Allied Health Services Avoiding Crises (1989) / Chapter Skim
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4 Demand and Supply in 10 Allied Health Fields
4 Demand and Supply in 10 Allied Health Fields
Pages 96-158
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From page 96... ...
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.
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From page 97... ...
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)
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From page 98... ...
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.
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From page 99... ...
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 Professions, 1985; American Hospital Association, 1987~.
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From page 100... ...
Possible reasons for the upturn include increased case complexity, fewer opportunities to shift care to outpatient settings, and fewer opportunities to eliminate unnecessary services (Prospective Payment Assessment Commission, 1987~. Medicare is not the only payer that is trying to reduce laboratory work.
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From page 101... ...
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 discussed as if changes will affect technologists and technicians equally.
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From page 102... ...
Together, these upward pressures should lead to employment 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 technologists will increase further.
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From page 103... ...
In sum, demand 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.
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From page 104... ...
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.
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From page 105... ...
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.
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From page 106... ...
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 further 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.
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From page 107... ...
As a result, only about half of the population visits the dentist each year (Grembowski et al., 1984~. HHS's Bureau of Health Professions in a recent report noted the relationship between demand for dental care and national economic growth.
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From page 108... ...
The major factors that those concerned with future demand for dental hygienists should track include the following: · number and age of working dentists · extent of dental insurance; · growth of real personal income; · dental disease patterns; · changes in the practice of dentistry that influence consumers' attitudes toward dental use (i.e., technological developments that may reduce the pain of dental treatment) ; · changes in staffing patterns in solo and group dental offices; and · progress toward independent practice.
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From page 109... ...
Conclusion Whether the number of dental hygienists available over the next 12 years will be enough to maintain a good balance between demand and supply depends in part on whether the decline in the number of dental hygiene graduates can be halted. If there is no further decline in graduations, there should be no need for major labor market adjustments.
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From page 110... ...
DIETITIANS Demand for Dietitians BLS predicts that by the year 2000 there will be 53,800 dietitian jobsan increase of 13,600 jobs, or 34 percent, since 1986. This employment growth rate is the same as the rate BLS expects for respiratory therapists and speech pathologists but substantially below that expected for some of the other allied health occupations (e.g., physical therapists dental hygienists, and radiologic technicians)
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From page 111... ...
Although prospective payment for hospital care is generating an increased need for home care, the growth of dietitian employment in home care is inhibited by Medicare reimbursement regulations that prohibit dietitians from billing for home visits. Instead, they are included in the administrative expenses of home health agencies.
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From page 112... ...
Overall, employment growth expectations for dietitians are well above the national average but are moderate to modest when compared with some other allied health fields. The hospital sector is not likely to be a major source of new demand.
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From page 113... ...
Scenario 2: Prospective Payment Although hospital utilization of dietitians would be reduced under this scenario, overall employment would be less affected than in other allied health occupations that are more dependent on hospital employment. The growth of HMOs and managed care systems that emphasize health promotion and disease prevention, as well as marketing to consumers, would increase the demand for nutritional services.
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From page 114... ...
This conclusion should be only tentatively modified by the salary increase of 29 percent between 1981 and 1986 received by dietitians who were employed in hospitals an increase comparable to that received by pharmacists and staff nurses, who are perceived to be in short supply (University of Texas Medical Branch, 1981, 1986~. Because no other evidence of shortage or surplus was found, it is assumed that a reasonable balance exists today.
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From page 115... ...
Progress in emergency medicine is also expected to increase demand. On the other hand, the rising cost of training and equipment coupled with the termination of federal start-up funds for community emergency medical services, taxpayer resistance to increased local government expenditures, and the availability of unpaid volunteers are factors that are likely to constrain job growth for paid EMTs (Bureau of Labor Statistics, 1986~.
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From page 116... ...
This projection is based on a determination that hospitals, expecting emergency medical services to be profitable, will compete with private ambulance services. Yet anecdotal evidence suggests that no trend toward hospital-managed emergency services is developing.
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From page 117... ...
The 1985 National Emergency Medical Services Data Summary lists a total of 5,059 EMT-Ps being trained annually; however, only 42 states and the District of Columbia responded to the survey. Three large states California, New York, and Texas were not among those reporting figures.
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From page 118... ...
This rapid growth exceeds the rate predicted for any of the other allied health fields discussed in this report, except for physical therapy. Unfortunately, BLS does not project employment for medical record administrators.
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From page 119... ...
Undoubtedly, the close connection between medical records, billing, and cash flow encourages automation to speed payments. The questions of whether and if so, when the use of computers will slow down the demand for medical record technicians are not clear.
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From page 120... ...
The spread of prospective payment stimulates demand as the amount and complexity of documentation tied to payment increase and facilities use the medical record to review utilization as a part of cost-control efforts. Under the access scenario' demand increases in proportion to the amount of additional service generated.
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From page 121... ...
Given this uncertainty, it is not possible to discuss differences in future demand for medical record administrators and medical record technicians. Supply of Medical Record Personnel Although graduations of both medical record administrators and medical record technicians have increased since 1980 20 percent for administrators, 27 percent for technicians the increase shown by technicians has been steadier.
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From page 122... ...
~ hIS predicted nigh growth rate is still lower than that predicted for physical therapists, in part because a greater proportion of occupational therapists are employed in the slow-growing educational sector. In 1986 just over 36 percent of occupational therapist jobs were in hospitals; 13.2 percent were in government employment (excluding educational institutions and hospitals)
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From page 123... ...
Hospitals provide more than one-third of the available jobs in the field today, and the growth rate in this sector alone will have an important influence on the demand for occupational therapists. Occupational therapy is one of the few allied health groups that sustained employment growth in the 2 years after the introduction of PPS.
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From page 124... ...
What the data do not show is the extent to which employment growth in the field was sustained by the use of occupational therapists in hospitalbased rehabilitation facilities, which have not come under PPS. According to the American Occupational Therapy Association's 1986 member survey, roughly 40 percent of hospital employment was in rehabilitation (American Occupational Therapy Association, 1987~.
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From page 125... ...
have now become the most frequently seen problem, rising from 5.8 percent in 1978 to 16.5 percent in 1986 (American Occupational Therapy Association, 1985, 1987~. In addition, the aging of the population has implications for greater use of occupational therapy in nursing homes, home care, and hospitals.
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From page 126... ...
The demand from skilled nursing facilities and home care agencies would also show modest but steady growth as more older people need services. Scenario 2: Prospective Payment The financial incentives incorporated in the prospective payment scenario would create downward pressure on the demand for occupational therapists.
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From page 127... ...
groups as homeless people also gained access to care and mental health coverage were expanded, the demand for occupational therapists would be increased. Supply of Occupational Therapists For the past decade the number of occupational therapy graduates has fluctuated from year to year but has averaged around 2,000 for the last 2 years.
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From page 128... ...
BLS expects the demand for physical therapy assistants to increase by 82 percent between 1986 and the year 2000, rising to 65,000 jobs. The similarity of the rate of growth for this group of practitioners to the predicted growth rate for physical therapists is due to the BLS analysts' de
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From page 129... ...
Unlike the level of hospital employment of most other allied health occupations, hospital employment of physical therapists was not reduced in the years immediately following the introduction of PPS. Rather, physical therapist employment continued to grow by 5.3 percent between 1983 and 1985 (Bureau of Health Professions, 1985; American Hospital Association, 1987~.
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From page 130... ...
Some physical therapists work for the proprietors of independent practices, for example. In 1987, 24.2 percent of respondents to the American Physical Therapy Association's survey said that they worked in a private physical therapy office.
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From page 131... ...
Increased sensitivity to long-term costs has stimulated employers to cover the rehabilitation of workers and to pay for injury prevention programs in the workplace. Medicare covers home visits by physical therapists and physical therapy services in inpatient and outpatient settings and has not yet placed rehabilitation facilities under any kind of prospective payment restrictions.
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From page 132... ...
One factor dampening demand, however, is an increasing effort on the part of the Health Care Financing Administration and other third parties to devise more stringent reimbursement screens as a way to constrain the growing utilization of services. Scenario 2: Prospective Payment With prospective payment the predominant form of financing, the demand for physical therapists would be somewhat lower than under the mixed payment model.
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From page 133... ...
is supported by some admittedly limited evidence. Statewide surveys of North Carolina health care facilities reported that the vacancy rate for staff physical therapists almost doubled from 13.8 percent in 1981 to 26.9 percent in 1986.
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From page 134... ...
Changes of this sort make major contributions to relieving labor market stresses. Employers who are concerned about enhancing the supply of physical therapists should begin to understand that the costs of participating in the clinical component of education programs will outweigh the costs of adjusting to both lower levels of physical therapy use and the major salary increases needed to attract therapists.
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From page 135... ...
This high rate of growth is similar to that expected for dental hygienists, and it exceeds the expected job growth rates for dietitians, speech-language pathologists and audiologists, and occupational therapists. totes for nuclear medicine technologists, who are excluded from the BLS definition of radiologic technologists and technicians, are expected to increase by nearly 23 percent, from 9,700 to 11,900.
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From page 136... ...
TABLE 4-9 Major Places of Wage and Salary Employment for Nuclear Medicine Technologists, 1986 Actual and Projected for the Year 2000 Employment Setting Total employments Total wage and salary employment Hospitals, public and private Medical and dental labs Offices of physicians Number of Jobs, 1986 Percentagea 9,700 Number of lobs, 2000 Percentagea 1 1,900 9,700 8,600 500 400 100.0 88.6 4.1 1 1,900 1 0,000 700 800 100.0 83.9 6.1 6.6 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. bTotal employment = wage and salary employment + self-employment.
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From page 137... ...
Factors that limit further ~~ffincr r~rl~~rti~n~ in the increased .~everitv of illness among patients, reduced opportunities to shift the patient to an outpatient setting, and fewer chances to cut unnecessary services (Prospective Payment Assessment Commission, 1987~. Looking to the future, the aging population and its need for more intensive care, together with the existing upward trends in radiologic usage, point to continued increases in the demand for radiologic personnel.
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From page 138... ...
For example, in some states, ambulatory care centers that hire personnel to carry out two functions must hire licensed x-ray technicians rather than laboratory technicians to provide both x-ray and lab services because the provision of x-ray services requires a licensed technician to operate the equipment. A committee site visit to Boston revealed that newly enacted licensing laws generated a sharp spurt in demand for technicians when licensed personnel had to be hired to replace unlicensed staff.
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From page 139... ...
Scenario 1: The Mined Model Under this scenario, overall growth in the health care sector, faster growth in outpatient care, and public and physician appreciation of diagnostic imaging would combine to generate prolonged growth in the demand for radiologic technicians and technologists. Scenario 2: Prospective Payment The rate of growth in the demand for radiologic technicians and technologists in hospitals would slow as admissions fell even though the intensity of care increased for an older, sicker patient population.
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From page 140... ...
Other data suggest that, if employers are having a hard time hiring radiologic staff, this may be a phenomenon of quite recent occurrence. A 1986 survey of health care facilities in North Carolina reported that at 8 percent the overall vacancy rate for radiologic personnel was very low compared to other allied health fields for example, 11.9 percent for medical record administrators and 17.9 percent for respiratory care personnel (North Carolina Area Health Education Centers Program, 1987d)
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From page 141... ...
. Yet such growth appears moderate when compared with that predicted for physical therapist and medical record technician employment (in excess of 70 percent)
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From page 142... ...
TABLE 4-10 Major Places of Wage and Salary Employment for Respiratory Therapists, 1986 Actual and Projected for the Year 2000 56,300 56,300 49,400 700 500 practitioners Other health and allied health care facilities 100.0 87.7 1.2 0.9 2,000 3,400 Employment Setting Total employments Total wage and salary employment Hospitals, public and private Outpatient care facilities Offices of physicians Offices of other health care Number of Jobs, 1986 Percentage" Number of Jobs, 2000 Percentagea 75,600 75,000 61,900 1,500 1,100 3.5 3,300 6.1 7,300 100.0 81.8 2.0 1.5 9.7 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. l7Total employment = wage and salary employment + self-employment.
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From page 143... ...
, respiratory therapists are unlikely to experience significant increases in home care work unless reimbursement policies change. A 1986 study by the American Association for Respiratory Care provides tentative support for the BLS view that respiratory therapy employment in hospitals has the potential to grow at a faster rate than overall hospital employment, once productivity gains have reached their limits.
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From page 144... ...
In sum, the BLS analysis of moderate growth in jobs for respiratory therapists is well substantiated. Hospital employment is the chief source of growth, stimulated by the aging population and the demand generated by new technologies that save extremely sick individuals.
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From page 145... ...
Hospitals would become purveyors of more intensive home care, including respiratory therapy in modest amounts. Employment by durable medical equipment companies would increase as they provided more intensive outof-hospital services.
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From page 146... ...
In the University of Texas's survey (University of Texas Medical Branch, 1981, 1986) , the rate of salary increase for respiratory therapists fell in the bottom third when compared with rates of increase for 19 other groups of hospital employees (Bureau of Labor Statistics, 1983-1986~.
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From page 147... ...
In conclusion, until better information about the long-term labor force behavior of respiratory therapists is available, it is reasonable to believe that labor markets will make necessary adjustments smoothly to maintain a reasonable equilibrium between the demand for and supply of respiratory therapists. The volatility of the number of graduates, however, suggests the need for close monitoring of emerging educational trends.
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From page 148... ...
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 , - ...
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From page 149... ...
. According to the Health Care Financing Administration the estimated number of speech-language pathologists employed by Medicarecertified 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.
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From page 150... ...
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.
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From page 151... ...
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.
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From page 152... ...
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 personnel demand and supply. For some fields (e.g., physical therapy, radiologic technology, medical record technology and administration, and occupational therapy)
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From page 153... ...
The way these issues are resolved could determine whether major imbalances will occur. The demand for and supply of speech-language pathologists, audiologists, respiratory therapists, and dietitians are expected to be sufficiently well balanced for the labor market to make smooth adjustments.
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From page 154... ...
American Hospital Association, Chicago. American Occupational Therapy Association.
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From page 155... ...
1984. UB-82 arrives with work for medical records departments.
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From page 156... ...
1987. Effect of the Medicare prospective payment system on the utilization of physical therapy.
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From page 157... ...
1987. The Impact of Prospective Payment on Medical Record Practitioners: A Follow-Up Study in 1986.
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From page 158... ...
American Medical Record Association, Chicago.
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