In a given healthcare organization, there will be many administrative, financial, operational, clinical, allied health, and other essential staff. We will bring a brief overview of many of the types of medical and allied health professionals expected, overall, in America.
Psychologists, Psychiatrists, and Counselors: The ultimate recognition is the diplomate in psychology, which requires a doctor of philosophy (Ph.D.) or doctor of psychology (PsyD) degree, a minimum of 5 years of postdoctoral experience, and the successful completion of an examination administered by the American Board of Examiners in professional psychology. Psychologists may specialize in several areas, such as clinical, counseling, developmental, educational, engineering, personnel, experimental, industrial, psychometric, rehabilitation, school, and social domains (APTA, 2019).
Doctor of Medicine (MD): the highest level of a medical degree, given to those who seek the role of a physician (Barringer & Ireland, 2018).
Doctor of Osteopathic Medicine (DO): fully licensed physicians who received an alternative education route to the traditional medical degree. DOs treat the whole person instead of an MD who looks at medicine allopathically (Hatten, 2018).
Osteopathic Medicine: a distinct pathway to medical practice in the United States that provides all of the benefits of modern medicine and the use of technology and provides the benefits of hands-on diagnosis and treatment through osteopathic manipulative medicine. Osteopathic medicine emphasizes helping each person achieve a high level of wellness by focusing on health promotion and disease prevention (Kimmel, 2019).
Allopathic Medicine: a system in which medical doctors and other healthcare professionals treat symptoms and disease using modern techniques. Also called biomedicine and Western medicine (Shi & Singh, 2019).
Nurses constitute the largest group of healthcare professionals: The nursing profession developed around hospitals after World War I, and it primarily attracted women. Before World War I, more than 70 percent of nurses worked on private duty, either in patients’ homes or private-pay patients (ASLHA, 2019).
The term advanced practice nurse (APN) is a generic name for nurses who have education and clinical experience beyond that required of an RN. Four areas of specialization for APNs exist: clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs), and certified nurse-midwives (CNMs). NPs and CNMs are also categorized as non-physician practitioners; they are discussed in the next section. Besides being direct caregivers, APNs perform other professional activities such as collaborating and consulting with other healthcare professionals, educating patients and other nurses, collecting data for clinical research projects, and participating in the development and implementation of total quality management programs, critical pathways, case management, and standards of care (APTA, 2019).
Nonphysician practitioner (NPP)—also called nonphysician clinician and midlevel provider—refers to clinical professionals who practice in many areas in which physicians also practice but do not have an MD or a DO degree. NPPs receive less advanced training than physicians but more training than RNs. They are also referred to as physician extenders because, in the delivery of primary care, they can, in many instances, substitute for physicians (ASLHA, 2019).
NPPs often work in close consultation with physicians. NPPs typically include physician assistants (PAs), NPs, and CNMs. NPs work predominantly in primary care, whereas PAs are evenly divided between primary care and specialty care. PAs are licensed to perform medical procedures only under the supervision of a physician. PAs assist physicians in delivering care to patients; the supervising physician may be either onsite or offsite. The major services provided by PAs include evaluation, monitoring, diagnostics, therapeutics, counseling, and referral. The American Nurses Association defines NPs as individuals who have completed a program of study leading to competence as RNs in an expanded role. NPs constitute the largest group of NPPs and have also experienced the most growth. The primary function of NPs is to promote wellness and good health through patient education. NPs spend extra time with patients to help them understand the need to take responsibility for their health (APTA, 2019).
Hence, they are an important adjunct to the practice of primary care physicians. Another area where they provide service is nursing homes. NPs have statutory prescribing authority in almost all states. CNMs are RNs with additional training from a nurse-midwifery program in maternal and fetal procedures, maternal and child nursing, and patient assessment. CNMs deliver babies, provide family planning education, and manage gynecologic and obstetric care. They often substitute for obstetricians/ gynecologists in prenatal and postnatal care but refer to abnormal or high-risk patients to obstetricians or jointly manage the care of such patients (Ferrand, 2018).
Efforts to formally establish the roles of NPs, PAs, and CNMs as nonphysician healthcare providers began in the late 1960s when it was widely recognized that they could improve access to primary care, especially in rural and medically underserved areas. It helps alleviate some of the problems created by the geographic maldistribution of physicians. Studies have confirmed the efficacy of NPPs, as many studies have demonstrated that they can provide both high-quality and cost-effective medical care. Compared to physicians, NPPs spend more time with patients and establish a better rapport with them (ASLHA, 2019).
Among the issues that remain to be resolved before NPPs can be used to their full potential are legal restrictions on the practice, reimbursement policies, and relationships with physicians. The lack of autonomy to practice is a significant barrier facing midlevel providers, as many states require physician supervision as a condition for practice. In some states, midlevel providers lack prescriptive authority. NPPs also face financial barriers related to reimbursement. Reimbursement for their services is generally indirect; payments are made to the physicians they practice (APTA, 2019).
In the early 20th century, the healthcare provider workforce consisted of physicians, nurses, pharmacists, and optometrists. The growth in technology and specialized interventions subsequently placed greater demands on the time physicians and nurses could spend with their patients. Such time constraints created a need to train other professionals who could serve as adjuncts or substitutes for physicians and nurses. Allied health professionals received specialized training, and their clinical interventions were meant to complement the work of physicians and nurses. Thus, physicians and nurses were relieved of time pressures to attend to functions that they had the expertise to perform. The extra time also allowed them to keep abreast of the latest advances in their disciplines (Ferrand, 2018).
An allied health professional has received a certificate, associate’s, bachelor’s, or master’s degree; doctoral-level preparation; or post-baccalaureate training in a science-related to healthcare and has responsibility for delivering health or related services. These services may include those associated with identifying, evaluating, and preventing diseases and disorders, dietary and nutritional services, rehabilitation, or health system management (ASLHA, 2019).
Allied health professionals can be divided into two broad categories: technicians or assistants and therapists or technologists. Typically, technicians and assistants receive less than two years of postsecondary education and are trained to perform procedures. These individuals require supervision from therapists or technologists to ensure that care plan evaluation occurs as part of the treatment process. This group includes physical therapy assistants (PTA), certified occupational therapy assistants (OTA), medical laboratory technicians, radiological technicians, and respiratory therapy technicians (RT) (APTA, 2019).
Technologists and therapists receive more advanced training, including education on evaluating patients, diagnosing problems, and developing treatment plans. They must also have the training to evaluate the appropriateness and potential side effects of therapy treatments and teach procedural skills to technicians (Ferrand, 2018).
Some key allied health professionals are graduates of programs accredited by their respective professional bodies. For example, such programs train physical therapists (PT), whose role is to provide care for patients with movement dysfunction. The earlier bachelor’s degree has been phased out, and those pursuing this profession now enter a master’s degree (MPT or MSPT) or doctoral degree (DPT) programs in physical therapy. Passing a licensure examination administered by the American Physical Therapy Association is also required for licensure (ASLHA, 2019).
Occupational therapists (OTs) help people of all ages improve their ability to perform tasks in their daily living and work environments. OTs help rehabilitate individuals who have mentally, physically, developmentally, or emotionally disabling conditions. OT interventions help people live independently or become more productive in their workplace. A bachelor’s, master’s or doctoral degree in occupational therapy and passing a certification examination administered by the National Board for Certification in Occupational Therapy constitute the minimum requirements for entering the OT profession. Dietitians, nutritionists and dietetic technicians ensure that institutional foods and diets are prepared following acceptable nutritional standards (APTA, 2019).
The Commission registers dietitians on Dietetic Registration of the American Dietetic Association. Dispensing opticians fit eyeglasses and contact lenses. They are certified by the American Board of Opticianry and the National Contact Lens Examiners (Ferrand, 2018).
Speech-Language Pathologists treat patients with speech and language problems, whereas audiologists treat hearing problems. The American Speech-Language-Hearing Association is the credentialing association for audiologists and speech-language pathologists (ASLHA, 2019).
For more information on the American Speech-Language-Hearing Association, go to asha.org (ASLHA, 2019). For more information on the American Physical Therapy Association (APTA), go to apta.org (APTA, 2019). These associations oversee standards of practice, the scope of these NPPs, and their licensure and renewals (APTA, 2019). It is helpful to check with these organizations whenever there is an operational, financial, ethical, or management-related question.
Athletic Trainers render services or treatment under the direction of or in collaboration with a physician. Services provided include primary care, injury and illness prevention, wellness promotion and education, emergent care, examination and clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. Athletic trainers improve functional outcomes and specialize in patient education to prevent injury and re-injury. ATs can reduce injury and shorten rehabilitation time for their patients, which translates to lower absenteeism from work or school and reduced health care costs (NATA, n.d.).
Athletic trainers can be found in many settings, including public and private secondary schools, colleges and universities, professional and Olympic sports; physician practice, similar to nurses, physician assistants, physical therapists, and other professional clinical personnel; clinics with specialties in sports medicine, cardiac rehab, medical fitness, wellness and physical therapy; police and fire departments and academies, municipal departments, branches of the military; and, Occupational Health (NATA, n.d. b).
Social workers help patients and families cope with problems resulting from a long-term illness, injury, and rehabilitation, to name a few. The Council on Social Work Education accredits bachelor’s and master’s degree programs in social work in the United States (APTA, 2019).