Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 96
4
Demand and Supply in
Allied Health Fields
MAJOR ECONOMIC, DEMOG~PHIC, AND SOCIAL FORCES must be taken
into account to assess the directions and magnitude of changes in
the U.S. health care system and the implications of these changes for allied
health employment. This chapter examines how each of 10 allied health
fields is affected by these forces and how they will determine the demand
for and supply of personnel for each field by the year 2000.
The discussion that follows deals with national trends, even though local
decision makers concerned with allied health practitioners may be faced
with conditions that differ substantially from the national experience. The
committee believes that its national analysis will be helpful to those who
must draw conclusions about the future of allied health personnel in their
own localities.
The committee based its assessment of the future on several types of
information. Bureau of Labor Statistics (BLS) projections of demand are
the source of quantified demand information which the reader will find
throughout this chapter (Bureau of Labor Statistics, 1987~. To draw con-
clusions about demand the committee incorporated its own judgments
about the impact of the many forces that drive demand. Assessments of
supply were based on what would happen if the situation remained un-
changed with respect to the rates at which individuals leave and enter the
allied health work force. To that assumption were added assessments of
the likelihood of the situation remaining unchanged. A final element in
trying to foresee the future was the application of our limited knowledge
of current demand and supply balances. Because decision makers must act
even in the absence of complete data, the committee decided to make
96
OCR for page 97
DEMAND AND SUPPLY IN 10 FIELDS
97
assessments of future labor markets for allied health practitioners using
BLS data. (Chapter 2 described the BLS data collection and projection
process.) The committee advises readers to view the projections critically,
in light of their inherent limitations. These projections should be inter-
preted not as a precise prediction of the future but rather as indications
of the magnitude of change. The tools can then be used as a basis from
which local and federal decisions makers can develop their own best esti-
mates of the labor market. The committee emphasizes the importance of
continued data collection to allow more precise projections.
In some allied health fields the committee's assessment showed large
discrepancies between demand and supply. The committee is not sug-
gesting, however, that these gaps will necessarily occur. Rather, the market
will eventually adjust so that a reasonable balance is achieved over time. If
employers are sufficiently hard-pressed, they will raise salaries, which will
attract more people to allied health careers. Employers whose ability to
pass on costs is increasingly limited by prospective payment will also try to
increase productivity and reduce the number of workers they employ as
those workers become more expensive.
Yet the committee is concerned that the market response will not be
quick or creative enough to avoid some negative consequences for ex-
ample, erosion of the quality of care, service disruptions, and constraints
on the ability of providers to make timely investments in new modes of
service. Because these are serious consequences, the committee believes
that it is important to try to anticipate them well enough in advance to
forestall them if possible. Later chapters in this report are devoted to
examining ways in which health care provider and educational institutions
can protect themselves and, ultimately, patients from the costs associated
with imperfectly working markets.
The committee's comments about the way the year 2000 will look do not
allow for major changes in the ways in which Americans pay for health
care. If a major financing change should occur, the future of many allied
health fields will be significantly altered. To illustrate the effects of financing
changes, the committee applied the scenarios presented in Chapter 3 to
each of the 10 allied health fields discussed in this chapter.
In assessing future personnel demand for each of the 10 occupations,
we have assumed that the current mix of fees for service and prospective
payment (i.e., the mixed model scenario) will prevail for the next 12 years.
As health care policy decisions are made at the national and local levels,
however, planners must adjust their views of future allied health employ-
ment. To assist in this process, the committee has indicated how each
profession might be affected by incentives characteristic of the access scen-
arios (which could include new state Medicaid entitlements or a nationally
mandated benefits program) or the prospective payment scenario (which
OCR for page 98
98
ALLIED HEALTH SERVICES
could include a new state hospital rate commission or the extension of PPS
to settings other than acute care hospitals).
The committee has also attempted to alert readers to the significant
trends in factors influencing supply most often, the number of graduates
and the number of educational programs. Yet labor force behavior is equally
important. Unfortunately, there are only crude data on entrance into and
exit from the allied health labor force; thus, the committee could make
only very rough estimates of future supply. What is known is that even
small changes in tenure in the work force can have a substantial effect on
the future supply of allied health personnel.
CLINICAL LABORATORY TECHNOLOGISTS
AND TECHNICIANS
Demand for Medical Laboratory Technologists and Technicians
BLS predicts that between 1986 and the year 2000 the number of clinical
and medical laboratory jobs for technologists and technicians will grow
from 239,400 to 296,300, an increase of 24 percent. Although the growth
rate is below that forecast for many other allied health occupations, it
represents a substantial number (57,000) of new jobs. By comparison, the
expected dramatic 87 percent increase in physical therapist employment
represents only 54,000 new jobs. It must be remembered that the BLS data
are based on employers' responses to questions about the numbers of
people performing defined tasks. Respondents are not asked to distinguish
licensed or certified personnel from those without such credentials.
Clinical laboratories are in a period of rapid change. Technological changes
are allowing the performance of tests in new settings and are also generating
new tests. PPS has caused hospital managers to rethink the relative roles
of in-house and reference laboratories. Changes in reimbursement have
made physicians seek the benefits of providing office laboratory services.
New settings for health care, such as ambulatory centers, are encouraging
the establishment of laboratories in nontraditional settings.
When analyzing these changes in terms of their impact on the demand
for technologists and technicians, it is important to distinguish between
changes that reduce demand, changes that increase demand, and changes
that make no difference to manoower but only represent a change in
location, techniques, or practice style.
Because approximately 63 percent of clinical laboratory technicians and
technologists are employed by hospitals (Table 4-1), changes in that setting
will greatly influence the demand for those personnel and where they work.
Indeed, a number of factors that are currently affecting the hospital lab-
oratory work load may, in turn, affect personnel needs.
~ 1
OCR for page 99
DEMAND AND SUPPLY IN 10 FIELDS
99
TABLE 4-1 Major Places of Wage and Salary Employment for
Medical and Clinical Laboratory Technologists and Technicians, 1986
Actual and Projected for the Year 2000
Employment Setting
Total employments
Total wage and salary
employment
Hospitals, public and
private 149,800
Offices of physicians 30,100
Offices of dentists and
other health care
practitioners
Medical and dental
laboratories 28,100
Outpatient care facilities 5,300
Number of
fobs, 1986 Percentagea
Number of
Jobs, 2000 Percentagea
296,300
239,400
238,400
890
100.0
62.8
12.6
0.4
11.8
2.2
295,200
160,000
46,200
1,800
43,200
13,000
100.0
54.2
15.7
0.6
14.7
4.4
aThese percentages were calculated using unrounded figures and therefore will not be
identical to percentages that are calculated using the rounded figures provided in the
table.
tTotal employment = wage and salary employment + self-employment. These figures
include 1,000 self-employed workers in 1986 and 1,027 in the year 2000 who are not
allocated by place of employment.
SOURCE: Bureau of Labor Statistics (1987); moderate alternative.
The introduction of PPS and the resultant reduction in occupancy rates,
as well as the incentives it offers to provide less costly care, all affect hospital
laboratories in several ways. Many hospitals have increased their use of
reference laboratories for specialized tests, concentrating in-house labo-
ratory work on widely used tests for which economies of scale can be
achieved. Simultaneously, much preadmission testing is done on an out-
patient basis, and the inpatient test mix has changed as more complex cases
are admitted. According to the American Hospital Association, full-time-
equivalent (FTE) employment in U.S. registered hospitals fell between 1983
and 1986, with medical technologist employment falling by 2.4 percent.
FTE employment of other laboratory personnel fell by 5.3 percent between
1983 and 1985 and rose by 2.1 percent in 1986 (Bureau of Health Profes-
sions, 1985; American Hospital Association, 1987~. A survey of the early
impact of the diagnosis-related group (DRG) system on 122 hospital lab-
oratories noted that 63 percent of hospitals experienced increased test
volume in 1983. Increases in test volume occurred in only 32 percent of
hospitals in 1984.
The number of hospitals experiencing decreased test volume almost
doubled from 24 percent in 1983 to 44 percent in 1984. The effect of the
OCR for page 100
100
ALLIED HEALTH SERVICES
decreases on staffing was observable. Fifty-seven percent of laboratories
reduced employment after PPS only 4 percent increased employment
(Medical Laboratory Observer, 1984~. These early changes that reduced
demand did not continue, however. Current utilization and budgets are
growing, and staff reductions have abated (Gore, 1987~. Because the hos-
pital census is thought to be a less reliable laboratory work load predictor
than the severity of patient illness (Harper, 1984), one must look to the
patient mix for explanation. With an aging population, the severity of illness
is increasing. Although the number of lab items per discharge fell sub-
stantially during the early years of PPS, it rose 19.8 percent in 1985. Possible
reasons for the upturn include increased case complexity, fewer oppor-
tunities to shift care to outpatient settings, and fewer opportunities to
eliminate unnecessary services (Prospective Payment Assessment Commis-
sion, 1987~.
Medicare is not the only payer that is trying to reduce laboratory work.
Other payers are becoming increasingly conscious of laboratory costs. For
example, in 1987 Blue Cross and Blue Shield issued diagnostic testing
. . At- ~ ..
guidelines tor the appropriate use of 13 laboratory tests. Some of these
tests are routine hospital admission or preoperative tests. While these guide-
lin~ Caere not ~C~ri~tr`~ with coverage rules. the recommendations are
A 1 1 $ q ~ ~
~ ,
ex pected to be adopted by most of the plans and possibly by other insurers
(A bramowitz, 19871. Efforts like that of Blue Cross and Blue Shield may
herald a move from exhaustive testing to more targeted use of laboratory
work.
Technological change affects clinical laboratories in all settings. Today,
while there is much discussion of automation in the laboratory even ro-
botics that may reduce personnel needs or lower the skill levels required,
concomitantly, there are potentially offsetting developments of new and
complex labor-intensive, nonautomated tests.
Technological changes, together with financial incentives and patients'
desires, have stimulated physicians to make laboratory services available in
their offices. Several surveys have been conducted of the extent of this
practice. Estimates of the number of physician office laboratories range
from approximately 80,000 to more than 250,000 (American Society for
Medical Technology, 19861. BLS estimates that there are 30,100 technol-
ogist and technician jobs in physicians' offices, a number that is expected
to rise to more than 46,200 in the year 2000. Observers close to the scene
. . ~
~ ~ _ A A A A
· ~ · · · ~ · . 1 · ~ 11 1 ~ r~ ~ ~ 1~C ~ _~:
perceive ulmlnlshlng enthusiasm ror small pnys~aun I; --I,
possibly because they are not proving to be cost-effective and possibly
because there are rising expectations of increased regulation to control
quality.
Two important questions for laboratory personnel demand emerge from
the physician office laboratory phenomenon. One is whether physician
OCR for page 101
DEMAND AND SUPPLY IN 10 FIELDS
101
office tests are additional tests or substitutes for testing at other sites. An-
other is whether physicians employ clinical laboratory technologists or tech-
nicians. No evidence exists to answer the first of these questions. On the
question of staffing, a literature review concluded that personnel other
than technicians and technologists are more likely to do laboratory work
in small or solo practices. Often, nurses are used. The larger the practice,
the more likely that trained laboratory personnel are employed. One study
found that more than 50 percent of group practices employed medical
technologists (Frost and Sullivan, Inc., 1985~. However, changes in the
staffing of physician office laboratories may be on the way. Under its
Omnibus Budget Reconciliation Act of 1987, congress enacted provisions
that will require office laboratories that perform more than 5,000 tests on
their own patients to conform to the Medicare conditions of participation
developed for independent laboratories. This policy is scheduled to become
effective in 1990. Technologists in independent practice are finding in-
creasin~ emnlovment onnortunities as consultants to ohvsicians who need
~ 1 ~ 1 1 1 ~
. . . . ... . .. . . . . . . . . . . . .
help with calloratlon, quality control, test interpretation, more sopnlstlcaten
procedures, and management of their office laboratories.
Other new sites for laboratory work include HMOs and ambulatory care
centers. Although 5,500 such centers are projected to be in operation by
1990, not all will employ highly trained lab personnel. At small centers
now, nurses and x-ray technicians often perform routine tests, with cross-
training conducted by the facility owner (Baranowski, 19851.
The development of HMO laboratories is providing employment op-
portunities in a new setting, but this employment site should not be thought
of as increasing the demand for personnel. Indeed, in the long run, as
HMOs in competitive environments begin to seek new ways to control costs,
it is reasonable to speculate that a reduction in demand for laboratory work
may be brought about by curtailing superfluous testing.
Future demand for clinical laboratory personnel has thus far been dis-
cussed as if changes will affect technologists and technicians equally. Whether
this will actually be the case is unclear. Although incentives to reduce costs
might lead one to expect that employers will seek to use less expensive
personnel, at times more highly trained staff can be more cost effective.
Similarly, although some technological changes, such as increased auto-
mation, may allow employers to expand their use of technicians or on-the-
job trained personnel, others will require more highly trained staff. The
trend in this field appears to be toward the increased use of higher level
personnel with demand for lower level staff strengthened by difficulties in
hiring more highly skilled workers. A 1987 survey of the American Society
for Medical Technology members reports: "Where hiring has occurred in
the past two years... more technologists with the bachelor degree were
hired than were clinical laboratory technicians (CLTs). Though some fa-
. . .
OCR for page 102
102
ALLIED HEALTH SERVICES
cilities reported substituting specialists and more advanced personnel for
entry-level practitioners, others reported hiring more CLTs and on-the-
job trainees (OiTs) to some extent as a result of a shortage of clinical
laboratory scientists (CLS) professionals" (Price, 19881.
In sum, many of the changes occurring in clinical laboratories involve
alternatives in the settings in which testing occurs. Some of these changes
are spurred by financial considerations; some are driven by changes in the
structure of the health care delivery system. Generally, these changes do
not affect the demand for trained personnel in a major way because they
do not have significant effects on the numbers or types of tests ordered.
Although some extra testing is stimulated by the new settings, not all of
the work is being done by clinical laboratory technologists or technicians.
A concern about laboratory work that has surfaced in the popular press
and that has also been voiced by the professional associations relates to
quality. Reports of inaccurate PAP smear readings and false-positive AIDS
tests have often focused on the laboratory personnel a focus that could
result in increased demand for licensed personnel or in the hiring of more
personnel of all kinds to relieve pressures on staff.
For the future, downward pressures on test volume caused by payers'
attempts to reduce costs will be offset by upward pressures as new tests
are developed and the aging population demands more services. Similarly,
technological change will cause as much expansion as reduction in demand
for trained personnel of all levels.
Any growth in the demand for medical and clinical lab technologists and
technicians will derive from a general expansion of the health care industry,
the aging of the population, and an increase in some specific trends such
as increased therapeutic drug monitoring, testing for substance abuse, and
AIDS screening. Together, these upward pressures should lead to em-
ployment growth at a rate that could even exceed BLS's predicted growth
of 24 percent to the year 2000. If either AIDS or drug testing becomes
widespread, the demand for clinical laboratory technicians and technolo-
gists will increase further. This rate of increase could be reduced if, as is
likely, tests eventually become more automated.
Factors that would cause demand to change significantly and should
therefore be monitored by those attempting to track the employment of
clinical laboratory personnel include the following:
· policies concerning AIDS screening;
policies concerning substance abuse testing;
technological change;
payers' attempts to control test volumes;
quality concerns; and
trends in state and federal regulation of laboratory settings.
OCR for page 103
DEMAND AND SUPPLY IN 10 FIELDS
103
The three scenarios described in Chapter 3 mixed financing, pro-
spective payment, and access—have some straightforward implications for
clinical laboratory technologist and technician demand. Under the mixed
model, growth in jobs is expected (as described earlier in this chapter)-
probably in excess of 24 percent to the year 2000. If prospective payment
becomes the dominant model, laboratory testing will come under scrutiny
and incentives will ensure that all testing contributes to the clinical man-
agement of patients. Technological changes to improve cost-effectiveness
and decrease personnel, both in numbers and skill levels, will be adopted.
Yet demographic pressures will still exert upward pressures. In sum, de-
mand will grow at a slower pace under the prospective payment model
than under the mixed financing scenario. If a policy to expand access to
health care occurs, additional individuals receiving care will increase the
demand for laboratory personnel in all settings.
Supply of Medical Technologists and
Medical Laboratory Technicians
The number of baccalaureate graduates in the field of medical tech-
nology has shown a downward trend since the end of the 1970s. In 1986
4,477 medical technologists graduated from accredited programs, a de-
crease of 28 percent from 1980. The number of accredited programs for
medical technologists also decreased 26 percent over the 10-year period
ending in 1986. Hospital-based programs closed most frequently, but clo-
sures in general occurred because of budget restrictions, the impact of PPS,
a lack of qualified applicants, and a decreased need for laboratory personnel
in the program's immediate geographic area (CAHEA, 1985b).
During the past 10 years, total certificate medical lab technician programs
decreased 69 percent. Yet associate degree medical lab technician programs
increased over the 10-year period, and they increased more than four
fold from 38 programs to 214 programs. Between 1985 and 1986, how-
ever, there was a 5 percent drop (CAHEA, 1987a).
The trend in certificate and associate degree personnel (technicians) is
less clear than that for technologists. Although the 2,747 technician grad-
uates in 1986 represent a 9 percent increase over 1980, graduations peaked
at nearly 4,000 in 1984 and show a downward trend since then. There are
two routes to becoming a technician. One is graduation from a certificate
program. Only 817 medical laboratory technicians graduated from certifi-
cate programs in 1986, 24 percent fewer than in 1981. The other route is
through associate degree programs, from which the number of graduates
(1,930) in 1986 was an increase of 11 percent over those graduating in
1981 (CAHEA, 1987a).
OCR for page 104
104
ALLIED HEALTH SERVICES
At the start of this study, anecdotal evidence from educators and others
pointed to a surplus of clinical laboratory technicians and technologists.
But during site visits and discussions with knowledgeable observers toward
the middle of 1987, the committee began to hear of managers who were
having trouble hiring staff for clinical laboratories. Other reports confirm
this change (Meyer, 1988), and other evidence supports the suggestion that
the labor market is getting tighter. A recent survey of the directors of
accredited education programs shows that between 1981 and 1986 the
percentage of directors who considered the job market for laboratory tech-
nicians and technologists to be attractive increased substantially (Parks and
Hedrik, 19881. An informal survey by the American Society for Medical
Technology found 54 percent of constituent societies reporting an under-
supply of clinical laboratory technologists. The undersupply figure was 38
percent for technicians (Meyer, 19881. A study commissioned by the Health
Resources and Services Administration noted that shortages of medical
technologists are occurring in some locales (Mathematica Policy Research,
Inc., 1987~. Statewide surveys in North Carolina (North Carolina Area
Health Education Centers Program, 1987b) showed the vacancy rates for
clinical laboratory staff increasing from 4.6 percent in 1981 to 16.5 percent
in 1986. However, the salaries of technologists and technicians employed
in hospitals between 1981 and 1986 increased 24 and 21 percent, respec-
tively. Yet this increase is small compared with 18 other types of hospital
employees of these employees, only engineering technicians had an in-
crease smaller than 21 percent (University of Texas Medical Branch, 1985,
1987~. These figures suggest that the difficulties in hiring noted earlier in
this paragraph may not have been evident in 1986.
Conclusion
Making statements about the likelihood of future balances or imbalances
between the demand for and supply of clinical laboratory personnel is
complicated by the multiple routes of entry into laboratory work. Labo-
ratory workers may have 4 or more years of postsecondary education, or
they may qualify for a job through a combination of shorter educational
programs plus experience. Baccalaureate-prepared technologists need less
supervision than other personnel, and they may hold a variety of higher
level positions for example, laboratory director, manager, consultant, and
education coordinator for hospital schools. Technicians may have 2-year
associate degrees or combine education and experience to become certified
through a professional organization. Other laboratory workers are certified
in special areas (e.g., cytotechnology or hematology), and still others may
have specialist certification in such disciplines as blood banking or micro-
biology. Finally, there are large numbers of uncertified workers as indicated
by the discrepancy between the BLS job count and the number of certified
OCR for page 105
DEMAND AND SUPPLY IN 10 FIELDS
105
personnel. These multiple routes of entry into a career in clinical labora-
tories make it difficult to assess the future supply of laboratory workers.
Taking into account the comparatively modest expected growth in new
jobs, and assuming that work force behavior and staffing patterns will not
change radically, graduations from clinical laboratory programs should be
sufficient to keep demand and supply in reasonable balance to the year
2000 if the rate of graduation is sustained at a minimum at its current
level. The recent decline in the number of graduates must be halted,
however. If this decline should continue, some improvements in salary and
working conditions can be expected to bring supply and demand into
balance. A number of factors make prognostications in this area tentative.
If the growing numbers of biomedical technology firms become major
users of laboratory personnel, thus diverting trained personnel from clinical
laboratories, salaries and benefits would improve as employers compete
for trained personnel. If personnel trained in such disciplines as chemistry
and microbiology are no longer available to medical laboratories, there
could be problems because these personnel are used to fill jobs when the
labor market is tight. A significant change could come about as a result of
employers using personnel differently. (For instance, laboratory managers
may choose to substitute one level of personnel for another.)
A great deal of flexibility is possible. Today, there is sometimes little or
no differentiation in the way technologists and technicians are used, a
situation that could change. If a 4-year degree becomes mandatory for
licensure and licensure becomes a more widespread requirement, the de-
mand and supply balance could be severely disrupted. There is increasing
debate concerning the advantages and disadvantages of licensure whose
purpose is to differentiate jobs according to academic qualifications. The
scope of this study did not admit of a conclusion on this matter.
As a final note, the clinical laboratory labor market seems to adapt rapidly
to change—for example, changes in health care financing incentives. In
the course of this study the reports of graduates having a hard time finding
jobs were succeeded by reports of shortages of personnel.
The reasons given for this turnaround are varied. Laboratories may have
allowed staffing levels to decline too far in an overresponse to prospective
payment. Laboratory volume may have risen faster than the supply. Others
say that the level of stress at the work site has increased because of pro-
ductivity pressures and the increased complexity of care. Fear of AIDS
adds to the stress, and salaries are not high enough to compensate for such
stress; consequently, people are leaving the field (Meyer, 19881. If these
factors do generate an increase in the separation rate of workers from the
labor force, it would have a significant negative impact on the supply of
clinical laboratory technologists and technicians and necessitate greater market
adjustments.
OCR for page 106
106
ALLIED HEALTH SERVICES
DENTAL HYGIENISTS
Demand for Dental Hygienists
BLS estimates that in 1986 there were 86,700 jobs for dental hygienists.
By the year 2000 this number is expected to have increased by 63 percent
to 141,000 jobs. Such rapid growth is based on several considerations. First,
BLS analysts consider employment growth in dental offices to be the most
important element in generating jobs for dental hygienists because the vast
majority (97 percent in 1986) is employed in that industry sector (Table
4-21. The BLS projection for dental hygienist employment is hampered by
data collection problems that apply only to this sector. The survey on which
the BLS data are based was sent to incorporated businesses only. A high
proportion of dentists are not incorporated and therefore were not in-
cluded in the survey.
Dentists' offices provided nearly 460,000 jobs in 1986; this number is
projected to reach 706,000 by the year 2000, a 53 percent increase. Con-
tributing to this projected expansion is the BLS expectation that the number
of working dentists will substantially increase by the year 2000 (from 151,000
to 196,000, almost 30 percent compared with 19.2 percent for all occu-
pations). Moreover, these dentists are expected to sustain their level of use
of dental hygienists. BLS analysts also believe that the entrance into the
dental profession of younger dentists, who are taught how to make effective
use of hygienists, will cause a slight increase in the ratio of hygienists to
total dentist office staff.
Other assumptions on which BLS has based its high-growth prediction
include the continued spread of dental insurance, which will generate fur-
ther demand for dental services; the aging population's need for dental
TABLE 4-2 Major Places of Wage and Salary Employment for Dental
Hygienists, 1986 Actual and Projected for the Year 2000
Employment Setting
Total employments
Total wage and salary
employment
Offices of dentists
Number of
lobs, 1986 Percentagea
Number of
lobs, 2000 Percentagea
14 1 ,000
86,700
86,700 1 00.0
84,300 97.3
14 1 ,000 1 00.0
1 37,300 97.4
aThese percentages were calculated using unrounded figures and therefore will not be
identical to percentages that are calculated using the rounded figures provided in the
table.
Total employment = wage and salary employment + self-employment. Self-employed
persons are not allocated by place of employment.
SOURCE: Bureau of Labor Statistics (1987); moderate alternative.
OCR for page 148
148
ALLIED HEALTH SERVICES
outside the health care system. In 1986 only 28.6 percent of speech-lan-
guage pathologist and audiologist jobs were in the health care services
industry. Sixty-four percent were in educational services a sector in which
BLS expects demand to be close to stagnant (Table 4-111. Between 1986
and the year 2000, speech-language pathology and audiology jobs in the
education sector are expected to increase by only 14 percent. ASHA notes
that 13.6 percent of speech-language pathologists and audiologists report
that they run their own practices or are independent contractors (American
S p e e c h - L a n g u a g e - H e a r i n g A s s 0 c i a t i 0 n , 1 9 8 8 ~ .
BLS analysts caution that their classification of speech-language pa-
thologists and audiologists includes those prepared only to the bachelor's
degree level. These practitioners are not certified by ASHA, which certifies
at the master's degree level and above, and thus cannot work in the 36
states with licensure requirements. BLS analysts believe that most non-
ASHA-certified personnel are employed in educational services by state
education departments in states that certify individuals who have only a
bachelor's degree or who lack other qualifications for ASHA certification.
TABLE 4-11 Major Places of Wage and Salary Employment for
Speech-Language Pathologists and Audiologists, 1986 Actual and
Projected for the Year 2000
Employment Setting
Number of
lobs, 1986 Percentagea
Number of
Jobs, 2000 Percentagea
60,600
Total employments
Total wage and salary
employment
Educational institutions, public
and private
Hospitals, public and private
Outpatient care facilities
Nursing and personal care
, - ... .
taalltles
Offices of physicians
Offices of other health care
45,100
42,100
27,000
4,400
2,700
1,200
1,800
00.0
64.0
10.4
6.4
2.7
3.6
56,500
30,800
5,600
4,400
1,900
2,900
00.0
54.62
9.9
7.7
3.4
5.2
practitioners 1,200 2.7 4,400 7.7
aThese percentages were calculated using unrounded figures and therefore will not be
identical to percentages that are calculated using the rounded figures provided in the
table.
tTotal employment = wage and salary employment + self-employment. These figures
include 3,000 self-employed workers in 1986 and 4,096 in the year 2000 who are not
allocated by place of employment.
Offices of health care practitioners other than physicians (including osteopaths) and
dentists. The figures include offices of speech-language pathologists and audiologists.
SOURCE: Bureau of Labor Statistics (1987); moderate alternative.
OCR for page 149
DEMAND AND SUPPLY IN 10 FIELDS
149
There is considerable support for the BLS estimates. Although speech-
language pathologists and audiologists may see new opportunities for em-
ployment growth under the 1986 Education of the Handicapped Act (which
increased the demand for these professionals by funding programs for
young children), total employment growth in the education sector will be
relatively slow. New employment opportunities will occur in other settings,
however. Speech-language pathologists and audiologists are well posi-
tioned to benefit from changes occurring in the health care system. Their
lesser dependence on hospital employment (which accounted for only 10
percent of jobs in 1986) makes them less vulnerable to any squeeze on
employment in that sector. Their reimbursement status positions them to
benefit from shifts to care outside of hospitals. Under the Omnibus Budget
Reconciliation Act of 1980, a speech-language pathologist may develop a
plan of care for patients referred by a physician and be reimbursed by
Medicare. Prior to 1980 the amount, duration, and scope of services had
to be specified by the physician. Since 1986 speech-language pathology
has been included among the therapies that together must be provided
for a total of 3 hours per day for a beneficiary to be eligible for Medicare
coverage in an inpatient rehabilitation facility. While this could provide an
impetus to increased demand for speech-language pathologists, it could
also be short-lived as Medicare seeks ways to find an equitable reimburse-
ment system that includes cost-control incentives. Medicare will also reim-
burse for home care visits, a provision that positions therapists to care for
the growing population of patients discharged from hospitals or in need
of long-term home care (American Speech-Language-Hearing Associa-
tion, 1987b). According to the Health Care Financing Administration the
estimated number of speech-language pathologists employed by Medicare-
certified home care agencies grew from 303 in 1983 to 5,503 in 1985; the
figure dropped to 3,113 in 1986 (American Home Care Association, 19871.
The extent to which this drop is due to increased contracting for services
or other arrangements is not known. Approximately 48 percent of free-
standing home health agencies offer speech-language and audiology ser-
vices (American Speech-Language-Hearing Association, Task Force on
Home Care, 1986~.
Although only a minority of speech-language pathologists and audiol-
ogists are employed in hospitals, their use in that setting has not been
constrained by PPS. Indeed, between 1983 and 1985 their FTE employ-
ment in hospitals increased by 21 percent from 2,684 to 3,252. Committee
site visits uncovered several possible reasons for this increase. One is ex-
panded speech and hearing coverage by HMOs. Audiology personnel
working in hospital outpatient areas are finding that HMO patients are
covered for the full range of diagnostic testing and hearing aids. (Previously,
commercial insurance subscribers were covered for only a narrow range
OCR for page 150
150
ALLIED HEALTH SERVICES
of hearing testing.) Speech-language pathologists also cited a growing
demand for services for stroke and head-injured patients whose survival
rates have improved with the advent of new knowledge and technology.
Audiologists noted a growing incidence of hearing defects in young people
who listen to music through headphones. Both occupations cited the grow-
ing numbers of elderly patients using their services plus an increasing
understanding of their work by physicians that has resulted in more nu-
merous referrals.
In sum, speech-language pathologists and audiologists in their major
employment setting educational institutions—are not likely to experience
rapid increases in demand. In health care settings, they are positioned for
steady growth. Reimbursement allows them to take advantage of the shift
to nonhospital care in many settings. Given the expected slow growth in
education and faster growth in health care settings, the overall moderate
growth predicted by BLS seems reasonable.
Factors to be monitored by those wishing to track future demand for
speech-language pathologists and audiologists include the following:
· Medicare reimbursement of rehabilitation services;
· school system growth and financing;
· patterns of specific diseases and treatment such as stroke, head trauma,
and deafness in youth; and
· growth in independent practice opportunities and contractual ar-
rangements with freestanding speech-language pathology and audiology
. .
Organlzatlons.
The way in which the three scenarios described in Chapter 3 play out
for speech-language pathology and audiology is largely determined by the
pattern of employment across the various health care settings and outside
the health care system.
Scenario 1: The Mixed Model
With this scenario, speech-language pathologists and audiologists would
be in steady demand as their services were included in comprehensive
HMO benefit packages and increasing numbers were needed to work in
the less productive home care environment. The demand for rehabilitation
and outpatient services would also show steady growth.
Scenario 2: Prospective Payment
Because only a small proportion of speech-language pathologists and
audiologists work in hospitals, the impact of increased prospective payment
in this setting would have little impact on total demand. Similarly, bringing
OCR for page 151
DEMAND AND SUPPLY IN 10 FIELDS
151
rehabilitation services under prospective payment would result in only a
small reduction in overall demand. Outpatient care would show overall
growth, but speech-language pathology and audiology would not benefit
greatly because these services would be seen as less vital than others that
related more directly to physical health. Less vital services would be most
vulnerable to reduction under prospective payment. Combining the slight
growth in outpatient demand with the reduction in inpatient demand would
yield stagnant total demand from the health care sector under this scenario.
Scenario 3: Access
Speech and hearing deficits are among the group of health problems
that are likely to go unserved if individuals experience financial barriers
to health care. Under this scenario, those financial barriers would be low-
ered and previously ignored communicative deficits would receive atten-
tion, stimulating greater demand for speech and hearing services in inpatient
. . .
and outpatient settings.
Supply of Speech-Language Pathologists
and Audiologists
In 1986 304 programs offered degrees in communication sciences and
disorders. Of these programs, 21 percent offered only undergraduate de-
grees. The total number of programs has been quite stable since 1983,
ranging between 293 and 304 (Cooper et al., 19871. The number of bach-
elor's degrees awarded has declined since 1981 by 15 percent to 4,300.
The decline was confined to only 2 years, however. The latest figures show
an upturn (CAHEA, 1987a).
The picture for master's degrees is a little clearer: the number of degrees
awarded since 1982 has remained relatively stable. Yet this trend must be
viewed together with that for bachelor's degree graduates (Cooper et al.,
1987~. Approximately 90 percent of master's degree graduates in speech
pathology and audiology have undergraduate degrees in the same disci-
plines. Furthermore, the number of master's degree graduates closely matches
the undergraduate degrees in speech and audiology with a 2-year time
lag (Cooper et al., 19874. It seems reasonable to conclude that most speech-
language pathology or audiology undergraduates move on to a speech-
language pathology or audiology master's degree and that bachelor's de-
gree graduates are the pool from which therapists are drawn. Consequently,
we must consider undergraduate as well as graduate degrees as an indicator
.
.
of future supply.
The committee is not aware of any evidence that demand and supply
are not currently in balance in this field. Although committee members
OCR for page 152
152
ALLIED HEALTH SERVICES
occasionally heard that rehabilitation facilities were experiencing difficulties
in filling vacancies for speech-language pathologists, they also heard that
some independent practitioners were unable to generate enough business
and were returning to employment in other facilities. Such comments were
rare, however, and do not disturb the overall picture of an adequate current
supply of practitioners. A national survey of starting salaries for speech-
language pathologists in hospitals shows an increase of 23 percent between
1981 and 1986. This increase was lower than that for 17 of 19 other types
of personnel. The 33 percent increase for audiologists, however, was higher
than that of pharmacists and nurses who are thought to be in short supply
(University of Texas Medical Branch, 1981, 1986~. These data indicate a
difference in demand for the two types of practitioners but are not in
themselves sufficient evidence on which to base a judgment of the markets.
Conclusion
If baccalaureate graduations remain at approximately the level of the
last few years and if most of these graduates go on to master's degrees in
speech-language pathology or audiology, there should be a continued
balance between demand and supply through the year 2000. This statement
implies that significant changes in the rate of salary growth or major im-
provements in the conditions of employment should not be expected. How-
ever, the production of baccalaureate graduates should be carefully
monitored. The data to this time do not indicate whether a downward
trend is beginning to develop. If a decline does occur, employers who feel
the impact of the drop will need such factors as higher salaries to influence
people to pursue careers in language and hearing disorders.
CONCLUSION
This chapter applies the best available data to assess how the forces that
drive the demand for and supply of allied health personnel will affect allied
health labor markets. The committee's intention is to alert decision makers
to the kinds and magnitudes of market adjustments that they should expect
and encourage to sustain a long-term balance between allied health per-
sonnel demand and supply.
For some fields (e.g., physical therapy, radiologic technology, medical
record technology and administration, and occupational therapy), we fore-
see a need for decision makers to use the mechanisms under their control
to improve the working of the market so that severe imbalances in demand
and supply may be prevented. Employers are already concerned about
difficulties in hiring in some of these fields, and there are signs that health
OCR for page 153
DEMAND AND SUPPLY IN 10 FIELDS
153
care providers are beginning to find some painful as well as some beneficial
ways to accommodate new realities. The committee is concerned that in-
action may have consequences that would have deleterious effects on the
level of health care.
For some other fields (e.g., clinical laboratory technology and dental
hygiene), there are factors that could cause instability in both demand and
supply. For these fields the market is more likely to make the needed
adjustments, and serious disruptions are less likely to occur. Yet there are
unresolved issues in both of these fields concerning the match between
tasks and levels and types of education. The way these issues are resolved
could determine whether major imbalances will occur.
The demand for and supply of speech-language pathologists, audiol-
ogists, respiratory therapists, and dietitians are expected to be sufficiently
well balanced for the labor market to make smooth adjustments. The kinds
of incremental adjustments that make careers attractive and the ways in
which personnel are deployed appear likely to remain in a state of equi-
librium over time. Nevertheless, changes in the factors the committee has
identified as having major effects on demand and supply could cause
disequilibrium. These factors should be monitored.
These conclusions about the future outlook refer to the long term. For
all fields, there are likely to be periods of greater and lesser imbalance
between now and the year 2000.
It is the nature of markets eventually to adjust to change. Projected
imbalances in demand and supply do not mean that shortages or surpluses
will occur. Rather, they signal that employers and potential employees must
and probably will make adjustments. Only rarely are markets unable to
accommodate changes in demand and supply through a variety of adjust-
ment mechanisms.
We have identified areas for potential adjustment in both demand and
supply, which forms a basis for understanding future policy directions
concerning supply and use of allied health personnel. The objective of
policy is to make the process of adjustment less painful and less costly.
Decrements in quality of care, interruptions or reductions of service, and
curtailment of investment in new technologies and organizational forms
(such as home care or HMOs) that might improve the efficiency of health
care delivery are all possible by-products of personnel shortages. Any de-
cision to intervene in the labor market is made through the political process
and reflects society's willingness or unwillingness to tolerate painful dis-
locations. In many industries, such dislocations are viewed as normal and
acceptable. Public policy actions have demonstrated that health care is
viewed differently. The next three chapters of this report describe what
educators, employers, and regulators, together with government, can do
to facilitate the smooth working of the market.
OCR for page 154
154
ALLIED HEALTH SERVICES
REFERENCES
Abramowitz, M. 1987. Blue Cross acts to curb some medical tasks. Washington Post,
April 2.
Amatayakul, M. K. 1987. Report from AMRA manpower survey. Journal of the American
Medical Record Association 58(3):25-36.
American Association for Respiratory Care. 1986a. AARC Membership Profile and Ben-
efits Survey. Dallas: American Association for Respiratory Care. August 14.
American Association for Respiratory Care. 1986b. Impact of the Prospective Payment
on the Respiratory Care Profession. Report of the Task Force on Professional Direc-
tion. Dallas: American Association for Respiratory Care.
American Dental Association, Division of Educational Measurements.1987. Annual Report
on Dental Auxiliary Education 1986/87. Chicago: American Dental Association.
American Dietetic Association. 1985. A New Look at the Profession of Dietetics: Report
of the 1984 Study Commission on Dietetics. Chicago: American Dietetic Association.
American Dietetic Association. 1987. Unpublished data. American Dietetic Association,
Chicago.
American Health Care Association. 1987. Unpublished data. American Health Care As-
sociation, Washington, D.C.
American Hospital Association. 1987. Unpublished data from the American Hospital
Association annual survey. American Hospital Association, Chicago.
American Occupational Therapy Association. 1985. Occupational Therapy Manpower: A
Plan for Progress. Report of the Ad Hoc Commission on Occupational Therapy
Manpower. Rockville, Md.: American Occupational Therapy Association. April.
American Occupational Therapy Association, Research Information and Evaluation Di-
vision. 1986a. 1986 Education Data Survey. Final Report. Rockville, Md.: American
Occupational Therapy Association.
American Occupational Therapy Association. 1986b. President Reagan Signs P.L. 99-457,
The Education for Handicapped Amendments of 1986. Government and Legal Af-
fairs Division Bulletin. Rockville, Md.: American Occupational Therapy Association.
American Occupational Therapy Association. 1987. 1986 Member Data Survey. Interim
Report No. 1. Rockville, Md.: American Physical Therapy Association.
American Physical Therapy Association. 1987a. Active Membership Profile Study. Alex-
andria, Va.: American Physical Therapy Association.
American Physical Therapy Association. 1987b. Comments from the American Physical
Therapy Association on Preliminary Draft Background Papers for the American So-
ciety of Allied Health Professions International Conference, January 15 - 16, 1987.
Alexandria, Va.: American Physical Therapy Association.
American Physical Therapy Association. 1987c. The Impact of the Medicare Prospective
Payment System on the Delivery of Physical Therapy Services. Alexandria, Va.: Amer-
ican Physical Therapy Association.
American Society for Medical Technology. 1986. Quality Assurance in Physician Office
Laboratories. A White Paper with Recommendations. Bethesda, Md.: American So-
ciety for Medical Technology.
American Speech—Language—Hearing Association. 1987a. Demographic Profile of the
ASHA Membership, 1987. Rockville, Md.: American Speech-Language-Hearing
. . .
Assomat~on.
American Speech-Language-Hearing Association. 1987b. Health Insurance Manual.
Rockville, Md.: American Speech-Language-Hearing Association.
American Speech-Language-Hearing Association. 1988. Demographic Profile of the ASHA
Membership. Rockville, Md.: American Speech-Language-Hearing Association. March
9.
OCR for page 155
DEMAND AND SUPPLY IN 10 FIELDS
155
American Speech-Language-Hearing Association, Task Force on Home Care. 1986. The
Delivery of Speech-Language and Audiology Services in Home Care. May. Rockville,
Md.: American Speech-Language-Hearing Association.
Baranowski, l. 1985. Labs in ambulatory care centers: Medicine's growth sector. Medical
Laboratory Observer May:27-34.
Bernstein, T. W. 1985. The Impact of PPS on Medical Record Practitioners Part II.
Journal of the American Medical Record Association 56(December):15-19.
Bishop, E. 1983. Dental Insurance: The What, the Why, and the How of Dental Benefits.
New York: McGraw-Hill.
Bryk, I. A. 1987. Report of the 1986 census of the American Dietetic Association. Journal
of the American Dietetic Association 87(8):1080-1085.
Burda, D. 1984. UB-82 arrives with work for medical records departments. Journal of
the American Medical Record Association 55(11):28-31.
Bureau of Health Professions. 1985. Trends in Hospital Personnel 1981-1983. ODAM
Report No. 5-85. Washington, D.C.: U.S. Department of Health and Human Services,
Health Resources and Services Administration.
Bureau of Health Professions, Division of Associated and Dental Health Professions. 1987.
Unpublished data. U.S. Department of Health and Human Services, Washington,
D.C.
Bureau of Labor Statistics. 1983-1986. Unpublished data from the Current Population
Survey. U.S. Department of Labor. Washington, D.C.
Bureau of Labor Statistics. 1986. Occupational Outlook Handbook. Bulletin 2250. Wash-
ington, D.C.: Government Printing Office.
Bureau of Labor Statistics, 1987. Employment by occupation and industry, 1986 and
projected 2000 alternatives. Washington, D.C.
CAHEA (Committee on Allied Health Education and Accreditation). 1979. Allied Health
Education Directory, 1979, 7th ed. Chicago: American Medical Association.
CAHEA. 1980. Allied Health Education Directory, 1980, 8th ed. Chicago: American Med-
ical Association.
CAHEA. 1981. Allied Health Education Directory, 1981, 9th ed. Chicago: American Med-
ical Association.
CAHEA. 1982. Allied Health Education Directory, 1982, 10th ed. Chicago: American
Medical Association.
CAHEA. 1983. Allied Health Education Directory, 1983, 11th ed. Chicago: American
Medical Association.
CAHEA. 1984. Allied Health Education Directory, 1984, 12th ed. Chicago: American
Medical Association.
CAHEA. 1985a. Allied Health Education Directory, 1985, 13th ed. Chicago: American
Medical Association.
CAHEA.1985b. A Report of a Survey on the Impact of PPS on Clinical Education. Chicago:
American Medical Association. December.
CAHEA. 1986. Allied Health Education Directory, 1986, 14th ed. Chicago: American
Medical Association.
CAHEA. 1987a. Allied Health Education Directory, 1987, 15th ed. Chicago: American
Medical Association.
CAHEA. 1987b. Voluntary Program Withdrawals from CAHEA Accreditation, 1983-87.
Chicago: American Medical Association.
Conway, I. B. 1985. Survey results: Programs, services and trends. Radiology Management
7(2):51-71.
Cooper, E. B., I. W. Helmick, and D. N. Ripich. 1987. Council of Graduate Programs in
Communication Sciences and Disorders: 1986-87 National Survey. Tuscaloosa, Ala.:
Council of Graduate Programs in Communication Sciences and Disorders. October.
OCR for page 156
156
ALLIED HEALTH SERVICES
Council on Medical Education of the American Medical Association. 1972. Allied Medical
Education Directory. Chicago: American Medical Association.
Council on Medical Education of the American Medical Association. 1973. Allied Medical
Education Directory. Chicago: American Medical Association.
Council on Medical Education of the American Medical Association. 1
Education Directory. Chicago: American Medical Association.
Council on Medical Education of the American Medical Association. 1978. Allied Medical
Education Directory, 6th ed. Chicago: American Medical Association.
Crucitti, T. W., and V. M. Pappas. 1986. The Impact of the Prospective Payment System
on the Delivery of Nuclear Medicine Services. Report to the Bureau of Health Profes-
sions, U.S. Public Health Service. Contract No. HRSA 85-351(P). July. New York:
The Society of Nuclear Medicine.
Dental Hygiene. 1982. Who we are: A report on the "Survey of Dental Hygiene Issues:
Attitudes, Perceptions and Preferences." Dental Hygiene, December: 13-18.
Dore, D. 1987. Effect of the Medicare prospective payment system on the utilization of
physical therapy. Physical Therapy 67(6):964-966.
Frost and Sullivan, Inc. 1985. Group practice laboratories benefiting from new federal
regulations. White paper with recommendations. News of International Research
Report for Business. Summer.
Gilmartin, M. E., and B. I. Make. 1986. Mechanical ventilation in the home: A new
mandate. Respiratory Care 31 (5) :406-411.
Gore, M. T. 1987. The impact of DRGs after year 4: A swing to better times. Medical
Laboratory Observer, December:27-30.
Grembowski, D., D. Conrad, and P. Milgrom. 1984. Utilization of dental services in the
United States and an insured population. Paper presented at the International As-
sociation for Dental Research Annual Conferences, Dallas, March. 1984. Washington,
D.C.: International Association for Dental Research.
Harper, S. S. 1984. The key to predicting laboratory workload. Medical Laboratory Ob-
server, November:65-67.
1974. Allied Medical
Havinghurst, C. C. 1987. Practice opportunities for allied health professionals in a de-
regulated health care industry. Preliminary draft background paper prepared for the
American Society of Allied Health Professions Invitational Conference, Washington,
D.C., June 15 - 16.
Health Care Financing Administration. 1986a. Report to (Congress. Study of Registered
Dieticians' Services in Home Care. Washington, D.C.: U.S. Department of Health and
Human Services, Office of Research and Demonstrations.
Health Care Financing Administration. 1986b. Report to Congress. Study of Respiratory
Therapy Services in Home Care. Washington, D.C.: U.S. Department of Health and
Human Services, Office of Research and Demonstrations.
Health Resources and Services Administration. 1984. An In-Depth Examination of the
1980 Decennial Census Employment Data for Health Occupations. ODAM Report
No. 16-84. Washington, D.C.: U.S. Department of Health and Human Services. July.
Journal of the American Medical Association. 1983. Number of programs, enrollments,
and graduates for each allied health occupation. Vol. 250(12):1567.
Journal of the American Medical Association. 1984. Number of programs, enrollments,
and graduates for each allied health occupation. Vol. 252(12):1569.
Journal of the American Medical Association. 1985. Number of programs (December
1984), enrollments, and graduates (academic year 1983-84) for each allied health
occupation. Vol. 254(12): 1606.
Kaufman, M., et al. 1986. Survey of nutritionists in state and local public health agencies.
Perspectives in Practice 86(11):1566-1570.
OCR for page 157
DEMAND AND SUPPLY IN 10 FIELDS
157
Lucash, P. 1983. EMS volunteers: Facing the challenges of the '80s. Journal of Emergency
Medical Services, October:41-45.
Mathematica Policy Research, Inc. 1987. Exploration of Trends and Changes in Clinical
Education in the Preparation of Allied Health Professions. Princeton, Ad.: Mathe-
matica Policy Research, Inc. tune.
McKay, I. I. 1985. Historical review of emergency medical services, EMT roles, and EMT
utilization in emergency departments. Journal of Emergency Nursing 11(1):27-31.
McMahon, E. M. 1986. Approval of a proposal to establish an associate degree in applied
science in dental hygiene at the Community College of Rhode Island. Memorandum.
State of Rhode Island Office of Higher Education, Providence. December 5.
Medical Laboratory Observer. 1984. The impact of DRGs after year 1: First steps toward
greater lab efficiency. December:33-38.
Meyer, D. M. 1988. The president speaks. ASMT Today 3(1):3.
National Association for Home Care. 1987. Unpublished data. National Association for
Home Care, Washington, D.C.
National Emergency Medical Services Clearinghouse. 1985. State Emergency Medical Ser-
vices Personnel Training. The 1985 National EMS Data Summary. Lexington, Ky.:
The Council of State Governments.
National Institute on Aging. 1987. Personnel for health needs of the elderly through year
2020. U.S. Department of Health and Human Services, Washington, D.C. September.
North Carolina Area Health Education Centers Program. 1987a. 1986 Allied Health Man-
power Surveys: Summary Report. Chapel Hill, N.C.: North Carolina Area Health
Education Centers Program. August.
North Carolina Area Health Education Centers Program.1987b.1986 Medical Technology
Manpower Survey: Final Report. Chapel Hill, N.C.: North Carolina Area Health
Education Centers Program. August.
North Carolina Area Health Education Centers Program. 1987c. 1986 Occupational Ther-
apy Manpower Survey: Final Report. Chapel Hill, N.C.: North Carolina Area Health
Education Centers Program. August.
North Carolina Area Health Education Centers Program. 1987d. 1986 Radiologic Tech-
nology Manpower Survey: Final Report. Chapel Hill, N.C.: North Carolina Area
Health Education Centers Program. August.
Packer, C. L. 1985. Automation in the medical records department. Hospitals 59(5): 100-
104.
Parks, R. B., and H. L. Hedrick. 1987. Program director perspectives on student and
employment characteristics. Committee on Allied Health Education Accreditations,
American Medical Association, Chicago.
Petty, T. L.1986. Rational respiratory therapy. New England Journal of Medicine 315(5) :317-
319.
Price, G. 1988. ASMT Survey II shows strong nonphysician purchasing consulting roles.
ASMT Today 3(1):3-4.
Prospective Payment Assessment Commission. 1987. Technical Appendixes to the Report
and Recommendations to the Secretary, U.S. Department of Health and Human
Services. Washington, D.C.: Prospective Payment Assessment Commission. April 1.
Schraffenberger, L. A. 1987. The Impact of Prospective Payment on Medical Record
Practitioners: A Follow-Up Study in 1986. Chicago: American Medical Record As-
. .
soclatlon.
Scott, S. I. 1987. Medicare extends coverage. July 1; HCFA issues interim instructions.
OT Week 1(25): 1.
Shewan, C. M. 1987. An Update on Supply Estimates for Speech-Language-Hearing
Personnel. Unpublished paper, American Speech-Language-Hearing Association.
Rockville, Md.
OCR for page 158
158
ALLIED HEALTH SERVICES
Smith, J. P., and B. I. Bodai. 1985. The urban paramedic's scope of practice. Journal of
the American Medical Association 253(4):544-548.
Solomon, E. 1988. Trends in dental education. Paper presented by the American Asso-
ciation of Dental Schools at the IOM meeting, "Roles and Training of Health Profes-
- sions," Washington, D.C.
Steinberg, E. P. 1985. The impact of regulation and payment innovations on acquisition
of new imaging technologies. Radiologic Clinics of North America 23(3):381-389.
University of Texas Medical Branch. 1981. 1981 National Survey of Hospital and Medical
School Salaries. Galveston: University of Texas. December.
University of Texas Medical Branch. 1986. 1986 National Survey of Hospital and Medical
School Salaries. Galveston: University of Texas. November.
Veterans Administration, Office of Personnel and Labor Relations. 1987. Report of 1986
Survey of Health Occupational Staff. Washington, D.C.: Veterans Administration.
March 27.
Whitlock, E., and J. Whitmore. 1987. A report from the American Medical Record As-
sociation: Non-management positions. American Medical Record Association, Chi-
cago. June.
Representative terms from entire chapter:
medical record
