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Nurses, health educators, exercise physiologists, public health specialists, registered dietitians, physical therapists, occupational therapists, and other clinical care personnel are all performing duties once clearly delineated by their educational requirements, and physician's requests.

Implications of Professional Overlap
Is this type of care good for patients ? Are there any effects from "sibling rivalry ?" To date, there are attempts from some allied health professionals to practice "exclusion" in the hope of maintaining standards in their particular fields.

In a recent issue of the Maryland Bodywork Reporter (1), the American Massage Therapy Association was in litigation with the state of Maryland regarding 50 massage therapists who received "cease and desist" orders from the Maryland physical therapy board. One therapist had received criminal inditement. The charge was practicing physical therapy without a license.

On the other side of the issue, recent information from the American Massage Therapy Association states that both physical and massage therapy can have a major impact on rehabilitation and alleviation of chronic pain and dysfunction arising from long-standing tissue problems (2). The question remains where to draw the line between cooperation between practices, and infringement on professional services.

The area of dietary and nutritional advice is another area of concern and disharmony within professions. A 1986 report sites numerous medical problems occuring from improper advice to clients who had some type of medical condition (4). The response from the American Dietetic Association has been to sponsor legislation to exclude those without the RD credentials from giving advice on nutrition (3). This has prompted a debate from other nutrition societies that many other allied health professionals are qualified to give nutrition advice, and guidelines should be implemented for the professional as a whole, and for the general public to make an informed decision.

An Overview of Overlap
The chart below is an attempt to show some of the many areas of clinical health care, and their overlap with other professions. As time goes by these professions will more and more performing multiple services once reserved for each separate division. Some of these professions are listed below:

ProfessionResponsibilitiesOver-lap
Chiropractor
(CP)
Spinal manipulation
nutrition counseling
physical/exercise therapy
DO
RD
PT, EP
Exercise
Physiologist
(EP)
exercise prescription
counseling/education
PT, CC,RD
Physical Therapist
(PT)
soft tissue mobilization
exercise therapy
MT,EP
CP
Registered Dietitian
(RD)
counseling, educationCC,RN
Occupational
Therapist (OT)
PT
Massage Therapist
(MT)
bodywork, soft tissue
mobilization
CP, PT
Clinical Psychologist
(CC)
education, counseling
diagnosis
MD
Registered Nurse
(RN)
education, rehabilitation
clinical services, counseling
CC, PT
EP

Health Care and the World Economy
The terms health care and world economy seem to be separate entities. However, recent television reports (5) have conceded the fact that our notion of what is usually thought of as an "American" product of service may in fact be the product of a global, multi-country effort designed to meet the needs of a changing world economy more efficiently. American cars that are manufactured abroad; airlines which use parts from over twenty countries, manufacturers that use multi-national labor to produce a better and less expensive product - are all examples of an economic base that is changing to meet the needs of many countries in response to demand.

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 About The Author
Eric Durak received his Master of Science degree from the University of Michigan in 1986. His research experience is in the application of exercise for special population groups, such as diabetes, high risk pregnancy,......more
 
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