From telephones to health care training: A story about access

There was a time in the United States when telephone communication was controlled by a single entity. AT&T built and maintained the infrastructure that allowed people to connect across cities, states, and eventually the country. In many ways, it was a remarkable achievement. The system worked. Calls went through. Standards were maintained.

But there was a trade-off. If you wanted access to telephone service, there was only one path. If you wanted something different – more affordable service, new technology, or faster expansion – you had little say in the matter. Innovation moved at the pace of a centralized system, and access expanded only as quickly as that system allowed.

In 1984, the breakup of AT&T reshaped the telecommunications landscape. Standards did not collapse, but opportunities expanded. Competition increased. Innovation accelerated. Costs began to shift. Most importantly, access widened. Instead of losing quality, the system gained flexibility.

Today health care faces similar tension surrounding workforce development. Hospitals and clinics across the country are asking an important question: how do we create enough qualified health care professionals to meet demand without compromising the industry standards that ensure patient safety, clinical competency, and quality care?

In some areas of health care training, the path into the profession is tightly defined. The American Registry of Radiologic Technologists, for instance, has established a clear and structured route to certification designed to ensure that anyone entering the field has met rigorous educational and clinical requirements – but structure can sometimes become constraint.

When access to a profession depends on a single, narrowly defined pathway, the pace of workforce development becomes tied to that structure. Training programs take years to complete. Educational models are often separated from the day-to-day realities of clinical environments. Meanwhile, the hospitals that depend on these professionals have limited ability to shape how their future workforce is trained. 

The result is a quiet but significant bottleneck. In many cases, the problem does not stem from a lack of individuals willing to enter health care professions but rather that hospitals lack the ability to train. In some cases, the pathways connecting willing learners to workforce needs are narrower than the demand requires.

In response, health care systems have adapted in other ways. They hire traveling staff. They pay premiums for temporary coverage. They stretch existing teams. These solutions address immediate needs, but they do not build sustainable pipelines.

History suggests that when systems become too narrow, expansion does not require lowering standards — it requires rethinking access. For example, certification bodies such as the National Center for Competency Testing recognize multiple pathways to competency. Individuals may qualify through formal education, work experience, or structured apprenticeship models. The standard remains the same; the routes to reach it expand.

This distinction matters. When multiple pathways exist, hospitals can participate more directly in workforce development. Training can occur within the environment where skills are actually used. Learners can contribute meaningfully while they are learning rather than waiting years before entering the field. The gap between education and practice begins to close.

This is not a rejection of traditional education. It is an acknowledgment that no single pathway can meet the full scope of today’s workforce demands.

The story of the telephone system offers a useful lens. When access expanded, quality did not disappear. It adapted, strengthened, and reached more people. The same principle can apply to health care training.

The goal is not to dismantle standards but to ensure they are not confined to a single route. When multiple, well-structured pathways lead to the same level of competency, the system becomes more resilient.

As history has shown, when access to opportunities expand, systems do not weaken – they evolve.

NRHA adapted the above piece from ICATAP Healthcare Apprenticeship Programs, atrusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 

Sheri Henry, BS, is the founder and CEO of ICATAP, LLC, where she works with health care organizations serving rural and underserved communities to develop apprenticeship-based workforce programs that strengthen clinical staffing pipelines. With more than 15 years of health care experience, she brings expertise in workforce development, operational leadership, and employer-sponsored training strategies that help organizations build long-term staffing stability.