Health care used to be delivered by a doctor, a nurse
and a pharmacist. Now many other specialists
have joined the team to deliver care focused
not just on saving lives but making life better.
By Crystal Baity and Marion Blackburn
Below, a profile of CAHS Dean Stephen Thomas
After her accident, Mikriam Lilja enrolled in ECU's falls clinic.
More than half of all occupational therapists, a third of all physical therapists and a quarter of all physician assistants practicing in North Carolina trained at East Carolina. Still, "there will be a critical shortage of allied health professionals to meet the growing aging population,” says CAHS Dean Stephen Thomas.
last place Miriam Lilja could have imagined herself was in the emergency room at Pitt County Memorial Hospital. Yes, she’s 90 but Lilja is a slim and athletic woman who takes water aerobics classes with others half her age. She practices Tai Chi for balance and strength. Still, there she was under the fluorescent lights of an examination room, waiting to be stitched up after falling at her Bethel home.
For many older adults, falls like Lilja’s start a cycle of decline that robs them of their independence piece by piece as their activities become more and more limited. Statistics show that when someone falls twice in six months—a hip fracture, a head injury—and they are left unchecked, it’s almost certain they will fall again.
One in three Americans 65 and older suffer a fall each year. Five percent fracture a hip, and while nine out of 10 will survive, half will never regain the mobility they had. Many go from living independently to assisted living. And they’re the lucky ones. Falls are the leading cause of accidental death in older adults. Every 18 seconds, an older adult is treated in a hospital for a fall, and every 35 minutes someone dies as a result of such injuries, according to the Centers for Disease Control and Prevention.
Hopefully, Lilja will escape that fate. She’s enrolled in a new falls prevention clinic at East Carolina University where faculty and students in the College of Allied Health Sciences are helping seniors remain independent, recover more quickly, avoid long hospital stays and possibly side step the high cost of long-term care. Thanks to innovative programs like this one, what was once seen as an inevitable part of getting older is now seen as a treatable condition. In the past Lilja probably would have been told to slow down and rest; now she’s looking forward to more exercise classes because research shows that older adults who stay active avoid future falls.
The therapists treating Liljia are among the many new hands of medicine supplementing traditional caregivers like doctors and nurses. These graduates of the College of Allied Health Sciences (CAHS) are in high demand in today’s health care system that is dominated by aging baby boomers who expect to maintain their lifestyles. Physical therapists, occupational therapists and physician assistants are the most plentiful of these new providers. Others are less well known because they work behind the scenes in labs—the clinical lab scientists, the health information and health services management specialists, rehabilitation specialists, and others who treat speech disorders.
Through them, medicine is bringing solutions to once devastating impediments, enabling people of all ages to confront illness, injury, aging, disability and even addiction. Allied health professionals work in some unexpected fields—such as using animals to help autistic children learn to relate to their world. Whatever their specific title, all CAHS graduates strive to do one thing: improve a person’s quality of life.
If health care once meant saving a life, today’s allied health professions aim to make sure that life is a good one. Expanding the mission of health care is central to allied health professions, making programs like ECU’s even more important.
“Because of the nature of health problems today, especially with older people who have chronic conditions, it takes a team of professionals from different areas to provide this level of care,” says Thomas Elwood, executive director of the Association of Schools of Allied Health Professionals in Washington, D.C., of which CAHS is a member. “As health care becomes more complex it’s necessary for people to have more advanced levels of education,” he adds.
ECU graduates more members of that team than any school in North Carolina, and the 42-year-old program continues growing by leaps and bounds. More than half of all occupational therapists, a third of all physical therapists and a quarter of all physician assistants practicing in North Carolina trained at East Carolina. CAHS is advancing programs such as the clinical doctorate in physical therapy, the first degree of its kind in the state. The college also offers a doctorate in communication sciences and disorders, as well as a doctorate in rehabilitation counseling and administration. These pioneering programs place ECU among the leading players in training professionals for a new health model.
“A college like ours is a collective,” says Dean Stephen Thomas. “We bring together smaller but significant health professions under one roof.”
Allied health care professionals now outnumber both nurses and doctors. Of the roughly 319,000 health care jobs in North Carolina today, 36 percent are allied health professionals. The field is growing rapidly and creating thousands of new jobs. “There will be a critical shortage of allied health professionals to meet the growing aging population,” Thomas says. Addressing this demand for such specialists requires “colleges that are extremely diverse,” Thomas adds. “But if you put all the groups together, they deal holistically with the individual.”
Service, engagement, research
CAHS students believe in community service. Faculty and supervised graduate students in communication sciences and disorders, the largest CAHS department, provide diagnostics and therapy to more than 3,000 children and adults each year in ECU’s speech language and hearing clinic. They also provide balance assessments, and evaluation and fittings for the SpeechEasy anti-stuttering device, invented by faculty Joseph Kalinowski, Michael Rastatter and Andrew Stuart.
Physical therapy students provide services in combination with ECU Physicians, the Brody School of Medicine’s Child Healthy Weight Project, and gait and balance assessment for BSOM and Pitt County Memorial Hospital. Project Working Recovery, developed and operated by rehabilitation studies, helps unemployed or underemployed recovering substance abusers find meaningful work as a means to sustain sobriety.
“Students are learning in-house first, under close supervision, to make sure clients and patients receive the best services,” Thomas explains. “Every lab you go into here is a simulation. Every room has to look like what exists in a hospital or clinic. When our students go to work, employers are not expecting to train these students but hone the skills they already have.”
Research is directed at solving real-life problems from reading disorders to improved function following a stroke to the challenges of older drivers. “The college is truly representative of ECU’s commitment to community service. The faculty, staff and students are engaged in service activities throughout eastern North Carolina and provide health care services that are vital to the health and well being of our citizens,” says Phyllis Horns, vice chancellor for health sciences.
Outreach and engagement are put to practice in the Tillery Wellness Project, where students and occupational therapy faculty are immersed in addressing health disparities in the small northeastern North Carolina town. In conjunction with BSOM’s family medicine department, CAHS’s occupational therapy and physical therapy departments developed a falls risk screening clinic. It’s there that older adults like Lilja who’ve been treated for fall-related injuries are referred for assessment. CAHS sponsors the annual Jean Mills Health Symposium focused on rural, underserved and minority populations.
Several CAHS faculty are conducting National Institutes of Health-funded research, while others are nationally known experts in their fields. The rehabilitation counseling graduate program is consistently ranked in the top 20 by U.S. News & World Report; the communication sciences and disorders department is ranked in the top 10 in a national study of faculty scholarly productivity.
East Carolina launched what then was known as the Life Sciences and Community Health Institute in 1967, about the same time it began exploring founding a medical school to serve a region severely lacking health care providers. In less than a year the name changed to the School of Allied Health Professions and Medical Education Center. Dr. Edwin Monroe, a Greenville physician, became the first dean. The school’s first degrees were in medical technology and social welfare. The first students graduated in 1973, and today there are more than 350 program alumni.
ECU received approval in 1969 to develop programs in physical therapy, occupational therapy and medical record science. Monroe recruited George Hamilton to begin the physical therapy department with the mission of serving the community through physical therapy programs in hospitals and clinics throughout the region. Hamilton, who retired in 1995, remembers those early days: “So many places had no services at all.”
The baccalaureate program began with five students, grew to 12 in the first 10 years and now graduates 30 a year, having moved from a master’s to doctoral degree. Today, there are about 150 physical therapists and 40 physical therapy assistants in Pitt County alone, Hamilton points out.
In 1972, rehabilitation counseling and speech language pathology transferred from the School of Education to allied health. The expanding division needed more space, a need filled when it moved to the Carol G. Belk Building that summer. Dr. Ronald Thiele, a pediatrician in Nashville, Tenn., was recruited as dean in January 1972 and served 19 years. Monroe became vice chancellor for health affairs, which included allied health sciences, nursing and the new medical school.
Thiele was instrumental in creating a biostatistics and epidemiology program. Social welfare, later named social work, became a separate school in 1983. Environmental health would move to the School of Industry and Technology in 1999. “It was a fun time and all done with awfully good people,” Thiele recalls. “The people are the important thing. You can do anything with good people.”
Thiele’s successor, Harold Jones, joined the school as the third dean in 1992, and began work to raise awareness of allied health sciences on campus and in the community. During his tenure, enrollment grew 70 percent, the number of programs increased, the first doctoral-level program in communication sciences and disorders in the state was approved, the first state university physician assistant department began and the state’s first distance education-based programs in allied health were offered. Today, about one in six students entering ECU declares allied health as their major.
Soon, the Belk Building couldn’t hold all the new programs, an overcrowding solved by the 2000 statewide higher education bond referendum. In 2006 ECU opened a new four-story health sciences building that brought all allied health departments under one roof for the first time in 20 years. The additional classrooms, labs and research space have again helped spur record enrollment under Thomas, who was appointed interim dean when Jones left in 2001 and permanent dean in 2003.
CAHS now has eight departments, 794 students and 110 faculty and staff and is one of the fastest growing, most complex and diverse on campus. Enrollment is up 71 percent since 2001. About 60 percent of students entering the college last fall were at the master’s and doctoral levels. Allied health received more than 1,300 applications last fall for undergraduate and graduate school, and admitted 322 students. Twenty-four percent of all those applicants were CAHS undergraduates.
For Greg Antal of Taylorsville, the combination of a public university, a new facility and the opportunity to do research in a state-of-the-art lab sealed his decision to attend ECU’s highly demanding three-year doctoral program in physical therapy. He attends classes four to six hours weekdays all year round. He leaves campus for 32 weeks in clinical rotations interspersed within the curriculum, says Dr. Walter L. Jenkins, associate professor and associate chair of physical therapy. “A large percentage of what we do is laboratory-based teaching,” Jenkins adds. “Eventually students will get paid to put their hands on people, to examine them and treat them.”
The new Health Sciences Building gives Physical Therapy, which had been in a mobile unit, two large teaching labs and three research labs. “We are no longer encumbered by our facilities. Our facilities now enhance our ability to teach and we are able to do the research necessary to keep us on top of our profession,” Jenkins said.
Every student is involved in research, as it has been since the program began. Being able to engage students is a point of pride among faculty. “The faculty has a genuine concern for us to achieve, and to be well-rounded physical therapists,” says Antal, 24. “The faculty is very approachable. They have an open door policy. I know they want us to succeed and they care about our success.”
Antal is studying fall prevention and fall risk assessment in the elderly population and multisensory integration with Dr. Leslie Allison, assistant professor of physical therapy. “It’s a huge research area because so much of our health care money goes to fall-related injuries,” Antal says. “If someone breaks a hip, often that’s the beginning of a gradual decline. That’s why we’re looking at preventing these falls from happening. We want to give them appropriate prevention and balance training so they don’t incur a fall.”
When Antal graduates next May, he plans to work in an outpatient clinic somewhere in North Carolina in orthopedic and neurological rehabilitation. “There is more a demand than we can supply. I don’t know what the job market is going to do, but we’re still going to be in need,” he says.
Another profession with dramatic workforce shortages is clinical laboratory science, the smallest department in CAHS. “Most people don’t know that 70 percent of diagnosis and treatment decisions are made by medical lab tests,” says Dr. Richard Bamberg, department chair. “You don’t just put a sample in a machine and push a button. You have to have someone to tell if it’s accurate, valid and reliable results.”
The shortages are so extreme that medical technologists are beginning to see offers of sign-on bonuses, relocation and tuition assistance, incentives typically seen in nursing, Bamberg says. “Nationally all the clinical laboratory science programs together are producing half of the number of vacancies,” he adds.
Novice Hoskins is a rising senior and registered nurse who first became interested in clinical laboratory science working as a phlebotomist. She will graduate in 2010, with an eye to medical school one day. Evaluating a blood cell count for infection or identifying a microorganism is some of the behind-the-scenes work that a medical technologist does. “People don’t know how that works. When I tell people I’m going into clinical lab science, they say, you already know how to do it (because she’s a nurse). It’s frustrating. The profession I’m going into now, you actually perform the test, not just collect the specimen. I’m performing the tests that I use as a nurse to take care of my patients.”
The department now offers a five-year degree curriculum with biology. Students study biology three years, then transition to clinical laboratory science for their final two years and earn a double degree. “This is particularly good for pre-med majors,” Bamberg says.
Many CAHS alumni have enjoyed stellar careers. Goldsboro native Jason Ezzelle graduated with a degree in clinical laboratory science in 1997. He took an entry-level position at PPD, a Wilmington-based contract research organization, monitoring clinical research sites and collecting data as part of research study protocols. He introduced the idea of monitoring labs, which quickly took off as a new service line for the company. Before long, he was traveling 75 percent of his time, often to developing nations inspecting labs. “It’s been an incredibly rewarding career,” says Ezzelle, now PPD’s senior project manager in the global laboratory services group. “We do regional workshop training for labs worldwide. It touches thousands of clinical laboratory scientists.”
Katina Eley was one of 20 students in ECU’s first class of physician assistant studies. After graduating in 1999, she went back home to Ahoskie to practice in obstetrics and gynecology. “I chose to go back to Ahoskie because I wanted to give back to my community,” Eley says. “It brings me joy to know that I have helped someone, whether it is practicing preventive medicine or helping to cure a problem presented to me.”
Challenges and responses
As the population ages, allied health professionals will continue playing a significant role in health care delivery, especially in rural areas. “There are not enough doctors to take care of everybody, and not everybody needs a doctor,” Thiele says.
Growth in the college will level off only “because we are filling the building,” Thomas jokes. CAHS also is challenged to find enough clinical training sites for students, a prerequisite to graduation for most degrees. The college already works with more than 700 clinical centers, mainly in North Carolina but also in other states.
Distance education is growing to offer coursework to as many students off campus as possible. CAHS is also considering an allied health dental program as part of ECU’s new School of Dentistry. Communication sciences and disorders is beginning a new project with the Wounded Warrior battalion at Camp Lejeune to assess and manage soldiers with balance disorders. The department also has begun an aphasia support group for people who have trouble communicating because of stroke or brain injury. In health services and information management, a new graduate certificate is being offered and a master’s degree is being planned in health informatics, a burgeoning field in the electronic management of health care data.
Occupational therapy graduate students Cara Wiseman and Scott Cormier are conducting trials in the motion analysis lab on the effect of mental practice. In one exercise, subjects are asked to think about building a pyramid with cups before they actually build it. Then they are asked to build it multiple times. “It’s similar to shooting a free throw,” Wiseman explains. “You think about it before you do it. Then you do it.”
Investigators are looking at the implications that this concept of mental practice has for different age groups and for people who have suffered strokes or brain injuries, and those with no injuries. “We are already seeing improvement with the older age group,” said Cormier, who hopes to work with injured veterans after graduation.
No doubt research will play an important role in the future of innovative programs in the allied health sciences—and the improved quality of life for generations to come. “Being an aging baby boomer myself,” Thomas says. “I have a vested interest in the thorough preparation of our graduates that all of us will someday rely on to provide excellent care and extend our quality of life.”
One of the most respected deans on campus'
r. Stephen Thomas’ pitch to students considering a health care career is direct and simple. His straightforward approach is just one of the many qualities admired by those who work with him and who have known him for years.
“You don’t have to go into medicine or nursing to have a great career in health care,” says Thomas, dean of the College of Allied Health Sciences. Thomas often explains to prospective students what allied health is by listing its varied job titles—physical therapist to speech language pathologist to health information administrator. Some have patient contact, some don’t, but all are in demand. “There are a lot of things you can do. There isn’t a profession that doesn’t have a shortage.”
Thomas has steered the college through record enrollment, the addition of master’s and doctoral programs, budget cuts, university leadership changes, the construction and move to a new building on the Health Sciences Campus and re-designation from school to college.
“Steve Thomas is an incredibly capable administrator who has the knowledge, experience and personal style needed for this challenging leadership role. His college is a large, complex and diverse academic unit with programs that address critical health care workforce shortages,” says Dr. Phyllis Horns, vice chancellor for health sciences and former longtime dean of the College of Nursing. “He has managed the growing demands for more graduates with skill and a sustained commitment to quality education and clinical competency. He is certainly one of the most respected deans on this campus and among his peers in allied health science schools across the country.”
Thomas came to ECU in 1980 as the third faculty member in the rehabilitation studies department with then department chair and professor emeritus Dr. Shel Downes and current department chair Dr. Paul Alston. Thomas was recruited to start and direct the vocational evaluation master’s degree program.
Vocational evaluators assist individuals who are disabled or disadvantaged to identify appropriate education, training, jobs and career paths in order to improve overall quality of health.
“We were extremely lucky to attract him when he was finishing his doctorate,” Alston says. “It’s really been a great match for the university and for Steve.”
Dr. Edwin Monroe, a physician and the first dean of allied health sciences, says Thomas is a good listener who “has been around here long enough to have a sense of what’s important to this region, and he is a leader.” They first met serving on a local vocational center board.
“I was impressed then not only with his youth and height but his quick grasp of problems and working toward solutions,” Monroe adds.
Before ECU, Thomas held academic, research and administrative positions with the University of Arizona in Tucson, the University of Wisconsin-Stout in Menomonie and the University of Texas Medical Branch in Galveston.
A Texas native, Thomas earned his doctoral and master’s degree in rehabilitation from the University of Arizona and his bachelor’s degree in psychology and sociology from Texas Christian University in Fort Worth.
Thomas was well-known in vocational evaluation and assessment before he became dean. He helped establish a national certification process for vocational evaluators and work adjustment professionals, and served on the commission created to oversee it.
His monograph for vocational evaluators on how to write reports is still cited today. “When we provide services, we must document those services, and he wrote about how to do that. It’s so old he talks about dictation. The technology may be outdated, but the basic premise and content is still current,” says Dr. Steven R. Sligar, who joined ECU as assistant professor and director of graduate programs in vocational evaluation after Thomas was appointed interim dean in 2001. They first met in the 1970s when both worked in Texas.
Dr. Tom Bacon, program director for NC Area Health Education Centers, has worked with Thomas both in his role as dean and on several statewide initiatives with the NC Council on Allied Health. Thomas is vice chair of the council.
“He has collaborated with other universities and agencies to bring greater awareness statewide to the vital role that the allied health fields have in improving the health of North Carolinians,” Bacon said. “He brings an important state and national perspective in articulating the allied health workforce needs we have as a state.”
Thomas has served as president of state and national rehabilitation associations and chair of his national professional certification commission. He serves on the board of the Eastern Area Health Education Center, the ECU Medical & Health Sciences Foundation, and the N.C. Agromedicine Institute. He is a member of the N.C. Institute of Medicine, and secretary of the Southern Association of Allied Health Deans in Academic Health Centers.
Part of Thomas’ administrative philosophy is to give his faculty and staff the resources and support they need to do their job. Then he steps back and lets them do it. “I think it makes a real difference, and recognizes and respects what they do,” Thomas says. “I have absolutely the greatest faculty and staff.” —
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