The established allied health professions

This chapter explores in detail using the examples of optometry and radiography the early development of the well-established and more mature allied health professions who have had to negotiate their professional boundaries with the state and the medical profession. In many ways, it is these early disputes and negotiations that are responsible for shaping the modern health workforce and the allied health division of labour. Optometry and radiology constitute two clear examples of professions that may be regarded as established within contemporary mainstream healthcare. One has a long pre-modern history, with a degree of autonomy built on its claim to a unique knowledge base that is independent of medicine and a track record of retail business success; the other emerged firmly rooted in hospital practice comprising technicians competing with medicine within a medical sphere of practice. Optometry, historically male-dominated, was established prior to the advent of full medical hegemony and power; radiography, mainly female, arose within it. Yet, both continue to operate within limits to a scope of practice defined by the presence of two major medical specialities with which they closely interface: ophthalmology and radiology. Both groups have a clearly limited and subordinate role in the provision of healthcare within their own spheres, and both had to concede the right to make diagnoses within their fields of expertise. It is the latter that has so clearly influenced the limitations set on the prescribing of medicines for both groups, even in the current policy climate of workforce redesign and role flexibility.