Coming Together, Moving Apart: A History of the Term Allied Health in Education, Accreditation, and Practice

Journal of Allied Health, Spring 2008 by Donini-Lenhoff, Fred G

In recent years, several groups, including the physician assistant, health information management, ophthalmic medical technician/technologist, and athletic training review committees, have left the Commission on Accreditation of Allied Health Education Programs (CAAHEP) system to form their own, profession-specific accrediting bodies. Their motivation was typically a desire for greater professional visibility and autonomy. Combined, these professions represented one third of the CAAHEP's programs. This article reviews the history of allied health and examines current attempts to bring cohesion and identity to this increasingly fractured segment of the U.S. health care system. J Allied Health 2008;37:45-52.

THE COMMISSION on Accreditation of Allied Health Education Programs (CAAHEP), in collaboration with its committees on accreditation, reviews and accredits more than 2,000 educational programs in 21 occupations in the health sciences field. The commission is facing a pivotal moment in its history. Over the past several years, the physician assistant (2000), health information management (2004), ophthalmic medical technician/technologist (2005), and athletic training (2006) review committees have left the CAAHEP system to form their own, profession-specific accrediting bodies. While each review committee had its own reasons for the decision to leave, for many the major impetus was a desire on the part of the profession to have more visibility and greater perceived autonomy. Combined, these professions represent more than 650 educational programs, or one third of the commission's programs. (In 2006, the Commission began accrediting programs in Polysomnographie technology and exercise science.)

At its 2004 annual meeting, CAAHEP directors and commissioners grappled with this issue and its repercussions, among them the following: What is allied health? What constitutes an allied health profession? When a profession leaves CAAHEP, is it still considered an allied health profession?

Some professions traditionally considered part of allied health have by and large left that designation behind. Having reached a critical mass of public/governmental awareness and number of practitioners, they develop more stringent educational/training requirements (e.g., master's-or PhD-level education) for both graduates and program directors and begin to "brand" themselves as an independent health profession, not an allied health profession, which to some connotes a secondary, subsidiary, and dependent relationship to physicians and medicine. Meeting the challenges of an expanded body of knowledge and scope of practice as well as a desire for increased social status, higher salary, and the title "doctor" all play a role in this process, as do the goals of direct patient access and "all privileges of autonomous practice."1

Physical therapy educational programs, for example, are converting to a clinical doctorate (Doctor of Physical Therapy [DPT]), with more than 80% of accredited programs enrolling students in DPT programs by 2006.2 Similarly, occupational therapy has set a postbaccalaureate entry-level requirement (master's level and clinical occupational therapy doctorate [OTD]) for professional practice.3 As of January 1, 2007, the accrediting body for audiology programs no longer accredits master's-level programs, only clinical doctorate programs.4 In addition, the accrediting body for clinical laboratory sciences programs is working to develop and implement the Clinical Doctorate in Clinical Laboratory Science (DCLS) as the terminal practice degree for the profession.5

This article reviews the history of allied health and examines current attempts to bring cohesion and identity to what is becoming an increasingly difficult to define, fractured, and sometimes fractious segment of the U.S. health care system. A key element in the history of allied health is the major role the American Medical Association (AMA) has played since the 1930s in defining and regulating allied health and supervising its practice and growth. Today, waning public and governmental support and lack of awareness of the critical role of allied health practitioners in health care are causes for concern. These issues may in part stem from the inability to develop a universally agreedupon definition of allied health.

The ramifications for the U.S. health care system are significant, not just semantic. The approximately 6 million allied health practitioners, representing more than 60% of the U.S. health care workforce, provide essential diagnostic and rehabilitation services and therapeutic treatments and help ensure continued access to high-quality, affordable health care services. Understanding the genesis and evolution of "allied health" from control and centralization to a more fluid, heterogeneous concept, and a full appreciation of the historical benefits and weaknesses of banding together under "allied health" (or moving toward autonomy), can inform the debate among workforce planners, policy makers, and professional associations as they attempt to assess and address current and projected allied health staffing needs.