Allied Health Services Avoiding Crises (1989) / Chapter Skim
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5 The Role of Educational Policy in Influencing Supply
5 The Role of Educational Policy in Influencing Supply
Pages 159-205
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From page 159... ...
THE ALLIED HEALTH STUDENT APPLICANT POOL For most fields the available trend data on allied health programs and graduations do not signal an imminent crisis requiring dramatic public intervention. Looking to the future, however, the committee is deeply concerned that the weak infrastructure of allied health education may compromise the system's ability to maintain enrollments, let alone increase the supply of personnel in fields in which employment demand is high.
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From page 160... ...
Of the 116 programs that voluntarily withdrew from CAHEA accreditation between 1983 and 1987, 36 attributed their decisions to a declining applicant pool. Unpublished survey data from the American Society of Allied Health Professions suggest that only physical therapy has a large applicant pool to draw upon, with about five applicants per academic space.
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From page 161... ...
Some of the students are often drawn from other disciplines TABLE 5-1 ACT Test Score Means for Students Specifying Academic Majors ACT Composite Test Scores Academic Major Percentage of Change, 1980-1981 1983-1984 1985-1986 1986-1987 1980-1987 Dental assisting 13.3 13.2 13.5 13.3 0 Dental hygiene 16.1 15.5 15.4 15.0 - 1.1 Medical technology 18.2 18.2 18.6 18.2 0 Occupational therapy 16.7 16.6 17.5 17.5 -0.8 Physical therapy 17.8 18.0 18.8 18.5 1.0 Radiological technology 14.4 15.4 15.9 15.8 1.4 Nursing (RN) 16.2 15.9 16.3 15.9 -0.3 Pharmacy 20.0 19.8 20.4 20.1 0.1 Overall college-bound population 18.5 18.2 18.3 18.7 1.1 SOURCE: Unpublished data from the American College Testing Program.
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From page 162... ...
Also, in comparison with such fields as clinical laboratory technology, physical therapy has greater public visibility and more patient contact. There may be lessons to be learned from schools of social work, which have succeeded in increasing their applicant pool from 2 applicants per opening in 1983 to 3.5 applicants per opening today.
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From page 163... ...
Some allied health occupations (e.g., medical technology and radiography) do not offer particularly good economic rewards but seek to attract scientifically oriented students to work in potentially hazardous environments in which they may be exposed to contaminated body fluids or radiation.
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From page 164... ...
The impact of several variables (including parental socioeconomic status ESES1, academic achievement, and sex) on both selection and persistence in career choice has been investigated in an attempt to determine who is being recruited into professions in general.
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From page 165... ...
For some allied health fields, there are already indications that potential practitioners are being lost to other professions. It is clear that educators, employers, and the professional associations must act if they want to maintain or increase their share of the work force.
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From page 166... ...
A school known to have a predominantly Hispanic student body and structured activities to recruit Hispanics to allied health programs was selected, as was a school in an area with a large American Indian population. Finally, a nonminority school in the South was added because it boasts the largest number of allied health programs on a single campus and has been actively involved in minority allied health recruitment
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From page 167... ...
labor force, in the 10 allied health fields studied by the committee and particularly in the fields requiring higher education. CAHEA reports that over the entire range of the fields it accredits the racial mix of students enrolled during 1986-1987 generally mirrored the racial mix of the U.S.
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From page 168... ...
Holland, Division of Disadvantaged Assistance, Health Resources and Services Administration, personal communication, 1987~. The Area Health Education Centers (AHEC)
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From page 169... ...
For example, Connecticut funds the Health Sciences Cluster Program, which exposes high school students to allied health professions; economically disadvantaged students in allied health in Georgia are eligible for a small grant program, the Regents Opportunity Grant Program (Mandex, Inc., 1987~. New York State has developed an action plan to improve minority access to the licensed professions (including dental hygiene, speechlanguage pathology and audiology, physical therapy, and occupational therapy)
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From page 170... ...
· Thirty-three of the 88 graduates specified that they would pursue a health career; 3 specifically cited physical therapy. · The Macy graduates took the mathematics placement exam given to all University of Alabama incoming freshmen.
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From page 171... ...
Lessons That Have Been Learned More than 20 years of experience in attempting to increase the number of minority allied health professionals suggest four areas that should be targeted for action: · academic preparation, especially in the sciences and mathematics; · knowledge of allied health careers and the promotion of minorities · financing of institutions and students; and · linkages and affiliations in training and employment. Despite efforts of the federal government and individual institutions, the barriers to allied health careers for minorities that were cited in the early 1970s remain serious problems.
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From page 172... ...
that such interventions can work, the conventional wisdom is that the emphasis on mathematics and science should begin as early as possible, starting at or even before junior high school (Bisconti, 1980; National Commission on Allied Health Education, 1980; Flack, 1982; La Jolla, 1984; The Circle, Inc., 1987; Mingle, 1987~. Perhaps allied health schools could gain more in the long run by helping to create alliances with others in the community to attack the root causes of poor academic preparedness.
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From page 173... ...
· Persons who are disenchanted with their current occupations in other fields may be seeking an opportunity to pursue a new, more challenging and rewarding career. Financing for Institutions and Students Deficiencies in academic preparation are fairly widespread among minority allied health students, and deans of allied health schools expect this shortcoming to continue in the near term.
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From page 174... ...
For example, there are currently no federal programs that support minority allied health faculty development or curriculum improvement in minority schools or in nonminority schools that view curriculum changes as one way to recruit and retain more minorities. The preeminent Minority Access to Research Careers (MARC)
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From page 175... ...
The erosion of federal support for this objective would undermine those in the education community who are struggling to gain or maintain such a commitment to minority allied health education. The committee endorses the objectives of HCOP and believes that funding levels must be maintained at least at current levels.
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From page 176... ...
Much of the decline in allied health educational capacity can be attributed to the closing of hospital-based training programs principally programs in laboratory and radiologic technology. Programs that have the largest number of withdrawals from CAHEA accreditation (and that are presumed by CAHEA to have closed)
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From page 177... ...
Further, since the average age of my faculty is only 49, natural attrition does not facilitate resource shifts. It would be easier for me to justify maintenance of high cost programs if external support were still flowing to my campus; however, as you are well aware, there has been a steady decline in the amount of federal dollars available for health education.
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From page 178... ...
In 1966, not long after Congress enacted federal education funding for medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, and pharmacy in one law and nursing under another authority, it also provided education funding for 13 allied health fields. The Allied Health Professions Personnel Training Act offered five types of grants: 1.
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From page 179... ...
179 Cal 50 ¢ oo 50 ~ Q
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From page 180... ...
Some collegiate program growth occurred at the expense of hospital-based programs and on-thejob training, another factor for which there are no reliable data. (Bureau of Health Manpower, Health Resources Administration, 1979)
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From page 181... ...
, 71 percent of public collegiate institutions had at least one allied health program, but only 36 percent of private schools offered allied health education (National Committee on Allied Health Education, 1980~. The propensity to invest in allied health education depends in part on the health of the state's economy.
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From page 182... ...
Student interest is not the major concern for expenditure of public tax funds for an occupational training program" (Allied Health Education Advisory Committee, 1980~. The ability of state coordinating bodies to enforce their resource allocation policies varies.
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From page 183... ...
For example, accreditation responsibilities for dietetics, physical therapy, and speech-language pathology and audiology are handled through independent entities operating in conjunction with the professional associations. It should be noted, however, that some of the allied health fields do not have a well-organized professional association that can engage in educational activities.
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From page 184... ...
They are also concerned about the future of allied health programs because the programs lack the capacity to foster research and produce teachers and academic leaders (Broski et al., 1985; Hedrick, 1985~. Although it is difficult to document the fragile condition of allied health education, the committee believes there is some basis for the deans' apprehension.
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From page 185... ...
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From page 186... ...
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From page 187... ...
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From page 188... ...
Faculty Shortages Because many allied health fields are relatively new to collegiate environments and have grown rapidly in the past 2 decades, allied health educational programs often face both quantitative and qualitative problems in filling faculty positions. In physical therapy, for example, the number of accredited university programs grew from 48 in 1970 to 113 in 1986.
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From page 189... ...
The recruitment of qualified new faculty is seriously hampered by the very limited pool of candidates. Even in relatively mature occupations such as occupational and physical therapy, professional associations report that only about 1 percent of all members have doctoral degrees and just over 24 percent have master's degrees (American Physical Therapy Assocation, 1987; American Occupational Therapy Association, 1987)
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From page 190... ...
Similar national goals relating to issues of rehabilitation, disease prevention, AIDS treatment, and geriatrics can be well served by the support of allied health education. The committee recommends that federal and state governments fund faculty development grants in allied health fields, especially in areas in which faculty availability and lack of clinical expertise inhibit the production of entry-level practitioners.
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From page 191... ...
Allied health fields vary in their maturity with respect to a productive research capacity. Some fields such as dental hygiene, in which most practitioners have less than a baccalaureate, are only now beginning to explore
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From page 192... ...
Allied health educators are also concerned about long-standing proposals to constrain or eliminate Medicare payments for education. Currently, Medicare pays hospitals for the direct educational costs of allied health programs on a reasonable cost basis as an addition to the DRG payment.
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From page 193... ...
Precipitate action to cut Medicare's educational support runs the risk of destabilizing vulnerable allied health education programs. In the committee's view, such destabilization is not worth relatively small, short-term budget savings.
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From page 194... ...
Although the models are useful tools for improving efficiency and then demonstrating those improvements to academic administrators, their explanatory power does not change the reality that allied health education is faculty intensive, that it necessitates clinical education experiences requiring coordination and supervision, and that it often has extensive laboratory and space requirements. The recommendations that have already been made in this chapter will help to address some of the weaknesses allied health programs have in competing for resources.
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From page 195... ...
To ensure that the clinical competence of allied health faculty is maintained, the institutional award system must accommodate clinical competence because faculty allocate what little nonteaching time they have to those activities that are highly rewarded. The committee recommends that institutions that offer allied health academic programs reward and encourage faculty clinical competence.
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From page 196... ...
Students with baccalaureates in other than health care fields were accommodated with certificate programs so they could pursue allied health careers. Students who were interested in careers in respiratory therapy, dental hygiene, and radiography, which were principally offered at the associate degree level, found themselves able to enroll in programs that also allowed them to obtain baccalaureate degrees.
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From page 197... ...
The Southern Regional Education Board (1980) has recommendedand the committee concurs that academic institutions contemplating the development of new allied health specialities ask themselves three practicerelated questions: · Are there any legal or professional restrictions on the new practitioners that will tend to inhibit employers from hiring these graduates?
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From page 198... ...
Articulation Allied health dean Elizabeth King from Eastern Michigan University describes two hypothetical students to illustrate the personal dimensions of the problems of articulation, the process by which students achieve upward educational transitions among academic programs (King, 1985~. One student, having worked 7 years as a certified occupational therapy assistant "with a love of the profession and a conscious decision to build upon her current skills," is confused and disillusioned when denied the opportunity to transfer her professionally related course work toward an occupational therapy degree.
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From page 199... ...
State higher education coordinating authorities and legislative committee.; .c;holil~l inelet ^^ Fl~v;~:l:~. :_ ~1~:~1 ~ _L.1' ~ _ ~ ~ mu '''uo''~y between community colleges and baccalaureate programs.
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From page 200... ...
This committee encountered a number of these types of controversies among the allied health fields. Some examples include physical therapists attempting to establish the master's degree as the entry-level standard, role delineation debates among baccalaureate medical technologists and 2-year medical laboratory technicians, proposals to limit the educational routes to entry-level dietetics, and the movement of respiratory therapy to a baccalaureate entry-level standard.
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From page 201... ...
Private foundations should support university-based centers for allied health studies and policy to provide a critical mass of researchers and resources to advance technology assessment, health care services research, and human resource utilization. States have a major role in allied health education by virtue of their support of public colleges and universities.
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From page 202... ...
Alexandria, Va.: American Physical Therapy Association. Area Health Education Centers Program.
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From page 203... ...
1987a. Allied Health Education Directory, 1987, 15th ed.
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From page 204... ...
Program directors' perspectives regarding CAHEAaccredited allied health education. Summary of a 1987 survey.
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From page 205... ...
1980. Planning and Designing Allied Health Education for Program Review.
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