VI.  Allied Health Findings and Recommendations

Allied Health Findings

Allied health encompasses a diverse array of health care professions.  Unfortunately, there is no agreement as to what professions comprise allied health and multiple definitions of allied health exist.  Some definitions, such as the one developed by the Health Professions Network, which represents over 75 organizations of allied health providers, educators, and accreditors, seek to describe specific attributes and qualifications of allied health professionals (see below).  Other definitions are based on exclusion and are mostly developed for funding purposes.  These definitions identify specific health professions, such as medicine and nursing, which are not allied health professions.  Many health care professions resist being classified as allied health, preferring to be viewed as distinct professions.

Because there is no clear agreement on what professions make up allied health, it is difficult to count the number of allied health professionals.  The U.S. Bureau of Labor Statistics reports that allied health care professionals make up approximately one third of the health care workforce, about 3 million workers.  Others use a broader definition of allied health, including over 200 different health professions, and estimate that there are about 6 million workers—two thirds of the entire health care workforce.

Regardless of the definition used, the professions that make up allied health are very diverse.  Education levels among allied health professionals vary from certificate to doctorate and salaries can range from minimum wage to over $100,000 a year.  The level of supervision required for allied health workers also varies, with some professions able to work and bill independently.  This diversity has created challenges in terms of increasing awareness about the important role of allied health providers within the health care system.  There is a perceived lack of awareness and understanding about the vital contribution made by allied health professionals on the part of the general public, policy makers, and other health care professionals.

This lack of awareness has translated directly into a lack of financial support for the training of allied health professionals.  During the 1970s, funding for allied health training ranged from $17.9 million in 1971 to a high of $35.6 million in 1973.  By 1980, funding had dropped to $9.5 million and no funding was provided from 1982 to 1990.  In 2005, funding for allied health training was $11.9 million.  In 2003, Congress appropriated ten times more funding to nursing education than to allied health education.  Although allied health workers make up an estimated 30 to 60 percent of the health care workforce, they do not receive proportionate levels of funding to support training. 

Shortages of Allied Health Professionals: Now and in the Future

There is an impending health care crisis in the United States.  It is forecasted that there will be insufficient numbers of health care professionals to meet increasing demand for care—driven primarily by an aging population.  Much of the attention relating to the crisis has focused on shortages of physicians and nurses.  Similar, if not greater shortages are predicted in allied health professions.

Fastest Growing Health Care Occupations, 2002-2012

Source: U.S. Bureau of Labor Statistics

Health care is the largest industry in the United States, representing an estimated 16 percent of the national gross domestic product in 2004 and providing 12.9 million jobs.   According to the U.S. Bureau of Labor Statistics, the health care industry is predicted to add nearly 3.5 million new jobs between 2002 and 2012, an increase of 30 percent.  A large majority of these new jobs will be in allied health professions.

At the same time that demand for allied health professionals is expected to grow, there are a variety of challenges relating to the training and retention of these professionals.  Should these challenges go unaddressed, it is highly unlikely that there will be sufficient allied health professionals to keep pace with growing demand.

The impact of the shortage of allied health professionals is evident.  Currently, many allied health professions have very high vacancy rates.  Occupational therapy has a vacancy rate of 15.7 percent.  In the imaging sciences, such as radiography and ultrasonography, there is a vacancy rate of 15.3 percent.  Other professions with high vacancy rates include respiratory and physical therapy, and clinical laboratory sciences.  Limited availability of these services can result in increased costs, limited access to services, and reduced quality of care.

These shortages come at a time when there is increasing need and demand for allied health providers.  For example, the President’s Health Centers Initiative, which began in FY 2002, is a 5-year initiative that will significantly impact 1,200 communities by creating new or expanded access points, which will enable community health centers to reach an additional 6.1 million patients by the end of FY 2006.  This increased capacity requires significant numbers of allied health professionals, as the community health care model relies heavily on interdisciplinary teams of providers.

There are various factors responsible for current and anticipated shortages of allied health professionals.

Aging Workforce – Many allied health professionals are nearing retirement age—the average age of allied health professionals is 40 years old.  

High Attrition – There is high turnover among allied health professionals, especially in low-wage positions.  According to the Bureau of Labor Statistics, wages have not increased for most allied health professionals (when adjusted for inflation, wages have decreased in some professions), despite vacancies and forecasted shortages.  In addition, many of the allied health professions are physically demanding.  These factors, paired with the stressful and fast-paced environment of most health care settings, can result in burnout, which may lead allied health professionals to leave the profession.  Strategies are needed to increase the job satisfaction of allied health professionals.

Shrinking Applicant Pool – For a variety of reasons, fewer students are entering allied health professions.  Traditionally, women have made up the vast majority of allied health professionals.  As additional opportunities have become available for women in non-health professions, allied health professions have become less attractive.  Other professions, such as information technology, are more appealing to students and offer higher pay and less demanding work environments.  Also, with greater resources available to support training in medicine and nursing, qualified students who may have considered careers in allied health in the past are drawn to nursing and medicine professions.  Allied health training programs report that many applicants are unprepared for college-level work, resulting in high attrition rates.  Since health career curricula are often demanding and may focus heavily on science, even greater pressure is placed on poorly prepared students.

Lack of Career Ladders – Many allied health professions offer little opportunity for advancement.  For those that do have career ladders, each step requires significant commitments of time and money.

Degree Creep – For many allied health professions, a masters degree is now required for entry-level positions.  The cost of this training constitutes a significant barrier.  Limiting the scope of practice for allied health professionals with associate degrees (2-year degrees) will further reduce the availability of providers.

Expanding and Improving Allied Health Training

According to the Health Professions Network, there are over 1,000 programs in the United States providing training in allied health professions.  These programs are staffed by 3,000 allied health faculty and enroll over 30,000 students each year.  Educational requirements vary among allied health professions.  Some programs provide specialized training right after high school.  Other programs lead to a certificate or a degree at the associate, baccalaureate, or graduate level.

Expanded and improved training opportunities will help to address current and future shortages of allied health professionals.  Multiple factors currently impact the training pipeline.  Allied health programs may not accept all qualified students due to a lack of funding, training facilities, and faculty.  While increasing the availability of training opportunities is imperative, there are other training-related challenges that must be addressed.  These include improved recruitment efforts and programs to better prepare students for allied health training and to support them through the training process.

Barriers to the training of allied health students are listed below.

Faculty Shortages – Lack of faculty is one of the most significant barriers to the training of allied health professionals—fewer faculty means fewer students can be trained.  As with providers, current faculty members are aging and nearing retirement.  However, replacements may be hard to find.  Faculty salaries are not competitive with the salaries of those providing clinical care and often faculty positions require a higher level of education than is necessary to provide clinical care.  Schools of allied health have seen a significant drop in applicants for faculty positions and existing faculty have become more difficult to retain.

Lack of Clinical Training Sites – The lack of clinical training sites is the second most frequently cited barrier to increasing enrollment in allied health programs.  Partnerships with hospitals and community-based organizations can serve to increase clinical training sites for allied health students.

Cost of Training – The cost of higher education has increased significantly, making it beyond the reach of many Americans.  Students are often attracted to professions that offer higher pay than most allied health professions in order to ensure that they can repay student loans after graduation.  Federal funding to support training of health professionals focuses on baccalaureate (4-year) and graduate-level programs.  Allied health scholarship and loan repayment programs would help make training more accessible to students.

Lack of Awareness of Allied Health Careers – Many students interested in health careers focus on medicine, dentistry, and nursing and many of the “Kids into Health Careers” programs emphasize these three professions.  Awareness must be increased regarding the wide range of opportunities in allied health.

Students are Unprepared for Health Careers Curricula – Rigorous, science-based curricula prove too challenging for many students, especially those who come from underserved populations and communities.  Programs to prepare high school students for allied health training and to support them once they enter training are lacking.  Mentoring programs, focused on allied health careers, are exceedingly rare.

Fewer Training Opportunities – For many institutions, State budget cuts have reduced the ability to expand existing programs and establish new ones.  Many programs have been cut.  Some allied health training programs are high cost and enroll and train few students, making them prime candidates when cuts are necessary.

Articulation – There is a rupture in the training pipeline between 2-year institutions and advanced education programs.  The articulation process for associate degree graduates must be streamlined so that associate degrees can serve as a stepping stone to advanced education and not be seen as an educational dead end.

Role of Community Colleges in Training Allied Health Professionals

As the most accessible and affordable entry into higher education, community colleges are a critical resource to ensure adequate numbers of well-prepared health care professionals.  The overwhelming majority of allied health professionals are educated via associate degree programs.  According to the National Network of Health Career Programs in Two-Year Colleges:

• 43.7 percent of all accredited allied health educational programs are located in 2-year community colleges and schools; and
• 97,206 students in various allied health professions and fields graduated from colleges, universities, medical schools, proprietary schools and hospital-based programs in 2002.  Of these students, 58,068 or (63%) graduated from 2-year colleges and schools.

The American Association of Community Colleges reports that associate degree programs are more time and cost efficient.  The cost of training in an associate degree program is an average of $1,379 per year vs. $3,746 for 4-year programs.

Historically, there has been a lack of participation in Title VII Interdisciplinary, Community-Based Training Grant Programs by 2-year community colleges.  For example, the number of Title VII Allied Health Program grants awarded to 2-year colleges is significantly out of balance with the level of allied health education delivered in this setting.  Since 1999, only 14 of 84 grants have been awarded to community colleges.  Funding is needed to allow community colleges to increase their training capacity.  In addition, providing financial support to allied health students receiving their training at community colleges will help to increase the accessibility of training. 

Diversifying the Allied Health Workforce and Serving Underserved Areas

Efforts are necessary to increase the number of racial/ethnic minorities in the allied health professions—as the population of the United States becomes more diverse, the allied health workforce must reflect these demographic trends.  Recruitment efforts that target these populations and programs to prepare students for higher education will be necessary.  While these programs are in place and have been successful in increasing the numbers of minority students entering medicine and nursing, they are lacking in allied health.  Expansion of existing health care pipeline programs to include allied health professions would build on existing infrastructure and expertise.  Another strategy is to support allied health programs at historically Black colleges and universities, tribal colleges, and Hispanic institutions and to recruit more students into these programs.

Allied health professions can play an important role in expanding the availability of health services in rural and underserved areas.  According to HRSA’s Bureau of Health Professions nearly 3,000, mostly minority and rural, communities throughout the United States do not have enough health care providers to meet basic medical, dental, and mental health needs.  Allied health professionals can help to meet the health care needs in these communities.  Some rural states are expanding the scope of practice for allied health professionals and removing supervision requirements so that they can provide a greater range of service to patients.

Research indicates that students from rural and underserved areas are more likely than other students to practice in these areas.  However, providing training in rural areas can be difficult.  Students face transportation issues and small rural colleges cannot offer a full range of allied health training programs.  Technological advances, such as distance learning, can greatly increase training options for students in rural areas.

Tracking Outcomes and Identifying Best Practices

There is a general lack of data regarding workforce, access, and diversity issues in the allied health professions—existing data from the Bureau of Labor Statistics is outdated.  Development of specific data collection methods and the identification/dissemination of best practices that demonstrate effective interdisciplinary allied health programs are necessary. 

An infrastructure is already in place to facilitate the collection and analysis of data.  There are six existing HRSA Workforce Centers capable of researching allied health shortages and recruitment/retention issues.  Title VII Interdisciplinary, Community-Based Training Grant Programs should more actively include allied health in their data collection and evaluation activities and develop partnerships with the HRSA Workforce Centers.

The Allied Health Reinvestment Act

There is growing recognition among policy makers concerning the shortage of allied health professionals and the impact this shortage will have on the availability and quality of health care in the United States.  The Allied Health Reinvestment Act (AHRA) (H.R. 215; S. 473) is designed to increase the number of allied health professionals.  It is modeled on the Nursing Reinvestment Act, which has been successful in increasing the number of students in nursing programs.

The proposed AHRA legislation addresses health care workforce issues including current and projected personnel shortages; lack of qualified, doctoral-educated faculty; declining enrollment in health care preparation programs; and demographic and epidemiological trends with an aging population with multiple chronic conditions and disabilities.  The AHRA legislation specifically requests funding for public service announcements to inform potential students about careers in health care fields; grants for health care practice, education, and retention; student and faculty education loans; establishment of Centers of Excellence and a Council on Allied Health Education to focus on the need to enhance workforce diversity and the establishment of best practice models; internships and residency opportunities; and collection and analysis of health care workforce data.

Recommendations on Allied Health

5.) The Secretary and Congress should appropriate funding, no less than the previous level of $35 million, under Title VII, Section 755 specifically for allied health programs to support interdisciplinary, community-based education and training projects.  With this funding, HRSA should consider providing traineeships as authorized under Section 755(b)(1)(i). 

The existing infrastructure of Title VII Interdisciplinary, Community-Based Training Grant Programs within Area Health Education Centers, Health Education Training Centers, and Geriatric Education Centers should be used to support interdisciplinary education and training.  Increased funding for Title VII Interdisciplinary, Community-Based Training Grant Programs will allow implementation of faculty development initiatives that address existing faculty shortages, and ensure adequate recruitment and retention of faculty in the future.  It has been demonstrated that interdisciplinary, community-based traineeships are an effective approach to placing allied health professionals in underserved areas.  Additional funding would also increase opportunities for collaboration between Title VII Interdisciplinary, Community-Based Training Grant Programs and community health centers. 

6.) Congress should expand the legislative authorities in Title VII, Section 755(b)(1) to include:

• Innovative projects designed to meet specifically defined and well justified local and regional allied health training needs (L);
• Faculty development demonstration grants to address severe faculty shortages in allied health profession programs including interdisciplinary, community-based faculty fellowships in allied health (M);
• Projects that establish partnerships with existing HRSA workforce centers to collect, analyze, and report data on the allied health workforce, access, and diversity and provide reports on workforce issues to Congress (N);
• Projects that provide incentives for partnerships with local higher education institutions such as 2-year community colleges, tribal colleges, historically Black colleges and universities (HBCUs), and Asian/Pacific Islander and/or Hispanic-serving institutions (O);
• Projects that provide rapid transition training programs in allied health fields to individuals who have certificate, associate, and baccalaureate degrees in health-related sciences (B); and
• Projects that expand or establish demonstration centers to emphasize best practices and innovative models to link allied health clinical practice, education, and research (H).

Expansion of Title VII’s legislative authority to support greater diversity across trainees, career ladders, and data collection regarding the allied health workforce and interdisciplinary best practices will increase the availability, impact, and effectiveness of allied health services in unserved and underserved areas.  Community college programs and baccalaureate degree programs must be better integrated into the overall training process to create a seamless transition into or advancement within allied health professions and to increase the number of future allied health professionals.  Development of a pipeline from 2-year community colleges and colleges that serve primarily underrepresented minority groups represents a significant opportunity for increasing the number of allied health professionals, including those who will choose to practice in underserved areas.  Flexibility to develop programs that meet documented local and regional needs will allow for targeted responses to the health needs and disparities of the Nation’s diverse populations.

7.) Congress should enact the Allied Health Reinvestment Act (AHRA) with the inclusion of Title VII, Section 755 with the revisions proposed by this Committee in this report.

The AHRA legislation seeks funding to resolve the current shortages of allied health professionals and prevent shortages in the future.  The AHRA should be incorporated into Title VII, Section 755.  Creation of additional Sections will be required with the passage of the legislation.