its understanding of the
forces that will shape the future of allied health occupations. The committee
could not make quantitative predictions of personnel shortages and sur-
pluses because of the usual uncertainties of occupational projections and
the absence of necessary data elements. Yet if employers, higher education
planners, federal and state officials, and others had soundly based projec-
tions, decision making might be improved.
The federal government in its role as monitor of the nation's economic
activity has a responsibility to monitor the health care work force and to
inform participants in the health care labor market and public policymakers
of trends and developments. The work of the Bureau of Health Professions,
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ALLIED HEALTH SERVICES
the Bureau of Labor Statistics, and the Center for Education Statistics is
to be commended and should be built upon. To improve the data on allied
health fields, the committee recommends that the secretary of health and
human services convene an interagency task force composed of repre-
sentatives from the Bureau of Labor Statistics, the Center for Education
Statistics, and other agencies that collect relevant data on the allied health
work force. This task force should work toward increasing the amount
and improving the quality of data needed to inform public policy decision
makers, health care managers, unions, prospective students, and aca-
demic institutions about the allied health occupations.
To help implement this recommendation and others that require federal
action, the committee recommends that the Department of Health and
Human Services maintain an organizational focal point on allied health
personnel to implement the grant programs recommended in this report,
to coordinate the recommended work of the interagency data task force,
and to facilitate communication among state legislative committees and
the federal government.
Factors That Affect the Demand for and Supply of
Allied Health Personnel
A first step in understanding or projecting the future of the allied health
occupations, either as a group or for individual fields, is to understand the
ways in which certain forces operate in the environment to drive demand
and supply. Early action in response to these forces can forestall the need
for more radical corrections at a later date.
THE CURRENT EMPLOYMENT SITUATION
Available data did not enable the committee to develop a reliable estimate
of whether the supply of practitioners in the various allied health fields
was in reasonable balance with demand. However, during the course of
the study, the committee was in contact with people who observe various
portions of the allied health labor market. These educators and employers
expressed increasing concern about the availability of students and prac-
titioners. Educators generally reported that their graduates found jobs
easily; employers, on the other hand, reported increasing difficulties in
filling vacancies. There are, of course, variations among fields and localities.
The committee heard reports of shortage most frequently for physical
therapists. For other fields there were reports of less severe shortages or
of hiring difficulties that were related to local conditions, to changes in
licensure, or to a particular employer's problems. The volatility of the labor
market could be easily seen: at the beginning of the study, some educators
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EXECUTIVE SUMMARY
5
were concerned about an oversupply of clinical laboratory personnel; 18
months later concerns centered on employers' growing difficulties in hiring
trained clinical laboratory personnel.
It is clear that changes in the health care system have caused and are
still causing shifts in employment patterns. Prospective payment and other
efforts to control hospital utilization caused initial reductions in hospital
employment for some allied health fields. For other fields the rate of
increase in hospital employment slowed; still others showed a substantial
increase. The growth of out-of-hospital care has accelerated, creating new
sites for the employment of allied health personnel. Whether in the long
run these changes translate into a substantial number of additional jobs or
merely a shift in the location of employment is an important question-
not only for projecting allied health personnel demand but also for the
way personnel are educated to practice in new settings. Moreover, allied
health practitioners working in these new settings also raise issues for reg-
ulators who are concerned with the quality of care and for traditional
employers who must now compete for personnel with employers who can
sometimes offer more attractive salaries and working conditions.
The committee used the best data available to make assessments of how
the forces that drive demand and supply will affect allied health labor
markets. Its intention is to alert decision makers to the kinds and magni-
tudes of market adjustments that they should expect and encourage to
sustain a long-term balance between allied health personnel demand and
supply.
Markets eventually adjust to change. Projected imbalances in demand
and supply do not necessarily mean that shortages or surpluses will occur.
Rather, they signal that employers and potential employees must and prob-
ably will make adjustments. Only rarely do markets fail to accommodate
changes in demand and supply. Yet there are inherent time lags and
inefficiencies in the process that can be lessened by public and private
interventions.
THE FUTURE EMPLOYMENT SITUATION
Barring major economic or health care financing contractions, the growth
in the number of jobs for allied health workers will substantially exceed
the nation's average rate of growth for all jobs. Unless some existing trends
are moderated, the flow of practitioners into the work force through grad-
uation from education programs will be, at best, stable.
For some fields, such as physical therapy, radiologic technology, medical
record services, and occupational therapy, the committee foresees a need
for decision makers to improve the working of the market so that severe
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ALLIED HEALTH SERVICES
imbalances in demand and supply may be prevented. Employers are al-
ready concerned about difficulties in hiring in some of these fields, and
there are signs that health care providers are beginning to search for ways
to accommodate new realities. Because some of the accommodations are
expensive and difficult to accomplish, the committee is concerned that
inaction may cause crises that could be avoided health care services could
be disrupted because providers of care are not available.
For some other fields, such as clinical laboratory technology and dental
hygiene, there are factors that could cause instability in both demand and
supply. For these fields the market is more likely to make the needed
adjustments, and serious disruptions are less likely to occur. Yet, in both
of these fields, there are unresolved issues concerning the level of personnel
that will be allowed to perform certain jobs. The way these issues are
resolved could determine whether major demand and supply imbalances
will occur.
Demand and supply for speech-language pathologists, audiologists, re-
spiratory therapists, and dietitians are expected to be sufficiently well bal-
anced for the labor market to make smooth adjustments. The kinds of
incremental adjustments that make careers attractive and the ways in which
personnel are deployed appear likely to maintain a state of equilibrium
over time. Nevertheless, for these and other allied health occupations,
changes in a number of factors that affect the health care environment
could cause disequilibrium. These factors include health care financing
policies, technology change, decisions about education programs, and reg-
ulatory policies. Those concerned with respiratory therapy, for example,
must closely monitor an educational capacity that has proved volatile, as
well as changes in home care reimbursement policy.
Our conclusions about the future outlook for allied health personnel
refer to the long term and are national in scope. For all fields, there are
likely to be periods of greater and lesser imbalance between now and the
year 2000, as well as local variations in demand and supply. The objective
of policy is to make the process of adjustment less painful and costly. A
decline in the quality of care, interruptions or reductions of service, and
the curtailment of investment in new technologies and organizational forms
(e.g., home or outpatient care) that might improve the efficiency of health
care delivery are all possible by-products of personnel shortages. The de-
cision to intervene in the labor market is made through the political process
and reflects society's willingness or unwillingness to tolerate painful dis-
locations. In many industries, such dislocations are viewed as normal and
acceptable. Yet public policy actions have demonstrated that health care is
viewed differently. The committee investigated how educators, employers,
regulators, and government can facilitate the smooth working of the
market.
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EXECUTIVE SUMMARY
7
EDUCATION
The function of the education sector in determining the size and com-
position of the work force is clear. Unless educators, in league with em-
ployers and professional associations, are successful at fostering an interest
in allied health careers among qualified prospective students, both the
education programs and the allied health work force will be weakened.
Demographic studies show that the proportion of the U.S. population
18 to 23 years old has been declining since the beginning of this decade
and will continue to decline through the mid-199Os. This shrinkage of the
college-age population will make it increasingly difficult for allied health
programs to attract qualified applicants. In addition, other attractive op-
portunities compete for that population's attention. This competition sug-
gests that greater attention will have to be paid to maintaining allied health's
share of the traditional pool of students and that less traditional sources
of students (e.g., minorities, older persons, and career changers) should
be tapped.
Academic allied health programs must overcome the perception, and to
some extent, the reality, that they are excessively costly and that their faculty
do not make sufficient scholarly contributions to their institutions. Modest
but strategic actions by the federal government can help education pro-
grams deal with these problems and compete more effectively for acade-
mia's limited resources. The committee recommends federal actions that
would provide a signal to those who carry most of the responsibility for
allied health education states, education administrators, and employers-
that these programs must not be undervalued.
The problems of allied health educators can be analyzed in terms of the
recruitment of students, the financing of programs, and the supply of
qualified faculty.
Faced with increased competition for students, educational institutions
must become creative in their approaches to recruitment. Alliances must
be forged with organizations that are also interested in recruiting allied
health personnel. The committee therefore recommends that educational
institutions, in close collaboration with employers and professional as-
sociations, organize for the recruitment of students. Students should be
sought in less traditional applicant pools among minorities, older stu-
dents, career changers, those already employed in health care, men (for
fields in which they are underrepresented), and individuals with hand-
icapping conditions.
One way to create access to a larger pool of students is to allow entry
into education through multiple routes.
Alternative pathways to entry-level practice should be encouraged
whenever feasible. State higher education coordinating authorities and
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ALLIED HEALTH SERVICES
legislative committees should insist that educational institutions facilitate
mobility between community college and baccalaureate programs.
The recruitment of minority students is a particular concern for several
reasons: minorities represent a relatively untapped source of manpower;
their representation in the population as a whole is increasing; and minority
professionals are more likely to serve underserved populations.
There have been a number of attempts to recruit and retain minorities
in the health professions. The lessons from successful models suggest that
interventions must occur early in a student's life and continue through the
academic career. The major source of support from the federal govern-
ment has come from the Health Careers Opportunity Program.
The committee recommends that minority recruitment efforts begin
before high school. Academic institutions must offer academic support
services for the retention of students and seek to promote educational
mobility. To succeed over the long term, these efforts must be made
integral to the mission of educational institutions.
The committee endorses the objectives of the Health Careers Oppor-
tunity Program and believes that funding levels must be maintained at
least at current levels.
Allied health programs are vulnerable to closure because they appear to
lag behind other programs in contributing to the academic standing and
financial health of the institution in which they are located. The committee
made a number of recommendations directed toward several aspects of
this problem. The overall strategy it recommends is to put allied health
programs on a more equal footing with other academic programs.
To enhance the stability of allied health education, national organi-
zations such as the American Society of Allied Health Professions should
investigate models in which academic institutions have succeeded in
broadening their financial base through such mechanisms as faculty prac-
tice plans, extension courses, and industry relationships. These national
organizations should also hold workshops to help institutions implement
the models and disseminate information.
Until credible alternative approaches are developed, the federal gov-
ernment and other third-party payers should maintain current reim-
bursement levels and mechanisms of support for clinical education.
The committee found that in some fields, shortages were inhibiting the
expansion of educational capacity despite strong student and employer
demand. More generally, deans believe that allied health faculty are be-
coming disassociated from clinical practice to the detriment of students'
preparation for the workplace. This is due in part to the academic reward
system, which does not place a high value on patient care. Attention to
faculty skills, however, should not come at the expense of progress in
solidifying the research underpinnings that guide everyday practice.
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EXECUTIVE SUMMARY
9
The federal government and the states should fund faculty develop-
ment grants in allied health fields, especially when faculty availability
and lack of clinical expertise inhibit the production of entry-level work-
ers.
A cadre of researchers and academic leaders is needed to advance the
scientific base of allied health practice. To accomplish this goal, insti-
tutions with strong research commitments should consider developing
programs that identify and nurture talented individuals. The committee
recommends the development of a federal research fellowship program
to support these activities.
Private foundations should support centers for allied health studies
and policy development. These university-based centers would provide
a critical mass of researchers and resources to advance technology as-
sessment, health services research, and human resource utilization.
Institutions offering allied health academic programs should reward
and encourage faculty clinical competence. Clinical practice that sustains
this competence should be made a requirement and a criterion for pro-
motion.
HEALTH CARE INSTITUTIONS
Health care employers directly generate demand for allied health work-
ers and indirectly affect supply by the conditions of employment they offer.
The committee reviewed the available literature to determine the sorts
of activities that employers could undertake to enhance the supply of allied
health workers by making a career in an allied health field more attractive
to people choosing an occupation and by increasing retention rates. Few
studies of allied health were found. Most of the relevant work is from
nursing, where intermittent shortages have focused interest on what it takes
to reduce nurse turnover. The literature makes it clear that employers are
able to affect work force entrance and exit rates. Even a small increase in
tenure has a significant impact on the size of the work force.
The committee recommends that employers strive to increase the sup-
ply of allied health practitioners by attracting people into allied health
occupations and prolonging their attachment to their fields. Some ways
to do this include increasing compensation and developing mechanisms
for retention. Employers should also look to new labor pools that include
men, minorities, career changers, and individuals with handicapping
conditions.
Despite the reluctance of employers to raise pay in a cost-contained
environment, if shortages occur, compensation will increase as administra-
tors are compelled to try to attract new entrants into allied health profes-
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ALLIED HEALTH SERVICES
signs. This increased compensation will make allied health personnel a
more costly resource.
The committee found little evidence of the strategic planning and re-
search that could help employers effectively use allied health practitioners
and at the same time preserve the quality of care, working within regulatory
constraints and avoiding professional resistance. Nowhere is there a sub-
stantial body of research to improve the effectiveness of allied health prac-
· . . . . .
Atoners activities.
Available data indicate that in many allied health occupations entry-level
pay is currently competitive with other comparable occupations, but allied
health salaries over the life of a career are so compressed that there is no
incentive to remain in the occupation. The effective use of human resources
will necessitate compensation incentives to increase tenure; it will also re-
quire that work be organized in a way that uses the greater experience of
the more expensive members of the work force.
The committee recommends that health care providers and adminis-
trators seek innovative ways to channel limited allied health resources
toward activities of proven benefit to consumers. Agencies such as the
National Center for Health Services Research and the Health Care Fi-
nancing Administration should sponsor research and technology assess-
ment to ensure that allied health services are effective and that they are
organized efficiently. Associations of employers, unions, accrediting
agencies, and professional associations should assist in disseminating
research findings and providing technical assistance in their implemen-
tation.
Health care managers will not succeed if they must act alone in these
efforts. Educational institutions and the professional associations, which
provide the basis for practitioners' goals and aspirations as well as technical
knowledge and skills, must also participate. Educators, employers, and
professional associations must engage in a regular exchange of ideas and
. .
experlmentatlon.
Chief executive officers, human resource directors, and other health
care administrators must develop methods for the effective utilization of
the existing supply of allied health personnel. Such methods must grow
cut of experimentation with new ways of organizing work efficiently and
the distribution of labor among skill levels, always ensuring that the
quality of care is not compromised.
Employers and educators must forge a relationship to ensure that grad-
uates are not frustrated by unrealistic expectations about what their work
will entail and employers do not ignore the need for career paths and
professional stimulation. To be successful, this effort requires that em-
ployers and educators try to understand each other's concerns and con-
straints and the pressures exerted by a changing environment.
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EXECUTIVE SUMMARY
11
Health care administrators and academic administrators must engage
in constructive exchanges to improve the congruence of employment and
education. These exchanges, which should take place at the state and
local levels, will be enhanced by the participation of educators who are
also leaders of the professional associations.
To facilitate this interaction, the committee recommends that state
legislatures establish special bodies whose primary purpose would be to
address state and local issues in the education and employment of allied
health personnel.
LICENSURE, CERTIFICATION, AND ACCREDITATION
the committee took a broad view of the charge from Congress and
examined the full spectrum of allied health personnel regulation, including
state licensure of individuals and health facilities, certification of individuals
by private organizations, the imposition of standards by third-party payers,
and voluntary accreditation of education programs.
Collectively, these regulatory measures affect the size and characteristics
of the allied health work force. They affect the functioning of the labor
market for allied health workers by defining who may enter the various
fields, by determining who has what degree of control over health care
services and dollars, and by constraining the range of staffing options
available to employers. They provide identity and legitimacy to newly
emerging occupations and their members.
Occupational licensure is of particular concern to the committee on sev-
eral grounds. As the most restrictive type of regulation, it grants exclusive
control over some health services to one type of worker. The committee
concluded that licensure is costly and cumbersome and that its effectiveness
in protecting the public has not been conclusively demonstrated. The ef-
forts being made in a number of states to reform the regulatory process
are encouraging, particularly the evolution of"sunrise" criteria to evaluate
the need for regulating new occupations, which the committee endorses.
Increasing the public's participation in the regulatory process is also a
positive development. The committee recommends that states strengthen
the accountability and broaden the public base of their regulatory statutes
and procedures. In the near term, the committee suggests that licensing
boards draw at least half of their membership from outside the licensed
occupation; members should be drawn from the public as well as from
a variety of areas of expertise such as health administration, economics,
consumer affairs, education, and health services research.
Flexibility in licensure statutes should be maintained to the greatest
extent possible without undue risk of harm to the public. This may mean,
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ALLIED HEALTH SERVICES
for instance, allowing multiple paths to licensure or overlapping scopes
of practice for some licensed occupations.
In light of concerns about the future availability of adequate numbers
of allied health personnel and in light of the rapid changes in health care
delivery, licensure appears to be inconsistent with the flexibility that will
be needed in the years to come. The committee believes that states should
try to find alternatives to licensure. Professional groups should work toward
strong title certification, devoting their efforts to convincing the public and
the industry of the credential's value much as certified public accountants
have done in their sphere.
The committee recommends statutory certification for fields in which
the state determines there is a need for regulation because this form of
regulation offers most of the benefits of licensure with fewer of its costs.
Medicare and other third-party payers should accept state title certifi-
cation as a prerequisite for reimbursement eligibility. Such certification
can and should be based on examinations and any other eligibility criteria
the states may establish.
The committee was concerned that jurisdictional struggles among health
occupations over scopes of practice and over referral and supervision re-
quirements were conducted without a body of research literature or the
informed judgments of knowledgeable, disinterested parties to guide those
decisions. Without such information, there is considerable risk that deci-
sions will be made on purely political and economic grounds. It was the
committee's view that the federal government should take an active part
in developing the necessary evidence for use by authorities responsible for
these decisions.
The Bureau of Health Professions (or other future focal points for
allied health personnel in the Department of Health and Human Services)
should sponsor a body with members drawn from allied health and other
health professions and from the health and social science research com-
munities to assess objectively the evidence bearing on "turf" issues. This
body, in consultation with other experts and interested parties, should
consider issues of risk, cost, quality, and access. It should draw on avail-
able scientific evidence and identify topics on which research is needed.
LON~TERM CARE
The committee chose to devote special attention to long-term care for a
number of reasons. The aging of the population and the need for long-
term care for the elderly are major forces in future demand for allied
health services. Despite broad concern about the needs of the elderly, there
is no certainty that the current financing systems will enable providers to
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EXECUTIVE SUMMARY
13
satisfy those needs. Furthermore, because long-term care requires both
therapeutic and social support services, it affords an opportunity to examine
the issues that surround the interaction of allied health practitioners with
other professionals such as nurses, as well as with workers having relatively
minimal formal education an important group of workers on which the
committee wished to focus attention.
Allied health practitioners relate differently to their clients and to other
health care providers in each of the three long-term settings that were
studied nursing homes, home care, and rehabilitation facilities. In nurs-
ing homes, minimally trained nurse's aides are often the primary care givers
with the most frequent patient contact. Recent congressional and Health
Care Financing Administration actions to increase aide training are a step
in the right direction. Yet, in the future, aides will require an even higher
level of training to link them more effectively to nursing and allied health
personnel in the delivery of hands-on care.
In recognition of the fact that the greatest amount of direct patient
contact and care in long-term care settings and programs is provided by
personnel at the aide level, the federal government and other responsible
governmental agencies should require education and training to increase
the knowledge and skills of these personnel. Demonstration projects should
be funded to encourage joint efforts by educators and employers in cre-
ating career paths for aides.
Some types of organizations that provide long-term care, such as home
health agencies and nursing homes, must coordinate a wide array of services
that are needed by fragile clients with multiple disorders. If this coordi-
nation is mishandled, the result may be fragmented care, sometimes du-
plicative efforts, and often less than optimal use of each service. Collaborative
team work by the care providers can improve the quality of care by helping
team members better understand each other's roles; it also helps to ensure
appropriate, coordinated care and might even reduce staff turnover by
increasing each team member's involvement in the job.
Therefore, the committee recommends that, because the problems as-
sociated with chronic illness do not fall within the boundaries of any
single discipline, administrators and care coordinators in long-term care
settings develop effective means to ensure that all personnel involved in
patient care work closely together to meet patient needs.
More generally, allied health workers in all long-term care settings need
special preparation to care for patients with chronic illness, to understand
the psychological aspects of aging, and to confront disability, death, and
dying. Therefore, the committee recommends that all allied health ed-
ucation and training programs include substantive content and practical
clinical experience in the care of the chronically ill and aged.
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ALLIED HEALTH SERVICES
COLLABORATIVE ACTION
Taken as a whole, the committee's recommendations are designed not
merely to advance the role of allied health occupations but also to preserve
the ability of the health care system to confront the problems of the next
decade. In drafting its recommendations the committee was cognizant that
no one entity in the public or private sector now has the power or re-
sponsibility to determine whether allied health education and practice will
adequately respond to the challenge of changing patterns of illness and
care requirements. Ultimately, collaborative action will be required. None
of the committee's recommendations is self-implementing. Each requires
a principal party to convince others to join in their efforts or to accede to
alterations in traditional ways of operating, whether in educating students,
delivering services, or supporting professional interests.
Representative terms from entire chapter:
health personnel
