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Steve Olson, Rapporteur Board on Health Care Services

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HHSH250200976014I between the Na- tional Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-22059-0 International Standard Book Number-10: 0-309-22059-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC, 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap. edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Allied health workforce and services: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR A WORKSHOP ON ALLIED HEALTH WORKFORCE AND SERVICES1 SUSAN CHAPMAN (Chair), Associate Professor, School of Nursing, Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF); Director, Masters Program in Health Policy Nursing, School of Nursing, UCSF; Senior Research Faculty, Center for Health Professions, UCSF FRED DONINI-LENHOFF, Medical Education Communications Director, American Medical Association ERIN FRAHER, Director, North Carolina Health Professions Data System; Assistant Professor, Departments of Surgery and Family Medicine, University of North Carolina at Chapel Hill EDWARD SALSBERG, Director, National Center for Health Workforce Analysis, Health Resources and Services Administration ROY A. SWIFT, Senior Director, Personnel Credentialing Accreditation Programs, American National Standards Institute Project Staff TRACY A. HARRIS, Senior Program Officer AMY ASHEROFF, Senior Program Assistant ROGER HERDMAN, Director, Board on Health Care Services 1 Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: ALLYNE BEACH, Kaiser Permanente National Workforce Planning and Development KRISTEN C. DAVIDSON, Northridge High School, Layton, UT THOMAS ELWOOD, Association of Schools of Allied Health Professions GAMUNU WIJETUNGE, National Highway Traffic Safety Administration Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by JACK C. EBELER, Health Policy Alternatives, Inc. Appointed by the Insti- vii

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viii REVIEWERS tute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Re- sponsibility for the final content of this report rests entirely with the authors and the institution.

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Contents 1 INTRODUCTION 1 Definitions, 2 Organization of the Report, 3 2 THE ONGOING TRANSFORMATION OF HEALTH CARE 5 Transition of the Current Health Care System, 5 Legislative Drivers, 7 Demographic Changes, 7 The End of the Flexnerian Paradigm, 8 Discussion, 9 3 ALLIED HEALTH: AN OVERVIEW 11 Accreditation of Education and Training Programs, 12 Issues in Allied Health, 13 4 SUPPLY AND DEMAND 15 Data from the Bureau of Labor Statistics, 15 Allied Health Workforce Planning in North Carolina, 19 A Uniform Health Professions Dataset, 23 Discussion, 25 5 NEW AND CHANGING NEEDS 29 An Allied Health Workforce Survey in California, 29 New and Changing Needs in Chicago, 32 ix

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x CONTENTS Community Health Centers and the Allied Health Workforce, 34 Discussion, 37 6 EDUCATION AND TRAINING 39 Accreditation of Allied Health Programs, 40 Community Colleges and the Education of Allied Health Professionals in Rural Areas, 42 Career Advancement Through Work-Based Learning, 44 Discussion, 47 7 THE FUTURE OF TEAM-BASED CARE 49 Interprofessional Education and Training, 49 Team-Based Care and Health Care Reform, 53 Scope of Practice and Team-Based Care, 58 Discussion, 60 8 PERSPECTIVES FROM STAKEHOLDERS 63 The National Society of Allied Health, 63 The National Network of Health Career Programs in Two-Year Colleges, 64 The Association of Schools of Allied Health Professions, 65 The Health Professions Network, 66 Discussion, 67 9 OPEN DISCUSSION 69 Data Collection and Analysis, 69 Education and Training, 70 Practice Issues, 71 The Future of Allied Health, 71 Other Individual Comments, 72 REFERENCES 73 APPENDIXES A 77 Workshop Agenda B 83 Planning Committee Biographies