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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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Suggested Citation:"Index." Institute of Medicine. 1989. Allied Health Services: Avoiding Crises. Washington, DC: The National Academies Press. doi: 10.17226/769.
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INDEX 331 Index A Professional associations and societies Access to health care Administration on Aging, 277 scenario Administrators, see Health care adminis- general, 92-93 trators; Medical record administra- occupation-specific, 103, 113-114, tors and technicians 126-127, 132, 139, 145, 151 Aging and aged persons, see Elderly state regulatory restrictions, 240, 243, AIDS, 68-70, 102, 124, 262 246, 256-257 Allied health occupations Accountants, 248-249 alternative financing scenarios Accreditation, 18-19, 42, 182-183, 188 general, 90-93 barriers to career promotion, 79-80 by occupation, 103, 113-114, 126-127, cardiovascular technicians, 40-41 131-132, 139, 145, 150-151 dental hygienists, 23, 298 definitional issues dietitians, 25 general, 1-3, 15-20, 41-42 emergency medical technician educa- occupation-specific, 20-41, 291-295 tion, 27, 117 included in study, criteria, 2, 19 lab technicians, 22 metro-nonmetro population, 226 perfusionists, 39 multiple competencies development, physical therapists, 30 220, 223, 229, 265-266 private sources, 253, 254-255 new fields, 38-41 radiologists, 35, 146 public awareness of, 15 respiratory therapists, 36 study approach, 1-4, 44-45, 59, 96, speech-language pathologists and audi- 283-284 ologists, 38 supply/demand measurement, 44-61, statistics from accrediting bodies, 60 63-94 see also Committee on Allied Health by occupation, 96-153 Education and Accreditation; see also specific occupations

INDEX 332 Ambulance attendants, see Emergency Applied Management Services, Inc., 193 medical technicians Area Health Education Centers, 168-169, Ambulatory care. see Outpatient care 277 American Academy of Speech Correction, Associate degrees, 83-84, 103, 109, 196, 37 211 American Association for Respiratory Associations, see Professional associa- Care, 36, 143, 301 tions and societies American Association of Medical Record Astin, A. W., 171 Librarians, 28 Audiologists, see Speech-language pathol- American Board of Cardiovascular Perfu- ogists and audiologists sion, 39 Automation, 77, 119, 120, 138 American College of Physicians, 269-270 American College Testing Program, 161 B American Dental Association, 23, Begun, J. W., 246 243-244, 245-246 Biomedical Sciences Preparation Pro- American Dental Hygienists' Association, gram, 170-171 23, 109, 243 Blacks, 167, 170, 175, 218, 264 American Dietetic Association, 19, 25, Blue Cross, 100 111, 297 Blue Shield, 100 American Hospital Association, 49, 99, Boards, state regulatory, 241-242, 118, 137, 223, 225-225 249-251, 255 personnel supply/demand data, 297, Bureau of Health Professions, 3-4, 12, 299, 300, 301 178, 252, 256-257 American Hospital Radiology Administra- dental care, 107, 297 tors, 137 lab technicians, 22, 300 American Indians, 166, 167 needs projections, 53, 61 American Medical Association radiologists, 35 definition of allied health, 16 supply/demand data, 45-46, 76, 260-261 occupational therapy and, 30 Bureau of Labor Statistics, on allied American Medical Record Association, health, 4 28, 118, 299 projections methodology and data, American Occupational Therapy Associa- 54-57, 59-60, 61, 70-71, 73, 96 97, tion, 30, 31, 124, 125, 189, 300 307-310, 311-318 American Physical Therapy Association, salaries and wages, 49-50, 212-214 32, 33-34, 60, 79, 130, 189, 212, 300 supply/demand and characteristics, 25, American Society for Medical Technol- 29, 37, 46, 54, 59, 85, 296-302 ogy, 104 Burnout, 117, 172, 173, 218, 219-220 American Society of Allied Health Profes- sions, 8, 15, 160, 261 C American Society of Clinical Patholo- California, 271-272 gists, 298 California Dental Association, 245 American Society of Extra-Corporeal California Dental Association v. Office of Technology, 39 Statewide Health Planning and American Speech-Language-Hearing Development et al., 245 Association, 37-38, 60, 147, 302 Cardiovascular technology, 40-41 American Women's Physical Therapeutic perfusionists, 39-40 Association, 32

INDEX 333 Career choice, 8, 163-165, 196, 218 minorities, 167 employer role, 208-209 occupation-specific activities, 16, 36, federal vocational guidance, 304 39, 40 job mobility, 47, 220-221, 229, 247 statistical data on supply/demand, 50, minority access, 8, 169-175 60, 160, 161 nursing aides, 274 women, 85 rural service, 227-228 Committee on Nursing Home Regulation, salaries and, 214 264 see also Women's career choices Committee on the Cost of Medical Care, 52 Carpenter, E. S., 237, 253 Committee to Study the Role of Allied Census Bureau, 50, 55, 65, 66-67, 225, 308 Health Personnel Center for Education Statistics, 4, 60, 82, study goals, methodology, themes, and 83-84 organization, 1-4, 44-45, 59, 96, Center for Nursing Research, 191 283-284 Certification, 18-19, 42, 252, 255 Community colleges, 83-84, 103, 109, accountants, 248-248 173, 176, 188, 198 cardiovascular technicians, 40-41 Compensation, see Salaries and wages dental hygienists, 23 Competition dietitians, 25 among allied health turfs, 36, 126, 243 emergency medical technicians, 27, 298 employer considerations, 206-207 federal guidelines, 252, 324-328 job vacancies and, 48 lab technicians, 22, 299 other professionals and allied health perfusionists, 39 personnel, 78-79, 113 physical therapists, 30 salaries, 209-210 private sources, 252-253 see also Supply/demand, general; radiologists, 35 Supply/demand, specific occupations respiratory therapists, 36 Comprehensive Employment Training speech-language pathologists and audi- Act, 180 ologists, 38, 302 Comprehensive Health Manpower Act of by states, 238, 239 1973, 168 supply/demand and, 11-12 Computer-based technology, 77, 119, 120, Children, 66-67 138 handicapped, 125, 126, 262 Consumerism, 113, 238, 249-250, 255 hearing impairments, 150 Cooperatives, 228 Chronic diseases, 70, 144, 230, 276; Cost containment, 93 see also Long-term care dietitians, 112 Classification of allied health instructional physical therapists, 135 programs, 291-295 Sunrise provisions, 319-323 Clearinghouse on Licensure, Enforce- Council of State Governments, 247, 252 ment, and Regulation, 252 Court decisions, 245 Clinical education, 176, 192-194, 195 Credentials, 235; Clinical laboratory personnel, see Labora- see also Certification; tory technologists and technicians Licensure; College of Health Deans, 160 State licensing Commission on Dental Accreditation, 298 Cumulative Index of Nursing and Committee on Allied Health Education and Accreditation, 42, 176, 192

INDEX 334 Allied Health Literature, 216 occupation-specific, 108, 125, 144, 150 Current Population Surveys, 50, 59, 61, Drugs, 102 82, 146, 316 E D Economic models, see Models Demographics, 7, 64, 65-68, 164, Economically disadvantaged, 168, 218, 304 217-218, 225, 261-262, 264 Educational finance Demand, see Supply/demand, general; clinical training, 192-194 Supply/demand, specific occupations federal funds, 8, 9, 87, 168, 178-180, Dental hygienists 190, 192-193 definition and characteristics, 22-24, minorities, 168 291, 293, 297 private funds, 9, 15, 169-171, 172, education, 23, 109, 161, 196, 293 182-183 history, 23 state funds, 9, 87-88, 174, 180-182, 190 licensure, 23-24, 297-298 student investment, 197 research, 191-192 supply/demand and, 86-88, 168, salaries, 24, 106 173-174, 178-180, 189 state regulation, 243-246 Education, general, 2 supply/demand, 106-110, 153, 297-298 accreditation, 253 Department of Education, 60, 309, 310 applicant trends, 159-175, 188 Department of Energy, 309 associate degrees, 83-84, 103, 109, 196, Department of Health and Human Ser- 211 vices. 12, 16, 26, 202, 252, 283-284 capacity maintenance and expansion, statistics, 4, 51, 53, 61, 202 176-202, 221-222 Department of Health, Education, and classification of instructional programs, Welfare, 240, 247, 252, 256-257 291-295 Department of Labor, 180, 310 clinical education, 176, 192-194, 195 Department of Transportation, 26. 180 college preparation, 171-172, 173-174 Diagnostic testing, see Laboratory tech- cost of education, 194-195 nologists and technicians; Radiologic employer role, 207, 208 technologists and technicians enrollment trends, 82-84 Dietitians. 254 faculty development, 188-192, 277 alternative financing scenarios, 113-114 handicapped, 149, 274 definition of, 19-20, 24-26, 291, 297 hospital-based, 176, 192-194 education, 25-26, 114 in-service, 220, 228 history, 24-25 labor force and, 7-9, 10 hospital employment, 110, 111, 297 liberal education, 197-198 licensure, 25 linkages with employers, 175, 188, 196, supplydemand, 6, 25, 110-115, 153, 297 197, 198-202, 227-229, 231 Disabilities, see Handicapped persons long-term care and, 13, 231, 232-233, Disease patterns, and allied health demand 274-277 general, 68-70, 261-262

INDEX 335 Medicare support for, 180, 192-194 physical therapy, 131 minority recruitment and retention, 8, respiratory therapy, 144 166-175, 171-172, 173-174 women, 262, 264 public information on state regulation. see also Medicare; 251, 326 Nursing homes recruitment, 163-166 Emergency medical technicians retraining, 220 definition, 26-27, 291, 298 rural areas, 227-228 education, 26-27, 117-118 salaries and, 211, 213-214 history, 26 statistics collection, 50, 52, 60 licensure, 27 supply/demand and, 159-202, 221-222, privatization of services, 115-116 304-305 salaries, 116 women, 81, 82-86; supply/demand, 115-118, 298 see also Women's career choices volunteer, 27, 115, 116-117 see also Accreditation Employers, 2, 4-5, 206-233 Education of the Handicapped Act of labor supply enhancement 208-227 1986, 149 labor unions, 88-89, 220 Education, specific occupations linkages with educational institutions, cardiovascular technicians, 40 175, 188, 196, 197, 198-202, classification of instructional programs, 227-229, 231, 232-233 291-295 long-term care, 230-231 dental hygiene, 23, 109, 161, 196, 293 productivity enhancement, 209, dental schools, 108 214-215, 221-224 dietitians, 25-26, 114 recruitment role, 166 emergency medical technicians, 26-27, rural facilities, 225-229 117-118 salary/staff considerations 206-207, lab technicians, 103, 104, 105, 160, 229, 209-215, 222 293-294 staff tenure increases, strategies, medical record personnel, 28-29, 121, 216-221, 222 122, 189 see also Health care administrators; nursing aides, 274, 275-276 Self-employment occupational therapists, 30, 127-128, 189 Employment perfusionists, 39, 161 burnout, 117, 172, 173 218, 219-220 physical therapists, 33, 133-135, 160, macroeconomic model of, BLS, 54-57, 161, 176, 189 90-91 radiologists, 34-35, 140, 141, 196 see also Career choice; respiratory therapists, 36, 146-147, 196 Labor market; social work, 162 Part-time employment; speech-language pathologists and audi- Salaries and wages; ologists, 38, 148, 150, 151, 152 Self-employment; see also Accreditation Supply/demand, general; Elderly Supply/demand, specific occupations; allied health demand, 65-66, 70, 274, 278 Tenure; dietitians, 112 Unemployment; labor force demography, 218 Working conditions long-term care of, 12-13, 260-261, 275, Epidemiology, see Disease patterns 276-278 Equipment and supplies, 143 occupational therapy, 125

INDEX 336 Ethnic minorities, see Minorities Handicapped persons, 125, 126, 149, 262, Extended care, see Long-term care 274 Health care administrators, 11, 206-233, F 269 Facility administrators, see Health care labor supply enhancement, 208-227 administrators long-term care and, 13, 277-278 Faculty development, 188-192, 277 productivity enhancement, 209, Family medicine, 190 214-215, 221-224 Federal government, 202 rural facilities, 225-229 definition of allied health, 16-17 salaries and worker supply, 206-207, educational finance, 8, 87, 178-180, 209-215, 222 190, 192-194, 304 staff shortages and, 206-207, 273-274 emergency medical services start-up staff tenure increases, strategies, 216-221 funding, 115 see also Medical records administrators faculty development, 190 and technicians licensure and certification and, 12 Health care costs long-term care, role, 13 allied health education, 194-95 minority recruitment and retention, dental, 107 168-169 hospital operating margins, 216 monitoring of work force, 3-4 labor costs, 210, 214, 215 regulatory role, 251-252, 324-328 rehabilitation facilities, 271 spending, 71, 168, 193, 304 state regulation and, 243, 246, 247, see also Health Careers Opportunity 248-249, 256-257 Program (HCOP); Sunrise provisions, 319-323 Medicare see also Cost containment Federal Industrial Rehabilitation Act, 30 Health care delivery systems Federal Trade Commission, 251 alternative financing scenarios Fee-for-service, 91, 97 general, 90-93 Finance, see Educational finance; Health by occupation, 103, 113-114, 126-127, care financing 131-132, 139, 145, 150-151 Foundations, see Private foundations cooperatives, 228 Forum on Allied Health Data, 51, 61 productivity, 209, 214-215, 221-224 rural, 225-229 G unnecessary procedures, 223-224 Genetic technologies, 77 see also Access to health care; Geriatric Education Centers, 277 Health care facilities; Geriatrics, see Elderly Home care; G.I. Bill, 35, 307 Long-term care Gilmartin, M. E., 64 Health care facilities Goldstein, Harold, 55 regulation of, 238 Government, see Federal Government; rural, 225-229 Licensure; Regulatory issues; State Veterans Administration rehabilitation governments; State licensing facilities, 272-274 Graduate Medical Education National see also Hospitals; Advisory Committee, 53, 78-79 Nursing homes; Gross national product, and labor supply/ Rehabilitation facilities demand, 55-56, 308 Health care financing alternative scenarios Grossman, Jerome, 210 H

INDEX 337 general, 90-93 Medicaid, 268 by occupation, 103, 113-114, 126-127, Medicare, 64, 65, 75, 111, 130, 131, 131-132, 139, 145, 150-151 149, 268, 269 dentistry, 108-109 occupational therapy, 124-125, 126 government, 8-9 physical therapy, 131, 268 home-based care, 64-65 physicians, 269-270 long-term care, 262-263 prospective payment, 111 mandated benefits, 76 respiratory therapy, 63-65, 142, 143 medical record services and, 28 speech-language pathologists, 149, 150 occupational therapy, 125 Hospitals, 5, 91 physical therapy, 131 accreditation standards, 253, 254-255 salaries of allied personnel, 209-215 clinical education, 176, 192-194, 195 supply/demand for allied health and, dietitians, 110, 111, 297 74-76 lab technicians, 98-100, 104 see also Cost containment; medical record personnel, 119, 299 Health care costs; multihospital systems, 73 Insurance; occupational therapists, 123-124 Prospective payment system (PPS); operating margins, 216 Third-party payers physical therapists, 129-130, 131, 133 Health Care Financing Administration, prospective payment system and, 75-76 65, 149, 180, 266 radiology, 135-138, 139, 141, 301 Health Careers Opportunity Program respiratory therapists, 141-142, (HCOP), 8, 168, 171-172, 173-174, 143-144, 146, 301 175 rural, 225-226 Health maintenance organizations salaries of allied workers, 210, 215 (HMOs), 73, 92, 224 speech-language pathologists, 149, lab technicians and, 101 301-302 speech-language pathologists, 149, 150 Hudson Institute, 165, 217-218 Health planning agencies, statistical Human resources administrators, see responsibilities, 52 Health care administrators Health Professions Training Act of 1985, 168 I Health Programs Extension Act of 1973, Illinois, 181 168 Income, personal, effect on allied health Health promotion, 113 demand, 71, 108; Health Resources and Services Adminis- see also Salaries and wages tration, 51-52, 104, 193 Information services, see Medical record see also Bureau of Health Professions administrators and technicians Health Training Improvement Act of Inhalation Therapy Association, 36 1970, 240 In-service training, 220, 228 Hearing impairments, see Speech- Institute of Medicine (IOM), 45, 190, 231, language pathologists and audiologists 264, 266 Highway Safety Act of 1966, 26 Insurance, 71, 149-150 Hill Burton Act of 1946, 225 dental, 108 Hispanics, 166, 167, 218 malpractice, 89-90 Home care, 91, 274 state-mandated benefits, 76 long-term, 267-270

INDEX 338 see also Medicaid; Law, see Court decisions; Statutes Medicare; Librarians, see Medical record administra- Third-party payers tors and technicians Intensive care units, 144 Licensure, 18-19, 235-257 Internships, for dietitians, 114 cardiovascular technicians, 40-41 dental hygienists, 23-24, 297-298 J dietitians, 25 Job mobility, 47, 220-221, 229, 247 emergency medical technicians, 27 Job Partnership Training Act, 180 lab technicians, 22 Job placement, education-services link- occupational therapists, 30 age, 175, 188, 196, 197, 198-202, perfusionists, 39 227-229, 231, 232-233 physical therapists, 33, 300 Job satisfaction, see Burnout; Working radiologists, 35, 139 conditions respiratory therapists, 36 Job vacancies, as labor shortage indicator, speech-language pathologists and audi- 47-48, 49 ologists, 38, 148-149 Joint Commission on Accreditation of supply/demand and, 11-12 Health Care Organizations. 253, see also State licensing 254-255 Local governments, 233, 310-311 Josiah Macy Foundation. 169-171, 172 Long-term care, 12-13, 259-278 administrators, 13, 277-278 K definition, 260 Kellogg Foundation, 15. 183 dietitians, 111 King, Elizabeth, 198-199 employer issues, 230-231 occupational therapists, 126 L see also Nursing homes Long-Term Care Gerontology Centers, 277 Laboratory technologists and technicians alternative financing scenarios, 103 M definition and regulation of, 20-22, 254, 291, 293-294, 298 Make, B. J., 64 education, 103, 104, 105, 160. 229, Malpractice, 89-90, 197, 238, 248 293-294 incompetence, 242 history, 21 unnecessary procedures, 223-224 licensure, 22 Mandated benefits, 76 salaries, 104 Marital status, 261 supply/demand, 5, 22, 98-105, 153, 271, Market forces, see Labor market; Supply/ 298-299 demand, general; Supply/demand, Labor market, 4-5 specific occupations characteristics, 2, 18-19 Medical record administrators and techni- general trends, 80-81 cians, 254 regulatory actions and, 11-12 definition, 27-29, 118, 292 see also Competition; education, 28-29, 121, 122, 189 Salaries and wages; history, 28 Supply/demand, general; salaries, 121, 162, 163 Supply/demand, specific occupations; supply/demand, 29, 118-122, 299 Unemployment Medicaid, 251, 268 Labor unions, 88-89, 220 respiratory therapy, 64-65 Language pathologists, see Speech- Medicare, 12, 71, 251, 252, 270-270 language pathologists and audiologists diagnostic tests and, 101

INDEX 339 education, support for, 180, 192-194 National Association of Rehabilitation emergency medical services, 117 Facilities, 271 home care, 64, 65, 75. 111, 130, 131, National Association of Teachers of 149, 268, 269 Speech, 37 nursing homes, 264, 266 National Certification Agency for Medical occupational therapy, 124, 125, 126 Laboratory Personnel, 298-299 physical therapy. 129, 130, 131 National Commission for Health Certify- respiratory therapy, 143, 145 ing Agencies, 252, 324-328 speech-language pathology, 149 National Commission on Allied Health see also Prospective payment system Education, 15, 17 (PPS) National Institute on Aging, 260-261 Mental health, 230, 294; National Institutes of Health, 174, 191 see also Occupational therapists; National Occupational Information Coor- Psychiatric services dinating Committee, 310 Mental retardation, 262 National Research Council, 26 Minnesota, 247-249, 319-323 National Society for Allied Health, 166 Minorities National Society for Promotion of Occupa- demographics and allied health demand, tional Therapy, 30 67-68, 81, 218, 264 National Task Force on Gerontology and educational recruitment and retention, 8, Geriatric Care Education in Allied 169-175 Health, 261 Minority Access to Research Careers, 174 New England Medical Center, 210 Minority Biomedical Research Support, New York State, 181 174 Nonprofit organizations, see Private foun- Missouri, 182 dations Model programs, educational, 8, 201, 229, Nuclear medicine technologists, 136, 137, 275-276 300-301 Models Nurses and nursing, 190-191, 193, 231, alternative financing scenarios 264, 268-269, 294 general, 90-93 competition with allied health person- by occupation, 103, 113-114, 126-127, nel, 80 131-132, 139, 145, 150-151 employment needs assessment, 53, 58 educational costs, 194-195 job satisfaction, 218-219, 220-221 education-services linkage, 201-202, 229 linkage with allied health, 274 nursing home teams, 265 salaries and supply, 211, 271 projecting labor supply/demand, 52-54, Nursing aides, 19, 231, 265-267 55, 91-93 education, 274, 275-276 Monthly Labor Review, 310 Nursing Home Standards Committee, 266 Mundinger, M., 268-269 Nursing homes, 73-74, 91, 230-231, 253, 260, 263-267 N dietitians, 110 National Academy of Sciences, 283-284, occupational therapists, 126 317 physical therapy, 130 National Advisory Commission on Health quality control, 265-267, 274, 276 Manpower, 240 Nutrition, see Dietitians National Association for Home Care, 268

INDEX 340 O home care, 131, 268 Occupational Employment Statistics, licensure, 33, 300 315-316, 317 salaries, 34, 134, 135, 212, 271, 272-273 Occupational Employment Survey, 60, supply/demand, 4, 33, 128-135, 208, 296, 311 271-272, 273, 300 Occupational health and safety, 131 Physicians Occupational Outlook Handbook, 307, ambulance services owned by, 115-116 310, 217 home care, 269-270 Occupational therapists, 162-163, 272 lab technicians and, 100-101 alternative financing scenarios, 126-127 nurses and, 219 definition, 29-31, 292, 299 supply of, 78-79 education, 30, 127-128, 189 Poliomyelitis, 32-33 history, 29-30 Political issues, educational support, 178, licensure, 30 181, 182 salaries, 31, 128, 271, 273 Poverty, see Economically disadvantaged supply/demand, 31, 122-128, 271-272, Prediction, see Supply/demand, general; 273, 299-300 Supply/demand, specific occupations Omnibus Budget Reconciliation Act of Private foundations, 9, 15, 183, 202 1987, 101, 149, 275 minority recruitment and retention, Organizational frameworks and structures, 169-171, 172 153 rural health care, 229 alternative financing scenarios Private sector, see Employers; Profes- general, 90-93 sional associations and societies; by occupation, 103, 113-114, 126-127, Self-employment 131-132, 139, 145, 150-151 Privatization, emergency medical ser- demand for services and, 72-74 vices, 116-117 home health care, 268-270 Productivity, employer role, 209, state regulation, 241-246, 249-251 214-215, 221-224 Outpatient care, 101, 111; Professional associations and societies, see also Home care 232, 252-253 certifying agencies, federal guidelines, P 252, 324-328 definition of allied health Part-time employment, 75, 76, 189, general, 17-18 230-231 by occupation, 297-301 dental hygienists, 107 educational responsibilities, 8, 183, dietitians, 297 194-195 physical therapists, 130, 230-231 occupational recruitment incentives, 10, Pathologists, see Laboratory technologists 166, 167 and technicians surveys and statistical data, 49, 50, 51, Perfusionists, 39-40, 161-162 60, 300, 302 Personnel administrators, see Health care see also individual associations and administrators societies Perry, Seymour, 77 Professional qualifications, higher educa- Physical therapists, 162, 254, 273 tion and, 189, 197, 200; alternative financing scenarios, 131-132 definition, 31-34, 292, 300 see also Certification; Licensure education, 33, 133-135, 160, 161, 176, Projections, see Supply/demand, general; 189 Supply/demand, specific occupations history, 32

INDEX 341 Prospective payment system (PPS), 91, Regulatory issues, 2, 18, 102, 235-257 92, 268, 271 federal role, 251-252 demand for allied health and, 75-76, history, 236 97-98 labor force characteristics and, 11-12 dietitians, 111, 113 nursing homes, 266 educational funding and, 193 private sector role, 252-253 emergency medical services, 117 quality of care, 5 employment patterns and, 5 state-level, 236-251 lab technicians, 98-99, 100, 103 see also Accreditation; medical record occupations, 118, 120 Licensure; occupational therapy, 124, 125, 126 Standards; physical therapy, 129, 132 State licensing radiology, 136-137, 139, 145 Rehabilitation facilities, 270-274, 295 respiratory therapy, 64, 144 Report on Allied Health Personnel, 16 salary costs and, 215 Report on Licensure and Related Health speech-language pathologists and audi- Personnel Credentialing, 240 ologists, 150-151 Research Psychiatric services, 124 academic, 184, 190-192 Public accountability, 251, 255 on career choice and development, 163 Public health, 112 committee study goals, methodology, themes, organization, 1-4, 44-45, 59, Q 96, 283-284 Quality control, 5, 102 data limitations, 3-4, 45-46, 50-52, education and, 161, 199-202 59-61, 296 emergency medical services, 117-118 dissemination of findings, 10, 232 medical records and, 119 on effectiveness of specific professions, nursing homes, 265-267, 274, 276 224, 232 rehabilitative services, 274 on employee retention, 219-220 state regulation and, 243, 245-247, financial support of, 9 256-257 minority opportunities, 174 see also Accreditation; on nursing, 190-191 Certification; on personnel policies, 231, 232 Licensure; on regulation, 251 Professional qualifications; on supply/demand, 305-310, 311-314, Regulatory issues; 319-320 Standards see also Bureau of Labor Statistics; Statistical programs and activities R Respiratory therapists, 255 Racial minorities, see Minorities alternative financing scenarios, 145 Radiologic technologists and technicians definition, 35-37, 292, 301 alternative financing scenarios, 139 education, 36, 146-147, 196 definition, 34-35, 292, 300 history, 36 education, 34-35, 140, 141, 196 home care, 63-65, 75 history, 34-35 hospital employment, 141-142, hospital employment, 135-138, 139, 143-144, 146, 301 141, 301 licensure, 36 licensure, 35, 139 salaries, 146 salaries, 140-141 supply/demand, 6, 37, 63-65, 141-147, supply/demand, 34, 35, 135-141, 271, 153, 208, 271, 301 300-301 Recordkeeping, see Medical record admin- istrators and technicians

INDEX 342 Retraining, 220 education, 38, 148, 150, 151, 152 Robert Wood Johnson Foundation, 169, hospital employment, 149, 301-302 229 licensure, 38, 148-149 Rural health care facilities, 225-229, 273 research, 192 salaries, 38, 152 S supply/demand, 6, 38, 147-152, 153, Salaries and wages, 2, 10, 230-232, 274 271, 301-302 dental hygienists, 24, 106 Standards, 252, 266 employer considerations, 206-207, state-level, 238-239 209-215, 222 see also Accreditation; lab technicians, 104 Licensure labor shortage indicator, 48 State governments medical record personnel, 121, 163 boards, regulatory, 241-242, 249-251, nurses, 211, 271 253, 255 nursing aides, 266-267 cost, quality, access, and regulation, occupational therapists, 31, 128, 271, 273 240, 243, 245-247, 248-249, 253, 255 perfusionists, 162 dental hygienists, regulation, 243-246 physical therapists, 34, 134, 135, 212, educational financing, 9, 87-88, 174, 271, 272-273 180-182, 190 radiologists, 140-141 education-service linkages, 201-202, respiratory therapists, 146 232-233 social workers, 162 mandated insurance benefits, 76 speech-language pathologists and audi- minority recruitment and retention, 169, ologists, 38, 152 174 Selden, 250-251 regulator), powers, 236-251, 252 Self-employment Sunrise procedures, 247-249, 255, complex medical settings and, 221 319-323 dietitians, 110-111 supply/demand data, 310-311 physical therapists, 130-131, 212 State licensing, 200, 202, 236-238 social work, 162 criticisms, 240-249, 253 speech-language pathologists and audi- definition, 237-238 ologists, 150, 301 dental hygienists, 23-24, 297-298 Sex discrimination, salaries, 212 dietitians, 25 Shimberg. B., 238 emergency medical technicians, 27 Social work, 162 history, 236, 238 Societies, see Professional associations lab technicians, 22 and societies; and individual associa- occupational therapists, 30 tions and societies physical therapists, 33, 300 Society of Diagnostic Medical Sonogra- radiologists, 35, 139 phers, 41 reforms, 247-251, 255-257 Southern Educational Research Board, 197 respiratory therapists, 36 Southern Illinois University, 229 speech-language pathologists and audi- Specialization, 196, 197; ologists, 38, 148-149 see also specific allied health professions statistics, 52 Speech-language pathologists and audiol- Sunrise procedures, 247-249, 255, ogists 319-323 alternative financing scenarios, 150-151 Statistical programs and activities definition, 37-38, 148, 292, 301

INDEX 343 data limitations, 3-4, 45-46, 50-52, Supply/demand, general, 44-61, 63-94, 59-61, 296 152-153, 296-297 education, 4, 60, 82, 83-84, 85, 180 AIDS, 68-70, 102, 124, 262 emergency services, 118 alternative financing scenarios federal government, 3-4, 304-310; general, 90-93 see also Bureau of Labor Statistics by occupation, 103, 113-114, 126-127, job vacancy data, 4 131-132, 139, 145, 150-151 salary and wage data, 49-50 current situation, 46-52 state and local efforts, 310-311 data available, 45-46, 50-52, 59-61 supply/demand data, 45-46, 50-52, 58-61 demography and, 65-68 projections purpose and methodology, economic growth and, 70-72 303-318 educational sector, effect on, 7-9, 82-88, see also Demographics; 176-202 Medical record administrators and tech- employers' role, 9-11, 206-233 nicians estimation methodology, 3-5, 54-57, Statutes 305-310, 311-314 certification, 255 financing of health care and, 74-76 Comprehensive Employment Training future Act, 180 general, 5-6, 52-61 Comprehensive Health Manpower Act by occupation, 96-153 of 1973, 168 industry structure and, 72-74 dental hygiene, 244 licensure, certification, accreditation Education of the Handicapped Act of and, 11-12 1986, 149 long-term care, 230-231, 278 Federal Industrial Rehabilitation Act, 30 malpractice, 89-90 G.I. Bill, 35, 307 other health professionals and, 78-80, 113 Health Professions Training Act of productivity issues, 209, 214-215, 1985, 168 221-224 Health Programs Extension Act of 1973, projections, methodology and uses, 168 303-318 Health Training Improvement Act of rural areas, 225-229 1970, 240 salary and, 209-215 Highway Safety Act of 1966, 26 shortages Hill Burton Act of 1946, 225 indicators, 47-49 Job Partnership Training Act, 180 strategies for remediation, 210-211, licensure, 11-12, 241 273-274 occupational therapy, 125 state and local projections, 310-311 Omnibus Budget Reconciliation Act of unions, 88-89, 220 1987, 101, 149, 275 Supply/demand, specific occupations, Sunrise procedures, 247-249, 255, 96-153, 296-302 319-323 alternative financing scenarios, by occu- Structural issues, see Organizational pation, 103, 113-114, 126-127, frameworks and structures 131-132, 139, 145, 150-151 Student aid, 174, 180 dental hygienists, 106-110, 153, 297-298 Study Commission on Dietetics, 25 dietitians, 6, 25, 110-115, 153, 297 Substance abuse, 102 emergency medical technicians, Sunrise procedures, 247-249, 255, 319-323 115-118, 298

INDEX 344 lab technicians, 5, 22, 98-105, 153, 271, Training, see Education, general; Educa- 298-299 tion, specific occupations medical record personnel, 29, 118-122, 299 U occupational therapists, 31, 122-128, Unemployment, 165, 304 271-272, 273, 299-300 factor in demand for allied health, 71 physical therapists, 4, 33, 128-135, as labor shortage indicator, 48-49, 50 271-272, 273, 300 Unions, see Labor unions radiologists, 34, 35, 135-141, 271, University of Alabama, 227-228, 229 300-301 University of Wisconsin, 229 respiratory therapists, 6, 37, 63-65, 153, Unnecessary procedures, 223-224 208, 271, 301 speech-language therapists and audiolo- V gists, 6, 38, 147-152, 153,271, Vascular technicians, see Cardiovascular 301-302 technology Surveys, see Statistical programs and Veterans, 35, 180 activities Veterans Administration, 180, 272-274, 277, 307 T Volunteer emergency medical technicians, Technical assistance, 10 27, 115, 116-117 statistics, 51-52 Technicians, see Emergency medical tech- W nicians; Laboratory technologists and Wages, see Salaries and wages technicians; Radiologic technologists Western Interstate Commission on Higher and technicians Education, 53 Technological innovation, 6, 18, 91-92, Women, elderly, 262, 264 108, 255 Women's career choices, in allied health demand for allied health and, 76-78 labor force, 2, 160, 165, 218 dietitians, 111 American Women's Physical Therapy emergency medical services, 116-117 Association, 32 lab technicians, 98, 100, 102 dietitians, 25 productivity and, 222 education, 81, 83-86 radiology, 135, 137-138, 139 lab technicians, 22 respiratory therapy, 64, 142 medical records personnel, 29 Tenure, 200 radiologists, 35 employers' strategies for increasing, and salaries in labor force, 212, 215 216-221 Working conditions, 218-219, 219, 222, supply/demand for labor and, 9, 134 230-231, 267 Texas, 181, 182, 196, 208-209 burnout, 117, 172, 173, 218, 219-221 Therapists, see Occupational therapists; Workmen's compensation, 131 Physical therapists; Respiratory ther- apists X Third-party payers X rays, see Radiologic technologists and clinical education, 8 technicians demand for allied health and, 75 occupational therapists, 30 social work, 162 state certification and eligibility, 12 see also Insurance; Medicaid; Medicare; Prospective payment system (PPS) Torts, malpractice, 89-90, 197, 238

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With estimates of their numbers ranging from one million to almost four million people, allied health care personnel make up a large part of the health care work force. Yet, they are among the least studied elements of our health care system. This book describes the forces that drive the demand for and the supply of allied health practitioners—forces that include demographic change, health care financing policies, and career choices available to women. Exploring such areas as credentialing systems and the employment market, the study offers a broad range of recommendations for action in both the public and private sectors, so that enough trained people will be in the right place at the right time.

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