Several health care issues attract considerable attention in Congress such as rising health care costs and an increase in the number of Americans who lack health insurance coverage. Other concerns include controlling the growth in medical malpractice costs and the continuation of funding for the National Institutes of Health to maintain the nation's preeminence in research leading to innovative treatments and cures. One key dimension that fails to receive sufficient notice, however, is the adequacy of the health workforce.
Even if every person in the United States could be handed a health insurance card, access to health care would not be guaranteed. Health personnel shortages would prevent that outcome from occurring. A national shortage of nurses attracted widespread coverage by the media. Legislation aimed at addressing the problem was enacted in August 2002, but Congress has not funded all its provisions adequately. Meanwhile, other kinds of shortages represent a more hidden element of an overall situation that would benefit from federal intervention.
Across the health professions, there has been a decline in recent years in student applications and in subsequent enrollment in academic institutions. Apart from the nursing situation, a vivid illustration of this disturbing trend may be found among the allied health professions.
A somewhat vague term, allied health was coined by the federal government in 1966 when legislation was needed to remedy severe workforce shortages among professions such as physical therapy. A way of depicting what is embraced by allied health is to envision all personnel in a hospital who are involved in patient care except for physicians, nurses, and pharmacists.
For example, a serious car accident would result in an appearance on the scene of emergency medical personnel to provide some immediate treatment and be involved in the safe transport of injured parties to a hospital. Medical technologists and radiologic technologists would aid in arriving at a diagnosis of the extent of sustained injuries.
Dietitians and respiratory therapists might need to furnish services at other treatment stages.
Health information management specialists would be responsible for the efficient flow of records and the sharing of information among all the parties involved in furnishing care. This group of health professionals will attain even greater prominence as steps move forward to create electronic medical records for everyone in the U.S. population. Both in the hospital and for a lengthy period after discharge, treatment by physical therapists and occupational therapists would be essential in assuring a successful recovery.
Currently, many sectors within the allied health professions are ailing and failing. Although a high proportion of all treatment furnished in a hospital is accompanied by medical laboratory tests, the medical technologists who perform these procedures are experiencing a personnel shortage that is just as severe, if not worse than what afflicts nursing. Possible consequences may include delays and disruptions of acutely needed services. Cytotechnologists assess Pap smears, which are used to detect changes that may be cancerous or may lead to cancer, but because of an inadequate supply of these health professionals, test results may not be available for as long as 12 weeks.
A growing shortage of radiologic technologists is causing patients to wait several months before routine annual mammogram tests can be scheduled. While the number of magnetic resonance imaging procedures rose from 11.9 million in 1998 to 18 million in 2001, the number of technologists did not increase accordingly. As the number of tests increases relative to the number of personnel who perform them, the possibility of a decline in quality becomes more likely.
Accredited respiratory therapy programs in 2000 graduated 5,512 students--21% fewer than the 6,062 graduates in 1999. In 2001, the number of graduates from these schools fell another 20% to 4,437. The Bureau of Labor Statistics expects employment of respiratory therapists to increase faster than the average of all occupations, going from 21% to 35% through 2010. An attendant rise in the incidence of respiratory ailments, including asthma, chronic obstructive pulmonary disease, and cardiopulmonary diseases drives this demand.
The aging of the U.S. population will be accompanied by an increased demand for the care of a wide range of chronic health conditions. Therapeutic services provided by allied health personnel will mean the difference between enabling older persons to remain at home and maintain their independence as long as possible versus placement in long-term care facilities. A related issue is the aging of the caregivers themselves at a time when the educational pipeline needed to produce replacement personnel is shrinking.
The Nurse Reinvestment Act represented a recent step in the right direction and was a proper response to a serious problem. Just as importantly, shortages among that group of professionals should serve as a warning. Federal policymakers need to be more attuned to taking constructive action before other kinds of personnel shortages become too severe. Otherwise, the picture on the near horizon will be of the prospect of an alarming increase in adverse events affecting patients because of an inadequate supply of allied health caregivers.
As a means of addressing the situation, the Association of Schools of Allied Health Professions (ASAHP), an organization based in Washington, DC, has taken the initiative to work with several other organizations in the development of legislation known as the Allied Health Professions Reinvestment Act of 2004. S. 2491 was introduced in the U.S. Senate and H.R. 4016 in the House. This important legislation is designed to furnish a remedy for the aforementioned kinds of allied health workforce problems and merits the support of federal elected officials.