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APPENDIX D - Estimates of the Current Supply of Personnel in :10 Allied Health Fielcis Making an accurate assessment of the supply of allied health practitioners in each of the various fields is not easy. For many occupations, there is no reliable data source for either the total number of qualified people, the number working, or the number not working but available if the right market conditions were to occur. BLS uses the Occupational Employment Survey (OES) to collect data on the number of filled jobs. In fields with a high incidence of persons holding multiple jobs, however, BLS data are an inaccurate reflection of the labor force. Another major source of data is the decennial census of the United States, which was last conducted in 1980. These data are now dated, and their definitions of allied health fields often do not match the professions' definitions. A third source of data, memberships of the allied health professional associations, may provide information from only a small fraction of the supply of practitioners. Be- cause not all practitioners in a field are listed as certificate, license, or registration holders and not all listed practitioners are in the active labor force, using these categories as a data source does not always offer accurate representations of the labor force. Despite these data limitations, some estimates of the supply of practi- tioners can be made. For example, in fields in which holding multiple jobs is not common, the BLS data closely approximate the number of people working in the field. In addition, professional associations collect data on both the number of qualified practitioners and the number of practitioners active in the field. This appendix presents supply estimates that have been derived from various sources of data. Although it is difficult to pinpoint a "best figure," the estimates can be used to map a reasonable range of the 296

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APPENDIX D 297 number of people working in each of the 10 fields highlighted in this report. Dietitians BLS estimated total dietitian employment in 1986 to be 40,201 positions (38,201 people held wage and salary jobs, and 2,000 people were self- employed dietitians). BLS defines dietitians as people who "organize, plan, and conduct food service or nutritional programs to assist in Ethel pro- motion of health and control of disease." Dietitians "may administer activ- ities of a department providing quantity food service" and "may plan, organize, and conduct programs in nutritional research." The American Hospital Association's 1985 annual survey indicated that there were 14,993 full- and part-time dietitians employed in U.S. registered hospitals that year. BLS estimates that 37 percent of all dietitians were employed in hospitals in 1986. Assuming that the number of dietitians working in hospitals did not change significantly between 1985 and 1986, and that the number in 1986 was roughly equal to the association's 1985 survey figure, we can then extrapolate from the American Hospital As- sociation data (14,933 dietitians employed/37 percent of dietitians) and estimate that there were about 40,100 dietitians employed in 1986 a figure that confirms the BLS estimate. The American Dietetic Association reported 44,570 registered active dietitians on its rolls at the end of 1987. Dental Hygienists The Occupational Employment Survey defines dental hygienists as peo- ple who "perform dental prophylactic treatments and instruct groups and individuals in the care of the teeth and mouth." BLS estimated that dental hygienists filled 86,676 jobs in 1987 none was self-employed. As men- tioned earlier, the BLS data pertain to jobs. People who hold more than one job are counted at each job site. Because the practice of holding multiple jobs is common among dental hygienists, the number of dental hygienist jobs that are filled greatly exceeds the number of working dental hygienists. The Bureau of Health Professions of the Health Resources and Services Administration estimate that there were 45,800 dental hygienists in 1984 filling an estimated 76,000 jobs. Thus, each working hygienist filled an average of 1.66 jobs. Assuming the job-to-hygienist ratio was about the same in 1986 as in 1984, the committee estimates that there were about 52,200 working hygienists in 1986. Dental hygienists are licensed in every state and the District of Columbia. To obtain a license, a candidate must graduate from a dental hygiene school

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298 APPENDIX D accredited by the Commission on Dental Accreditation and pass both writ- ten and clinical examinations. According to the commission's 1986/1987 annual report, a total of 51,713 students graduated from accredited schools between 1976 and 1986. Emergency Medical Technicians BLS estimates that there were 65,229 paid emergency medical techni- cians (EMTs) in 1986. According to the OES instrument, EMTs "administer first aid treatment and transport sick or injured persons to medical facilities, working as a member of an emergency medical team." EMTs are not ambulance attendants and drivers. Because there are many volunteer EMTs, the number of paid EMTs understates the true supply of practitioners. The 1985 National Emergency Medical Services Clearinghouse survey indicated that approximately 95,000 EMTs are certified annually in 42 states. However, New York, Texas, and California, three of the most populous states, were not among those re- porting. Certification is generally valid for 2 years; the committee therefore estimates that there are at least 200,000 certified EMTs in the United States . . in any given year. Medical Laboratory Technologists and Technicians According to BLS estimates, there were 239,350 jobs for medical labo- ratory technologists and technicians in 1986 (this figure includes 1,000 self- employed persons). The OES defines medical and clinical laboratory tech- nologists as people who "perform a wide range of complex procedures in the general areas of the clinical laboratory or Ewho] perform specialized procedures in such areas as cytology, histology, and microbiology." Their "duties may include supervising and coordinating activities of workers en- gaged in laboratory testing and include workers who teach medical tech- nology when teaching is not their primary activity." Medical and clinical laboratory technicians are defined as persons who "perform routine tests in medical laboratories for use in treatment and diagnosis of disease." They "prepare vaccines, biologicals, and serums for prevention of disease" and "prepare tissue samples for pathologists, take blood samples, and execute such laboratory tests as urinalysis and blood counts." Laboratory technicians "may work under the general supervision of a medical laboratory tech- nologist." Although BLS collects separate data for the two categories of laboratory personnel, the data are combined for reporting purposes. It is difficult to estimate the ratio of technologists to technicians. Of the 209,000 registrants of the American Society of Clinical Pathologists in 1987, 82 percent were medical technologists. In September 1987 the registry of the National Certification Agency for Medical Laboratory Personnel was

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APPENDIX D 299 composed of 83 percent technologists and 17 percent technicians. If the above ratios are applied to the BLS estimate of total employment of medical laboratory technologists and technicians, the numbers of technologists and technicians in the work force in 1986 would have been about 196,267 and 43,083, respectively. A word of caution is in order, however. Technicians may be less likely than technologists to be certified; thus, our estimate may underrepresent technicians and overrepresent technologists. Unfortu- nately, there is no easy way to verify the ratio of technicians to technologists. Medical Record Administrators and Technicians BLS does not estimate total employment for medical record administra- tors. The American Hospital Association's 1985 annual survey shows 7,639 full- and part-time medical record administrators employed in U.S. reg- istered hospitals in that year. If, as indicated by the American Medical Record Association 1986 membership survey, approximately 73 percent of all medical record administrators work in acute care facilities, we can extrapolate from the American Hospital Association data to determine the total number of persons employed as medical record administrators: 10,464. If this is the case, more than 20 percent of people filling medical record administrator jobs must be unregistered because the American Medical Record Association reported only 8,240 registered medical record admin- istators in 1987. Medical record technician employment was estimated by BLS to be 39,888 in 1986. The OES defines medical record technicians as persons who "com- pile and maintain medical records of hospital and clinic patients." The American Medical Record Association reported 14,690 accredited record technicians in 1987. The American Hospital Association's 1985 annual survey shows 43,383 full- and part-time medical record technicians employed in U.S. registered hospitals. This figure is not only substantially higher than the BLS estimate of 24,500 jobs in hospitals, but it is also higher than the BLS estimate of total technicians' jobs in all settings. The reasons for this difference are not known, but they may be sought in an examination of the ways in which job definitions are developed and then interpreted by survey respondents. Occupational Therapists BLS estimates that there were 29,355 jobs for occupational therapists in 1985. The OES defines occupational therapists as persons who "plan, or- ganize, and participate in medically oriented occupational programs in hospitals or similar institutions to rehabilitate patients who are physically or mentally ill."

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300 APPENDIX D The American Hospital Association 1985 annual survey shows 10,595 full- and part-time occupational therapists employed in U.S. registered hospitals. The American Occupational Therapy Association reports that about 28 percent of its members worked in general and pediatric hospitals in 1986. BLS estimates that 32.5 percent of total occupational therapy employment is in hospitals. The total active membership of registered occupational therapists in the American Occupational Therapy Association at the end of 1987 was about 27,300. Until mid-1987, registered occupational therapists automatically became members of the association, and the tally of active members rep- resented about 99 percent of the professional work force. Membership in the association is now voluntary. Physical Therapists Total 1986 employment of physical therapists was estimated by BLS to be about 61,168 positions, including 5,000 self-employed persons. The OES defines physical therapists as persons who "apply techniques and treatments that help relieve pain, increase the patient's strength, and decrease or prevent deformity and crippling." The American Physical Therapy Association estimated the number of licensed physical therapists to be 65,890 as of June 1986. All states require practicing professional physical therapists to be licensed. Radiologic Technologists and Technicians According to BLS estimates, there were 115,429 jobs for radiologic tech- nologists and technicians in 1986. The OES defines radiologic technologists as persons who "take x-rays, CAT scans, or administer non-radioactive materials into Lal patient's blood stream for diagnostic and therapeutic purposes." Hospitals were asked to include in the category of radiologic technologist all workers whose primary duties were to demonstrate portions of the human body on x-ray film or fluoroscopic screens. Radiologic tech- nicians were defined as persons who "maintain and safely use equipment and supplies necessary to demonstrate portions of the human body on x- ray film or a fluoroscopic screen for diagnostic purposes." Included in the BLS "radiologic technologists and technicians" category are radiation ther- apists and sonographers. Nuclear medicine technicians are not included. The Bureau of Health Professions estimates that there were 143,000 radiologic health service workers of all types in 1986, including nuclear medicine technologist Nuclear Medicine Technologists Nuclear medicine technologists "prepare, administer, and measure ra- dioactive isotopes in therapeutic, diagnostic, and tracer studies utilizing a

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APPENDIX D 301 variety of radioisotope equipment." They "prepare stock solutions of ra- dioactive materials and calculate doses to be administered by radiologists." They "subject patients to radiation Land] execute blood volume, red cell survival and fat absorption studies following standard laboratory tech- niques." BLS estimates that there were 9,677 nuclear medicine technologist jobs in 1986, of which 89 percent were in hospitals. Over 88 percent of the respondents to a 1987 survey conducted by the Nuclear Medicine Tech- nology Certification Board indicated that they worked in hospitals. The 1985 American Hospital Association survey of U.S. hospitals indi- cated that there were 7,972 full- and part-time nuclear medicine technol- ogists employed in U.S. registered hospitals in that year. If approximately 89 percent of all nuclear medicine technologists work in hospitals, the American Hospital Association data suggest that the total number of nu- clear medicine technologists employed in 1985 was about 9,000, which is in close agreement with the BLS estimate. The Nuclear Medicine Tech- nology Certification Board reported 10,298 certified technologists in Au- gust 1987. Respiratory Therapists BLS estimated that there were 56,333 jobs for respiratory therapists in 1986 there were no self-employed respiratory therapists. The OES de- f~nes respiratory therapists as persons who "set up and operate various types of equipment, such as iron lungs, oxygen tents, resuscitators, and incubators, to administer oxygen and other gases to patients." The 1985 American Hospital Association survey indicated that there were 32,623 respiratory therapists employed in U.S. registered hospitals in that year. The American Association for Respiratory Care states that the majority of respiratory care practitioners work in hospitals. BLS esti- mates that 88 percent of such jobs are to be found in hospitals. Speech Pathologists and Audiologists BLS estimates that jobs for speech pathologists and audiologists num- bered 45,129 positions in 1986, including 3,000 self-employed practitioners. The OES defines speech pathologists and audiologists as health care prac- titioners who "examine and provide remedial services for persons with speech and hearing disorders and perform research related to speech and language problems." The 1985 American Hospital Association survey identified 5,354 speech pathologists and audiologists who were employed in U.S. registered hos- 1 ~ ~ pitals in that year. Il. as BLS states, hospitals provide only about 10 percent of total employment for speech pathologists and audiologists, the total

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302 APPENDIX D number of speech pathologists and audiologists employed in 1985 would have been about 53,540 substantially higher than the BLS estimate. There are 56,287 speech pathologists and audiologists who are certified by the American Speech-Language-Hearing Association. Ninety-two per- cent of certified practitioners are members of the association. Although basic occupational preparation is at the master's level, persons holding only a bachelor's degree in speech pathology and audiology are employed in some settings and may be considered a part of the labor supply. There is no estimate of the number of bachelor's-level practitioners.